Dataset Information

Growth faltering in rural Gambian children after four decades of interventions: a retrospective cohort study.

ABSTRACT:

Background

Growth faltering remains common in children in sub-Saharan Africa and is associated with substantial morbidity and mortality. Due to a very slow decline in the prevalence of stunting, the total number of children with stunting continues to rise in sub-Saharan Africa. Identification of effective interventions remains a challenge.

Methods

We analysed the effect of 36 years of intensive health interventions on growth in infants and young children from three rural Gambian villages. Routine growth data from birth to age 2 years were available for 3659 children between 1976 and 2012. Z scores for weight-for-age, length-for-age, weight-for-length, mid-upper-arm circumference, and head circumference were calculated using the WHO 2006 growth standards. Seasonal patterns of mean Z scores were obtained by Fourier regression. We additionally defined growth faltering as fall in Z score between 3 months and 21 months of age.

Findings

We noted secular improvements in all postnatal growth parameters (except weight-for-length), accompanied by declines over time in seasonal variability. The proportion of children with underweight or stunting at 2 years of age halved during four decades of the study period, from 38·7% (95% CI 33·5-44·0) for underweight and 57·1% (51·9-62·4) for stunting. However, despite unprecedented levels of intervention, postnatal growth faltering persisted, leading to poor nutritional status at 24 months (length-for-age Z score -1·36, 95% CI -1·44 to -1·27, weight-for-age Z score -1·20, -1·28 to -1·11, and head circumference Z score -0·51, -0·59 to -0·43). The prevalence of stunting and underweight remained unacceptably high (30·0%, 95% CI 27·0-33·0, for stunting and 22·1%, 19·4 to 24·8, for underweight).

Interpretation

A combination of nutrition-sensitive and nutrition-specific interventions has achieved a halving of undernutrition rates, but despite these intensive interventions substantial growth faltering remains. We need to understand the missing contributors to growth faltering to guide development of new interventions.

Funding

UK Medical Research Council, UK Department for International Development.

SUBMITTER: Nabwera HM

PROVIDER: S-EPMC5340725 | biostudies-literature | 2017 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Growth faltering in rural Gambian children after four decades of interventions: a retrospective cohort study.

Nabwera Helen M HM Fulford Anthony J AJ Moore Sophie E SE Prentice Andrew M AM

The Lancet. Global health 20170201 2

<h4>Background</h4>Growth faltering remains common in children in sub-Saharan Africa and is associated with substantial morbidity and mortality. Due to a very slow decline in the prevalence of stunting, the total number of children with stunting continues to rise in sub-Saharan Africa. Identification of effective interventions remains a challenge.<h4>Methods</h4>We analysed the effect of 36 years of intensive health interventions on growth in infants and young children from three rural Gambian v ...[more]

PMID: 28104187

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Project description:BackgroundRapid growth of the integration of technology and psychotherapeutic interventions has been noted, but no clear quantification of this growth has been done.AimsThis bibliometric analysis seeks to quantify the growth, trends, and applications of technology in psychotherapeutic interventions over the last 40 years.MethodsSearches were conducted in the Web of Science (WOS) database for all existing technology-psychotherapy-related publications from 1981 to October 2020. Search terms were refined using a systematic screening strategy, based upon Cochrane protocol, generating 52 technology terms. Analyses across 40 years and by decade from 1981 to 2020 were conducted.ResultsA total of 13,934 peer-reviewed articles were identified. Yearly publication rate has increased from one in 1981 to 1902 by October 2020. The growth rate of publications across decades consistently tripled in size (762.50% from the 1980s to 1990s, 539.71% from the 1990s to 2000s, and 337.24% from the 2000s to 2010s). The author, country, journal, and institution with the most publications were Andersson, G., USA, Journal of Medical Internet Research, and Karolinska Institute, respectively. The most frequent technology search term across all four decades was "internet*." The trends in percentages of peer-reviewed publications within each decade showed: 1) a declining trend for the term "computer," 2) an upward trend for the combined terms, "internet," "online," and "web," 3) and a steady but smaller proportion of publications for other terms ("cell phone," "phone/telephone," "technology," "video," "virtual reality or VR," "apps," "digital," "machine learning," "electronic," "robo," and "telehealth").DiscussionThe rapid growth and trends identified in technology and psychotherapy publications can inform related policies addressing the role of technology in mental health. Moreover, pattern analyses may provide direction for a standard nomenclature to address terminology usage inconsistencies across the field.

Project description:Stunting prevalence is an indicator of a country's progress towards United Nations' Sustainable Development Goal 2, which is to end hunger and achieve improved nutrition. Accelerating progress towards reducing stunting requires a deeper understanding of the factors that contribute to linear growth faltering. We conducted path analyses of factors associated with 18-month length-for-age z-score (LAZ) in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements Project in Ghana (n=1039), Malawi (n=684?and 1504) and Burkina Faso (n=2619). In two cohorts, women were enrolled during pregnancy. In two other cohorts, infants were enrolled at 6 or 9 months. We examined the association of 42 indicators of environmental, maternal, caregiving and child factors with 18-month LAZ. Using structural equation modelling, we examined direct and indirect associations through hypothesised mediators in each cohort. Out of 42 indicators, 2 were associated with 18-month LAZ in three or four cohorts: maternal height and body mass index (BMI). Six factors were associated with 18-month LAZ in two cohorts: length for gestational age z-score (LGAZ) at birth, pregnancy duration, improved household water, child dietary diversity, diarrhoea incidence and 6-month or 9-month haemoglobin concentration. Direct associations were more prevalent than indirect associations, but 30%-62% of the associations of maternal height and BMI with 18-month LAZ were mediated by LGAZ at birth. Factors that were not associated with LAZ were maternal iron status, illness and inflammation during pregnancy, maternal stress and depression, exclusive breast feeding during 6 months post partum, feeding frequency and child fever, malaria and acute respiratory infections. These findings may help in identifying interventions to accelerate progress towards reducing stunting; however, much of the variance in linear growth status remained unaccounted for by these 42 individual-level factors, suggesting that community-level changes may be needed to achieve substantial progress.

Project description:BackgroundChild growth faltering persists in sub-Saharan Africa despite the scale-up of nutrition, water, and sanitation interventions over the past 2 decades. High temperatures have been hypothesised to contribute to child growth faltering via an adaptive response to heat, reduced appetite, and the energetic cost of thermoregulation. We did a cross-sectional study to assess whether child growth faltering is related to environmental temperature in sub-Saharan Africa.MethodsData were extracted from 52 Demographic and Heath Surveys, dating from 2003 to 2016, that recorded anthropometric data in children aged 0-5 years, and were linked with remotely sensed monthly mean daytime land surface temperature for 2000-16. The odds of stunting (low height-for-age), wasting (low weight-for-height), and underweight (low weight-for-age) relative to monthly mean daytime land surface temperature were determined using multivariable logistic regression.FindingsThe study population comprised 656 107 children resident in 373 012 households. Monthly mean daytime land surface temperature above 35°C was associated with increases in the odds of wasting (odds ratio 1·27, 95% CI 1·16-1·38; p<0·0001), underweight (1·09, 1·02-1·16; p=0·0073), and concurrent stunting with wasting (1·23, 1·07-1·41; p=0·0037), but a reduction in stunting (0·90, 0·85-0·96; p=0·00047) compared with a monthly mean daytime land surface temperature of less than 30°C.InterpretationChildren living in hotter parts of sub-Saharan Africa are more likely to be wasted, underweight, and concurrently stunted and wasted, but less likely to be stunted, than in cooler areas. Studies are needed to further investigate the relationship between temperature and child growth, including whether there is a direct effect not mediated by food security, regional wealth, and other environmental variables. Rising temperature, linked to anthropogenic climate change, might increase child growth faltering in sub-Saharan Africa.FundingUK Medical Research Council and UK Global Challenges Research Fund.

Dataset Information

Growth faltering in rural Gambian children after four decades of interventions: a retrospective cohort study.

Background

Methods

Findings

Interpretation

Funding

Publications

Growth faltering in rural Gambian children after four decades of interventions: a retrospective cohort study.

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