RESUMO
BACKGROUND: There is little evidence on adult benefits from early childhood interventions in low and middle-income countries. We assessed adult cognition, psychosocial skills and behaviour from a stimulation trial conducted in Jamaica. METHODS: Children with stunted growth (height-for age <-2SD of references) aged 9-24 months were enrolled in a two-year randomised-controlled trial of nutritional supplementation and/or stimulation. At mean age 31.79 (SD 0.40) years, 95 of 127 participants (74.8%; 53.7% male) were assessed. Children without stunted growth were also followed as a comparison group (64 of 84 participants, 76.2%). Measurements included IQ, executive function, mental health, psychosocial skills, personality traits and risk behaviours. A block permutation test, valid for small sample sizes, was used. Analyses accounted for the randomisation protocol, multiple hypothesis testing and attrition. RESULTS: Treatment group participants (stimulation intervention with or without supplementation, n = 48) had significantly greater IQ (Hedges g effect size 0. 57; 95%CI 0.20, 0.95) and cognitive flexibility (0.61; 0.25, 0.98) compared with no-treatment (no-intervention and supplementation only, n = 47). They also had reduced depressive symptoms (0.61; 0.28, 1.00), increased grit (0.53; 0.16, 0.92) and conscientiousness (0.66; 0.31, 1.07), lower substance use (rank mean score, 0.45; 0.08, 0.81) and risk taking related to health and work (0.64; 0.27, 1.00). There were 18 significant outcomes of 33 assessed. Comparison participants had higher IQ than no-treatment (1.17; 0.81, 1.54) and treatment groups (0.62; 0.18, 1.07); and better executive function, lower social inhibition and risk taking than the no-treatment group. CONCLUSIONS: The wide-ranging benefits at 31 years from the stimulation intervention supports investment in larger scale programmes to promote early childhood development in disadvantaged children. The lower IQ in the treatment group compared with comparison participants, emphasises the need for continued efforts to prevent early childhood growth retardation.
Assuntos
Desenvolvimento Infantil , Transtornos do Crescimento , Adulto , Criança , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Cognição , Função Executiva , Feminino , Transtornos do Crescimento/prevenção & controle , Humanos , Jamaica , MasculinoRESUMO
OBJECTIVE: More than 200 million children globally do not attain their developmental potential. We hypothesized that a parent training program could be integrated into primary health center visits and benefit child development. METHODS: We conducted a cluster randomized trial in the Caribbean (Jamaica, Antigua, and St Lucia). Fifteen centers were randomly assigned to the control (n = 250 mother-child pairs) and 14 to the intervention (n = 251 mother-child pairs) groups. Participants were recruited at the 6- to 8-week child health visit. The intervention used group delivery at 5 routine visits from age 3 to 18 months and comprised short films of child development messages, which were shown in the waiting area; discussion and demonstration led by community health workers; and mothers' practice of activities. Nurses distributed message cards and a few play materials. Primary outcomes were child cognition, language, and hand-eye coordination and secondary outcomes were caregiver knowledge, practices, maternal depression, and child growth, measured after the 18-month visit. RESULTS: Eight-five percent of enrolled children were tested (control = 210, intervention = 216). Loss did not differ by group. Multilevel analyses showed significant benefits for cognitive development (3.09 points; 95% confidence interval: 1.31 to 4.87 points; effect size: 0.3 SDs). There were no other child benefits. There was a significant benefit to parenting knowledge (treatment effect: 1.59; 95% confidence interval: 1.01 to 2.17; effect size: 0.4). CONCLUSIONS: An innovative parenting intervention, requiring no additional clinic staff or mothers' time, was integrated into health services, with benefits to child cognitive development and parent knowledge. This is a promising strategy that merits further evaluation at scale.
Assuntos
Desenvolvimento Infantil , Intervenção Educacional Precoce , Poder Familiar , Atenção Primária à Saúde , Feminino , Humanos , Lactente , Jamaica , Masculino , MãesRESUMO
BACKGROUND: Linear growth retardation (stunting) is associated with lower adult cognition, educational attainment, and income. These effects, together with possible effects of stunting on birth weight and subsequent growth of offspring, suggest that stunting could be associated with poor development in the next generation of children. OBJECTIVE: The objective was to compare developmental levels in children born to parents who were stunted or nonstunted in early childhood. METHODS: This is a prospective cohort study of the children of participants in the Jamaica supplementation and stimulation study. The analysis compared children born to a parent who was stunted at age 9-24 mo, and did not receive the stimulation intervention, with children born to a parent in the nonstunted group. Developmental levels were measured with the Griffiths mental development scales between ages 12 and 72 mo. Mixed model regression analyses were conducted to allow for clustering of children within families and child (repeat assessments). The analyses included 89 children with a total of 156 assessments. Caregiver and home characteristics associated with the developmental quotient (DQ) or any of the subscales were included in the regressions. RESULTS: Children born to a stunted parent had lower DQs (-5.29 points; 95% CI: -9.06, -1.52 points; P = 0.01) and lower scores on the cognitive subscale (-5.77 points; 95% CI: -10.68, -0.87 points; P = 0.022). The offspring of stunted parents had lower height-for-age (-0.61 z scores; 95% CI: -1.13, -0.10 z scores; P = 0.021). In analyses, adjusting for child height-for-age or birth weight, the developmental differences remained significant. CONCLUSIONS: To our knowledge, this is the first report comparing the development of offspring of persons stunted in early childhood to the development of offspring of nonstunted parents. The findings suggest that the impact of stunting on development continues in the next generation of children. If replicated, these findings have important implications for estimation of the cost of stunting to social and economic development.
Assuntos
Transtornos Cognitivos/epidemiologia , Transtornos do Crescimento/epidemiologia , Adulto , Peso ao Nascer , Criança , Pré-Escolar , Cognição/fisiologia , Transtornos Cognitivos/etiologia , Feminino , Seguimentos , Transtornos do Crescimento/complicações , Humanos , Lactente , Jamaica , Masculino , Estudos Prospectivos , Análise de Regressão , Fatores SocioeconômicosRESUMO
OBJECTIVE: To assess the effectiveness of an integrated early child development intervention, combining stimulation and micronutrient supplementation and delivered on a large scale in Colombia, for children's development, growth, and hemoglobin levels. DESIGN: Cluster randomized controlled trial, using a 2 × 2 factorial design, with municipalities assigned to one of four groups: psychosocial stimulation, micronutrient supplementation, combined intervention, or control. SETTING: 96 municipalities in Colombia, located across eight of its 32 departments. PARTICIPANTS: 1420 children aged 12-24 months and their primary carers. INTERVENTION: Psychosocial stimulation (weekly home visits with play demonstrations), micronutrient sprinkles given daily, and both combined. All delivered by female community leaders for 18 months. MAIN OUTCOME MEASURES: Cognitive, receptive and expressive language, and fine and gross motor scores on the Bayley scales of infant development-III; height, weight, and hemoglobin levels measured at the baseline and end of intervention. RESULTS: Stimulation improved cognitive scores (adjusted for age, sex, testers, and baseline levels of outcomes) by 0.26 of a standard deviation (P=0.002). Stimulation also increased receptive language by 0.22 of a standard deviation (P=0.032). Micronutrient supplementation had no significant effect on any outcome and there was no interaction between the interventions. No intervention affected height, weight, or hemoglobin levels. CONCLUSIONS: Using the infrastructure of a national welfare program we implemented the integrated early child development intervention on a large scale and showed its potential for improving children's cognitive development. We found no effect of supplementation on developmental or health outcomes. Moreover, supplementation did not interact with stimulation. The implementation model for delivering stimulation suggests that it may serve as a promising blueprint for future policy on early childhood development.Trial registration Current Controlled trials ISRCTN18991160.
Assuntos
Desenvolvimento Infantil/fisiologia , Serviços de Saúde da Criança/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Suplementos Nutricionais , Programas Nacionais de Saúde , Desempenho Psicomotor/fisiologia , Adulto , Pré-Escolar , Análise por Conglomerados , Cognição/fisiologia , Colômbia , Feminino , Serviços de Assistência Domiciliar/organização & administração , Humanos , Lactente , Masculino , Micronutrientes/administração & dosagem , Jogos e Brinquedos/psicologia , Análise de RegressãoRESUMO
AIM: The aim of this study was to determine whether psychosocial stimulation up to the age of 2 years benefits cognition and behaviour at age 6 years in low-birthweight, term-born (LBW-T) children (gestational age > or =37 wk, birthweight <2500g), and to compare LBW-T and normal-birthweight (NBW) children. METHOD: LBW-T Jamaican infants were randomized at birth to a control group or an intervention group. Children in the intervention group received psychosocial stimulation for 2 years. LBW-T infants were also compared with NBW infants born in the same hospital. IQ, cognitive function, and behaviour were measured at age 6 years in 109 LBW-T infants. The LBW-T group were divided into the intervention group (55 out of 70 enrolled, 32 females, 23 males; mean birthweight 2190g, SD 200g; and the control group (54 out of 70 enrolled, 33 females, 21 males; birthweight 2240g, SD 180g]. These were compared with 73 out of 94 enrolled NBW infants (38 females 35 males; birthweight 3130g, SD 330g). RESULTS: Among the LBW-T children performance IQ scores were higher in the intervention group than in the control group (regression coefficient [B] 4.06, 95% confidence interval [CI] 0.01-7.98) as were visual-spatial memory scores (B 1.12, 95% CI 0.45-1.87). Children in the intervention group also exhibited fewer behavioural difficulties (B -2.21, 95% CI -4.13 to -0.10) than children in the control group. Compared with NBW children, LBW-T children in the control group had poorer selective attention (B=-3.35, 95% CI -5.59 to -1.26) and visual-spatial memory (B=-0.76, 95% CI -1.54 to 0.00), but there were no differences in IQ, language, or behaviour. INTERPRETATION: Stimulation had sustained benefits in LBW-T infants. Finding few differences between LBW-T and NBW school-aged children concurs with results from other developing countries.
Assuntos
Transtornos Cognitivos/prevenção & controle , Recém-Nascido de Baixo Peso , Transtornos Mentais/prevenção & controle , Relações Mãe-Filho , Jogos e Brinquedos , Reforço Social , Comportamento , Criança , Cognição , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Inteligência , Testes de Inteligência , Jamaica , Masculino , Testes Psicológicos , Resultado do TratamentoRESUMO
Stunting is associated with deficits in cognition and school achievement from early childhood to late adolescence; however, there has been little investigation of emotional and behavioral outcomes. The objective of this study was to determine whether linear growth retardation (stunting) in early childhood is associated with poorer psychological functioning in late adolescence. The study was a prospective cohort study of stunted and nonstunted children. Participants were identified at age 9-24 mo by a survey of poor neighborhoods in Kingston, Jamaica, and a 2-y intervention trial of supplementation and stimulation was conducted in the stunted children. Psychological functioning was assessed at age 17 y in 103 of 129 stunted children enrolled and 64 of 84 nonstunted participants. Anxiety, depressive symptoms, self-esteem, and antisocial behavior were reported by participants using interviewer-administered questionnaires and attention deficit, hyperactivity, and oppositional behavior were reported by parent interviews. The stunted participants reported significantly more anxiety (regression coefficient = 3.03; 95% CI = 0.99, 5.08) and depressive symptoms (0.37; 95% CI = 0.01, 0.72) and lower self-esteem (-1.67; 95% CI = -0.38, -2.97) than nonstunted participants and were reported by their parents to be more hyperactive (1.29; 95% CI = 0.12, 2.46). Effect sizes were 0.4-0.5 SD. Participants who received stimulation in early childhood differed from the nonstunted group in hyperactivity only. Children stunted before age 2 y thus have poorer emotional and behavioral outcomes in late adolescence. The findings expand the range of disadvantages associated with early stunting, which affects 151 million children <5 y old in developing countries.
Assuntos
Transtornos da Nutrição Infantil/psicologia , Transtornos do Crescimento/psicologia , Apoio Nutricional , Ludoterapia , Psicologia do Adolescente , Comportamento Social , Adolescente , Adulto , Criança , Estudos de Coortes , Suplementos Nutricionais , Emoções , Humanos , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Autoimagem , Apoio Social , Inquéritos e QuestionáriosRESUMO
AIM: To investigate the development and behaviour of low-birthweight (LBW) term infants compared with matched term infants of appropriate birthweight (ABW). METHODS: Two parallel cohorts of LBW infants (1500-2499 g) and ABW controls (3000-3499 g) were enrolled at birth in northeast Brazil. At 8 y, 164 children were assessed using clinical and psychological tests. RESULTS: The LBW group had lower IQ scores than ABW children on the Weschler Intelligence Scale for Children; differences were larger on the performance (5 points, p = 0.04) than the verbal scale (3 points, p = 0.11). LBW children had poorer dynamic balance (p = 0.03) and eye-hand coordination (p = 0.02), but better selective attention (p = 0.02). Hyperactivity and conduct problems were common in both groups, but fewer LBW children had peer problems (p = 0.04). After controlling for social background, IQ was not significantly associated with birthweight (p = 0.10). Significant determinants were maternal education, home stimulation and type of school attended. The effect of birthweight on coordination and selective attention remained significant. Birth head circumference and growth in head size in the first 6 mo had independent effects on IQ. CONCLUSION: After controlling for social background, LBW term infants did not differ from ABW infants in cognition at school age. Head circumference at birth and 6 mo was a better predictor than birthweight of IQ.
Assuntos
Transtornos do Comportamento Infantil/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Atenção , Brasil/epidemiologia , Criança , Transtornos Cognitivos/epidemiologia , Feminino , Seguimentos , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Análise Multivariada , Fatores de Risco , Fatores SocioeconômicosRESUMO
OBJECTIVE: To determine whether dietary supplementation or psychosocial stimulation given to growth retarded (stunted) children age 9-24 months has long term benefits for their psychosocial functioning in late adolescence. DESIGN: Sixteen year follow-up study of a randomised controlled trial. SETTING: Poor neighbourhoods in Kingston, Jamaica. PARTICIPANTS: Of 129 stunted children identified at age 9-24 months, 103 adolescents aged 17-18 were followed up. INTERVENTION: Supplementation with 1 kg milk based formula each week or psychosocial stimulation (weekly play sessions with mother and child), or both, for two years. MAIN OUTCOME MEASURES: Anxiety, depression, self esteem, and antisocial behaviour assessed by questionnaires administered by interviewers; attention deficit, hyperactivity, and oppositional behaviour assessed by interviews with parents. RESULTS: Primary analysis indicated that participants who received stimulation had significantly different overall scores from those who did not (F = 2.047, P = 0.049). Supplementation had no significant effect (F = 1.505, P = 0.17). Participants who received stimulation reported less anxiety (mean difference - 2.81, 95% confidence interval - 5.02 to - 0.61), less depression (- 0.43, - 0.78 to - 0.07), and higher self esteem (1.55, 0.08 to 3.02) and parents reported fewer attention problems (- 3.34, - 6.48 to - 0.19). These differences are equivalent to effect sizes of 0.40-0.49 standard deviations. CONCLUSIONS: Stimulation in early childhood has sustained benefits to stunted children's emotional outcomes and attention.
Assuntos
Suplementos Nutricionais , Transtornos do Crescimento/terapia , Transtornos Mentais/prevenção & controle , Ludoterapia/métodos , Adolescente , Estudos de Coortes , Seguimentos , Humanos , Lactente , Jamaica , Autoimagem , Comportamento SocialRESUMO
Growth retardation affects about a third of children younger than age 5 years in developing countries and is associated with poor development. Previously, we did a trial of nutritional supplementation and psychosocial stimulation in stunted children aged 9-24 months. Non-stunted children were also assessed. Both types of intervention improved development. We now present the effects of early interventions on cognition and education in 103 of the 129 stunted children and compare them with 64 of the 84 non-stunted children now aged 17-18 years. We recorded no significant effects of nutritional supplementation. Compared with no intervention, stimulation resulted in higher full scale IQ scores (coefficient 0.38, 95% CI 0.06-0.71, p=0.02) and higher scores on the verbal subscale (0.37, 0.07-0.68, p=0.02), Peabody picture vocabulary test (7.84, 0.73-14.95, p=0.03), verbal analogies (0.26, 0.03-0.49, p=0.03), and reading tests (4.73, 1.31-8.14, p=0.007, and 2.7, 1.12-4.37, p=0.001). Overall, stunted non-stimulated participants had significantly poorer scores than the non-stunted group on 11 of 12 cognitive and educational tests. Stunting in early childhood is associated with cognitive and educational deficits in late adolescence, which are reduced by stimulation at a young age.
Assuntos
Logro , Cognição , Transtornos do Crescimento/terapia , Apoio Nutricional , Apoio Social , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Testes de Inteligência , Jamaica , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de RegressãoRESUMO
BACKGROUND: Undernourished children have poor levels of development that benefit from stimulation. Zinc deficiency is prevalent in undernourished children and may contribute to their poor development. OBJECTIVE: We assessed the effects of zinc supplementation and psychosocial stimulation given together or separately on the psychomotor development of undernourished children. DESIGN: This was a randomized controlled trial with 4 groups: stimulation alone, zinc supplementation alone, both interventions, and control (routine care only). Subjects were 114 children aged 9-30 mo and below -1.5 z scores of the National Center for Health Statistics weight-for-age references who were recruited from 18 health clinics. Clinics were randomly assigned to receive stimulation or not; individual children were randomly assigned to receive zinc or placebo. The stimulation program comprised weekly home visits during which play was demonstrated and maternal-child interactions were encouraged. The supplementation was 10 mg Zn as sulfate daily or placebo. Development (assessed by use of the Griffiths Mental Development Scales), length, and weight were measured at baseline and 6 mo later. Weekly morbidity histories were taken. RESULTS: Significant interactions were found between zinc supplementation and stimulation. Zinc benefited the developmental quotient only in children who received stimulation, and benefits from zinc to hand and eye coordination were greater in stimulated children. Zinc supplementation alone improved hand and eye coordination, and stimulation alone benefited the developmental quotient, hearing and speech, and performance. Zinc supplementation also reduced diarrheal morbidity but did not significantly improve growth. CONCLUSION: Zinc supplementation benefits development in undernourished children, and the benefits are enhanced if stimulation is also provided.
Assuntos
Desenvolvimento Infantil , Transtornos da Nutrição Infantil/fisiopatologia , Relações Mãe-Filho , Zinco/administração & dosagem , Pré-Escolar , Suplementos Nutricionais , Feminino , Crescimento , Humanos , Lactente , MasculinoRESUMO
It is estimated that 11% of births in developing counties are term low-birth-weight (LBW); however, there is limited information on the development of these infants. Our objectives were to determine the effect of psychosocial intervention on the development of LBW infants and to compare term LBW and normal-birth-weight (NBW) infants. Term LBW (n = 140) and NBW infants (n = 94) were enrolled from the main maternity hospital in Kingston, Jamaica. The LBW infants were randomly assigned to control or intervention comprising weekly home visits from birth to 8 wk and from 7 to 24 mo of age. Development was assessed at 15 and 24 mo with the Griffiths Scales. The intervention benefited the infants' developmental quotient (DQ, P < 0.05) and performance subscale at 15 mo (P < 0.02), the hand and eye (P < 0.05) and performance subscales (P < 0.02) at 24 mo, and home environment at 12 mo. The effect of the intervention on development was mediated in part by the improvement in the home environment. The control LBW infants had significantly lower scores than the NBW in DQ and several subscales, whereas there were no significant differences between the NBW and the LBW infants after intervention. In conclusion, term LBW was associated with developmental delays, which were reduced with psychosocial intervention.
Assuntos
Desenvolvimento Infantil , Visita Domiciliar , Recém-Nascido de Baixo Peso , Apoio Social , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do TratamentoRESUMO
In the developing world, 39% of children <5 y old are short for their age (stunted, defined as height-for-age less than -2 SD of National Center for Health Statistics references), and many have poor levels of mental development along with behavioral problems. We showed previously that 8- to 10-y-old children from a longitudinal cohort who experienced early childhood stunting had altered hypothalamic-pituitary-adrenocortical (HPA) and sympathetic-adrenomedullary (SAM) system activity. We repeated the study with 31 newly recruited, stunted Jamaican school children (less than -2.0 SD height-for-age) and nonstunted controls (n = 31, more than -1.0 SD height-for-age) matched for sex, age and school. All children were tested in a 1.5-h session, including psychological and physiologic stressors, in which their behaviors, salivary cortisol concentrations and heart rates were measured. In addition, we measured urinary catecholamine (epinephrine, norepinephrine, dopamine) concentrations, which were not reported for the children in the longitudinal cohort. After controlling for covariates that differed between groups (child intelligence quotient, body mass index and birth weight), stunted children had faster resting heart rates while lying and sitting (P < 0.05) and also during psychological testing (P < 0.05), as well as higher concentrations of urinary epinephrine (P < 0.05) and norepinephrine (P < 0.05), compared with nonstunted children. In addition, the stunted children were less happy (P < 0.01), more inhibited (P < 0.01) and more frustrated (P < 0.05) during the psychological tests than nonstunted children. These results suggest that growth retardation is associated with alterations in stress-sensitive systems, particularly the SAM system, and that this connection may contribute to the poor levels of development observed in stunted children.
Assuntos
Comportamento Infantil , Transtornos do Crescimento/fisiopatologia , Estresse Fisiológico/fisiopatologia , Catecolaminas/urina , Criança , Frequência Cardíaca , Humanos , Hidrocortisona/análise , JamaicaRESUMO
STUDY OBJECTIVE: To determine the effects of birth weight and linear growth retardation (stunting) in early childhood on blood pressure at age 11-12 years. DESIGN: Prospective cohort study. SETTING: Kingston, Jamaica. Participants: 112 stunted children (height for age < -2 SD of the NCHS references) and 189 non-stunted children (height for age > -1 SD), identified at age 9-24 months by a survey of poor neighbourhoods in Kingston. MAIN RESULTS: Current weight was the strongest predictor of systolic blood pressure (beta= 4.90 mm Hg/SD weight 95 percent CI 3.97, 5.83). Birth weight predicted systolic blood pressure (beta= -1.28 mm Hg/SD change in birth weight, 95 percent CI -2.17, -0.38) after adjustment for current weight. There was a significant negative interaction between stunting in early childhood and current weight indicating a larger effect of increased current weight in children who experienced linear growth retardation in early childhood. There was no interaction between birth weight and current weight. The increase in blood pressure from age 7 to age 11-12 was greater in children with higher weigth at age 11-12 and less in children with higher birth weight and weight at age 7. CONCLUSIONS: Birth weight predicted systolic blood pressure in Jamaican children aged 11-12. Postnatal growth retardation may potentiate the relation between current weight and blood pressure. Greater weight gain between ages 7 and 11 was associated with a greater increase in systolic blood pressure. The relation between growth and later blood pressure is complex and has prenatal and postnatal components. (AU)
Assuntos
Feminino , Humanos , Masculino , Recém-Nascido , Criança , Peso ao Nascer/fisiologia , Pressão Arterial/fisiologia , Transtornos do Crescimento/fisiopatologia , Crescimento/fisiologia , Obesidade/fisiopatologia , Estudos Prospectivos , Análise de Regressão , Antropometria , Índice de Massa Corporal , Seguimentos , Aumento de Peso/fisiologia , JamaicaRESUMO
Health research and the dissemination of its findings are important to healthcare development. It is therefore useful to monitor the productivity of scientists and to examine the difficulties which affect their ability to conduct and publish research findings. This study aimed to examine these factors in six Caribbean countries. Health researchers published two or more papers in referred professional journals between 1987 and 1990 were interviewed to determine area of research, number of publications an research constraints. In those four years, 427 first authored article were published by those interviewed. University of the West Indies (UWI) researchers in the three campus territories published most of the articles, with little research being done in noncampus territories. Of seven priority areas defined by Caribbean Health Ministers, most researches were interested in chronic diseases, maternal and child health, followed by nutrition and the acquired immunodeficiency syndrome (AIDS). There was not much research on human resource development and strengthening of health care systems. Major constraints to research were lack of resources including funding, time, staff and equipment. Despite this, only 54 percent had applied for funding. There were few posts for research at the UWI. Notwithstanding these constraints, researchers were conducting several projects simultaneously and were involved with more projects that would be expected from the number of publications. Many expressed the need for experienced advice and assistance in writing protocols and analysing data. At the UWI it might be helpful to appoint a senior person or group in each department with specific responsibility for promoting research.(AU)
Assuntos
Humanos , Pesquisa/tendências , Editoração/estatística & dados numéricos , Região do Caribe , Apoio à Pesquisa como Assunto , Pesquisa/economiaRESUMO
In order to examine the mechanism whereby stunted children have poor developmental levels, we compared the behaviour of stunted (N = 78) and nonstunted (N = 26) children aged 12 to 24 months, and examined the relationship of their behaviour to their developmental levels. The effect of nutritional supplementation with or without psychosocial stimulation on the stunted children's behaviour was also examined. The children were observed at home during 4 days over a period of 6 months. The children significantly showed more apathy, and less enthusiasm and variety in exploring, were less happy and more fussy. Caretakers' vocalisations to them were less warm or instructive. Stunted children's activity level, exploratory and happy behaviours were predictive of change in developmental levels measured on the Griffiths Scales, from enrolment to 12 and 24 months later. Supplementation predicted mental age at 12 and 24 months later enrolment, however, it had no significant effect on behaviour (Au)
Assuntos
Criança , Lactente , Feminino , Humanos , Masculino , Transtornos do Comportamento Infantil/psicologia , Países em Desenvolvimento , Nanismo/psicologia , Desenvolvimento da Personalidade , Desnutrição Proteico-Calórica/psicologia , Jamaica , Poder Familiar/psicologia , Determinação da Personalidade , Carência Psicossocial , Transtornos do Comportamento Infantil/diagnósticoRESUMO
Hunger during school may prevent children in developing countries from benefiting from education. Although many countries have implemented school feeding programmes, few of these have been rigorously evaluated. We conducted a randomized, controlled trial of giving breakfast to undernourished and adequately nourished children. The undernourished group comprised 407 children in grades 2-5 in 16 rural Jamaican schools (weights-for-age < - 1SD of the National Centre for Health Statistics references) and the adequately nourished group comprised of 407 children matched for school and class (weight-for-age > - 1SD). Both groups were stratified by class and school, than randomly assigned to breakfast or control groups. After the initial measurements, breakfast was provided every school day for one year. Children in control group were given one-quarter of an orange and the same amount of attention as children in breakfast group. All children had their heights and weights measured and were given the Wide Range Achievement Test before and after the intervention. School attendance was taken from the school's registers. Compared with the control group, height, weight, and attendance improved significantly in the breakfast groups. Both groups made poor progress in Wide Range Achievement Test scores. Younger children in the breakfast group improved in arithmetic. There was no effect of nutritional group on the response to breakfast. In conclusion, the provision of a school breakfast produced small benefits in children nutritional status, school attendance, and achievement. Greater improvements may occur in more undernourished populations; however, the massive problem of poor achievement levels requires integrated programmes including health and educational inputs as well as school meals.(AU)
Assuntos
Criança , Humanos , Ciências da Nutrição/educação , Ensaios Clínicos Controlados Aleatórios como Assunto , Instituições Acadêmicas , Zona Rural , Jamaica , Escolaridade , Estado NutricionalRESUMO
Hunger during school may prevent children in developing countries from benefiting from education. Although many countries have implemented school feeding programmes, few of these have been rigorously evaluated. We conducted a randomized, controlled trial of giving breakfast to undernourished and adequately nourished children. The undernourished group comprised 407 children in grades 2-5 in 16 rural Jamaican schools (weights-for-age < - 1SD of the National Centre for Health Statistics references) and the adequately nourished group comprised of 407 children matched for school and class (weight-for-age > - 1SD). Both groups were stratified by class and school, than randomly assigned to breakfast or control groups. After the initial measurements, breakfast was provided every school day for one year. Children in control group were given one-quarter of an orange and the same amount of attention as children in breakfast group. All children had their heights and weights measured and were given the Wide Range Achievement Test before and after the intervention. School attendance was taken from the school's registers. Compared with the control group, height, weight, and attendance improved significantly in the breakfast groups. Both groups made poor progress in Wide Range Achievement Test scores. Younger children in the breakfast group improved in arithmetic. There was no effect of nutritional group on the response to breakfast. In conclusion, the provision of a school breakfast produced small benefits in children nutritional status, school attendance, and achievement. Greater improvements may occur in more undernourished populations; however, the massive problem of poor achievement levels requires integrated programmes including health and educational inputs as well as school meals.
Assuntos
Humanos , Criança , Ensaios Clínicos Controlados Aleatórios como Assunto , Ciências da Nutrição , Escolaridade , Jamaica , Estado Nutricional , Zona Rural , Instituições AcadêmicasRESUMO
A follow-up study is reported of 18 children 4 y after treatment for the Trichuris dysentery syndrome (TDS) and matched control children. The TDS children were initially severely stunted and had extremely low developmental levels. They showed catch-up in height of 1.9 z-scores even though they remained in very poor environments. Their intelligence quotients, school achievement and cognitive function remained significantly lower than those of the controls. Controlling for their earlier developmental levels, the TDS children showed a small improvement in mental development relative to the controls (Au)
Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Masculino , Disenteria/tratamento farmacológico , Disenteria/fisiopatologia , Disenteria/parasitologia , Crescimento , Tricuríase/fisiopatologia , Antinematódeos/uso terapêutico , Cognição , Seguimentos , Mebendazol/uso terapêuticoRESUMO
It is hypothesized that giving children a daily breakfast at school may improve their scholastic achievement through several mechanisms: increasing the time spent in school, improving certain cognitive functions and attention to tasks, and, perhaps indirectly, improving nutritional status. Two Jamaican studies showed that providing breakfast to students at school improved some cognitive functions, particularly in undernourished children. However, changes in classroom behavior varied depending on the quality of ths school. Children in better-organised schools concentrated on tasks for longer periods and made fewer undesirable movements, whereas in poorly organized schools the children's behavior deteriorated. Studies to date have provided insufficient evidence to determine whether children's long-term scholastic achievement is imporved by eating breakfast daily. Well-designed, randomized, controlled. long-term trials are essential for determining public policy on the implementation of schools feeding programme(AU)
Assuntos
Criança , Humanos , Cognição , Serviços de Alimentação , Instituições Acadêmicas , Atenção , Comportamento Infantil , Jamaica , População Rural , Fatores de TempoRESUMO
We examined the correlates of behaviour of 102 aggressive and 103 pro-social boys, selected by peer and teacher ratings, from grades 5 and 6 in 10 primary schools in urban Kingston and St. Andrew. The children were given in-depth questionnaires, school achievement test (WRAT) and verbal ability tests (Peabody Picture Vocabulary Test). Their parents were also given questionnaires. Interobserver and test retest reliabilities were established for all questionnaires and tests. Interviewers were unaware of the boys' groups. The aggressive group was significantly older (mean 11.1 years; t-test p<0.1). The aggressive group had significantly lower scores on both the number of possessions and the housing rating (proxies for socio-economic status); they showed significantly lower scores on spelling, arithmetic, reading and verbal IQ, and considered themselves less bright than the pro-social boys. Preliminary analyses indicate that, as expected, the aggressive boys fought more and used knives more compared with the pro-social boys. They reported receiving significantly more punishment at home. The aggressive group indicated that they saw significantly more family fights. All differences remained significant when socio-economic status was controlled in analyses of covariance except that the difference in the arithmetic scores was no longer significant. Many of these patterns are similar to those reported elsewhere.(AU)