RESUMO
Research conducted by the Child Development Research Group in the Tropical Medicine Research Institute has made significant contributions to the understanding of the importance of early nutrition and the home environment for children's development and the impact of psychosocial stimulation for disadvantaged and/or undernourished children. The work has provided critical evidence that has contributed to the increasing attention given to early childhood development in the work and policies of agencies such as the World Bank, World Health Organization (WHO) and United Nations Children Fund (UNICEF). This review concerns research which documented the impact of malnutrition on children's development and for the first time demonstrated the benefits and necessity of psychosocial stimulation for improvement in development. Subsequent research was critical in establishing the importance of linear growth retardation (stunting) as a risk factor for poor child development. A twenty-two-year study of stunted children has demonstrated benefits through to adulthood in areas such as educational attainment, mental health and reduced violent behaviour from an early childhood home visiting programme that works through mothers to promote their children's development. The group's research has also demonstrated that it is feasible and effective to integrate the stimulation intervention into primary care services with benefits to children's development and mothers'child rearing knowledge and practices. The group is currently conducting a study to provide information needed for scaling-up of parenting programmes through evaluation of a new approach to improving parenting through health centres and a modified home visit programme.
Assuntos
Desenvolvimento Infantil , Intervenção Educacional Precoce , Criança , Pré-Escolar , Pesquisa sobre Serviços de Saúde , Humanos , Lactente , Jamaica , Desnutrição , Saúde Mental , Poder Familiar , Medicina Tropical , UniversidadesRESUMO
PURPOSE: This study examines risk factors for aggression among boys in Kingston, Jamaica. METHODS: One hundred and one aggressive and 101 prosocial schoolboys in grades 5-6 (mean age 11.7, SD 0.6 years) were selected by peer and teacher ratings from 10 schools in the capital city, Kingston, during 1998. They were given in-depth questionnaires, arithmetic, reading and verbal intelligence tests and their behaviour was rated. Their parents were also given a detailed questionnaire. RESULTS: The aggressive boys reported significantly more involvement in fights than the prosocial boys. They had lower scores on spelling/reading and verbal IQ, less ambitious aspirations and poorer quality school uniforms. They were not more likely to infer hostile intent in ambiguous situations but were more likely to respond with aggression. Aggressive boys came from poorer homes with more marijuana use, less parental affection or supervision and more family discord. They were less exposed to religious instruction, their parents had lower occupational levels and were more likely to be in common-law unions than married. They were more exposed to neighbourhood violence and were punished more often at home and at school. Logistic regression analyses were carried out to determine the independent risk factors for aggression. Exposure to neighbourhood violence, physical punishment at home and family discord were associated with increased risk; parents' being married, practising religion as a family and better school uniforms were associated with reduced risk. CONCLUSIONS: Although community violence was a serious problem, family characteristics were also important risk factors for aggressive behaviour.
Assuntos
Agressão , Criança , Família , Humanos , Jamaica , Modelos Logísticos , Masculino , Fatores de Risco , Fatores SocioeconômicosRESUMO
PURPOSE: This study examines risk factors for aggression among boys in Kingston, Jamaica. METHODS: One hundred and one aggressive and 101 prosocial schoolboys in grades 5-6 (mean age 11.7, SD 0.6 years) were selected by peer and teacher ratings from 10 schools in the capital city, Kingston, during 1998. They were given in-depth questionnaires, arithmetic, reading and verbal intelligence tests and their behaviour was rated. Their parents were also given a detailed questionnaire. RESULTS: The aggressive boys reported significantly more involvement in fights than the prosocial boys. They had lower scores on spelling/reading and verbal IQ, less ambitious aspirations and poorer quality school uniforms. They were not more likely to infer hostile intent in ambiguous situations but were more likely to respond with aggression. Aggressive boys came from poorer homes with more marijuana use, less parental affection or supervision and more family discord. They were less exposed to religious instruction, their parents had lower occupational levels and were more likely to be in common-law unions than married. They were more exposed to neighbourhood violence and were punished more often at home and at school. Logistic regression analyses were carried out to determine the independent risk factors for aggression. Exposure to neighbourhood violence, physical punishment at home and family discord were associated with increased risk; parents' being married, practising religion as a family and better school uniforms were associated with reduced risk. CONCLUSIONS: Although community violence was a serious problem, family characteristics were also important risk factors for aggressive behaviour.
Propósito: Este estudio examina los factores de riesgo que influyen en la agresión entre los niños en Kingston, Jamaica. Métodos: Ciento un escolares agresivos y 101 escolares prosociales en los grados 56 (edad promedio 11.7, desviación estándard 0.6 años) fueron seleccionados de acuerdo con las valoraciones de los pares y los maestros de 10 escuelas en la ciudad capital, Kingston, durante 1998. Se les aplicó cuestionarios exhaustivos, así como pruebas de aritmética y lectura, tests de inteligencia, y se clasificó su conducta. A sus padres también se les aplicó un cuestionario detallado. Resultados: Los niños agresivos reportaron una participación en peleas significativamente mayor que los niños prosociales. Asimismo, tuvieron puntuaciones más bajas en deletreo, lectura y coeficiente de inteligencia (C.I.) verbal, mostraron tener aspiraciones menos ambiciosas, y vestían uniformes más pobres. No estaban más inclinados a inferir intenciones hostiles en situaciones ambiguas, pero si más propensos a responder agresivamente. Los niños agresivos provenían de hogares más pobres, caracterizados por mayor consumo de marihuana, menos afecto o supervisión por parte de los padres, y más discordia en la familia. Estaban también menos expuestos a la instrucción religiosa, sus padres tenían bajo nivel ocupacional, y vivían en su mayor parte más en unión consensual que en matrimonio. Estaban más expuestos a la violencia del vecindario, y recibían castigos en la casa y la escuela con mayor frecuencia. Se llevaron a cabo análisis de regresión logística a fin de determinar los factores de riesgo de la agresión. La exposición a la violencia del vecindario, el castigo físico en el hogar, y la discordia familiar estaban asociados con el aumento del riesgo. En cambio, padres casados en matrimonio, la práctica de la religión como familia, y mejores uniformes escolares, estuvieron asociados con la reducción del riesgo. Conclusiones. Aunque la violencia comunitaria constituía un serio problema, las características de la familia fueron también importantes factores de riesgo en el comportamiento agresivo.
Assuntos
Humanos , Masculino , Agressão , Criança , Família , Fatores Socioeconômicos , Fatores de Risco , Jamaica , Modelos LogísticosRESUMO
BACKGROUND: Cross-sectional studies have shown associations between stunting and overweight; however, there are few prospective studies of stunted children. OBJECTIVES: To determine whether stunting before age 2 years is associated with overweight and central adiposity at 17-18 years and whether growth in height among stunted children predicts body mass index (BMI) in late adolescence. DESIGN: Prospective cohort study. PARTICIPANTS: One-hundred and three participants stunted by age 2 years and 64 non-stunted participants (78% of participants enrolled in childhood). Participants were measured in early childhood and at ages 7, 11 and 17 years. RESULTS: Stunted subjects remained shorter and had lower BMIs, smaller skinfolds and circumferences than non-stunted subjects. Overweight (BMI >/=25 m(2)) was not significantly different among stunted and non-stunted male subjects (5.2 and 12.5%) but non-stunted female subjects were more likely to be overweight than those who experienced early childhood stunting (11.1 and 34.4%, P=0.013). Centralization of fat (waist to hip ratio (WHR), subscapular/triceps skinfold ratio (SSF/TSF)) did not differ between stunted and non-stunted groups (mean WHR 0.77 and mean SSF/TSF 1.18 in both groups). Stunted subjects with greater increases in height-for-age for the intervals 3-7 and 7-11 years had higher BMI at age 17 years (P=0.04 and P=0.001, respectively). CONCLUSION: Participants stunted by age 2 years were less likely to be overweight than those who were never stunted. This suggests that cross-sectional studies of the association between stunting and overweight may be misleading. Among stunted children, greater linear growth during mid- to late childhood was associated with greater BMI at age 17 years.
Assuntos
Adiposidade , Transtornos do Crescimento/fisiopatologia , Sobrepeso , Antropometria , Constituição Corporal , Estatura , Índice de Massa Corporal , Feminino , Seguimentos , Crescimento , Transtornos do Crescimento/terapia , Humanos , Lactente , Masculino , Estudos ProspectivosRESUMO
The objective of this study was to identify the factors associated with size and proportionality at birth in a cohort of term infants established to investigate their growth and development. One hundred and forty term low-birth-weight (birth-weight < 2,500 g) infants and 94 normal birth-weight infants (2,500- < 4,000 g) were recruited within 48 hours of birth at the main maternity hospital, Kingston, Jamaica. Birth anthropometry and gestational age were measured, and maternal information was obtained by interview and from hospital records. Controlling for gestational age, variables independently associated with birth-weight were rate of weight gain in the second half of pregnancy, maternal height, haemoglobin level < 9.5 microg/dL, time of first attendance in antenatal clinic, birth order, pre-eclampsia, and consumption of alcohol, with 33% of the variance in birth-weight explained. Birth length was associated only with maternal height and age, while measures of proportionality (ponderal index and head/length ratio) were associated with characteristics of the environment in late pregnancy, including rate of weight gain, weight in late pregnancy, and pre-eclampsia. The variation in maternal characteristics associated with size or proportionality at birth may reflect the times during gestation when different aspects of growth are most affected.
Assuntos
Peso ao Nascer , Desenvolvimento Embrionário e Fetal , Adulto , Antropometria , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Jamaica , Estudos Longitudinais , Masculino , Estado Nutricional , Pré-Eclâmpsia/embriologia , Pré-Eclâmpsia/metabolismo , Gravidez , Resultado da Gravidez , Análise de Regressão , Aumento de PesoRESUMO
AIM: To determine whether fasting serum concentrations of glucose, cholesterol and triglyceride at age 11-12 y (a) differed between children stunted in early childhood and those who were never stunted, (b) were related to birthweight or current anthropometry and (c) were related to stunting after controlling for current size. METHODS: Anthropometry, serum glucose and lipid concentrations were measured in 112 children stunted in early childhood and 181 non-stunted children. RESULTS: Children who were stunted in infancy remained shorter, weighed less and were significantly less fat than non-stunted children but had a more central distribution of fat. They were also less likely to have entered puberty. Non-stunted children had higher fasting serum triglyceride concentrations than stunted children (p < 0.05). There were no significant correlations between birthweight and fasting glucose or any measure of serum lipids. The percentage of variance in biochemical measures explained by anthropometry was low: between 2.1 for HDL cholesterol and 14.6 for triglyceride. Nutritional status in early childhood (stunted or non-stunted) made no additional contribution to the variance. CONCLUSIONS: Linear growth retardation in early childhood was not independently related to fasting serum concentrations of glucose, cholesterol and triglyceride at age 11-12 y. However, despite being thinner, stunted children had a more central distribution of fat.
Assuntos
Glicemia/análise , Desenvolvimento Infantil/fisiologia , Colesterol/metabolismo , Distúrbios Nutricionais/metabolismo , Triglicerídeos/metabolismo , Análise de Variância , Antropometria , Peso ao Nascer , Análise Química do Sangue , Composição Corporal , Criança , Colesterol/sangue , Estudos de Coortes , Jejum , Feminino , Humanos , Jamaica , Masculino , Probabilidade , Valores de Referência , Análise de Regressão , Sensibilidade e Especificidade , Dobras Cutâneas , Triglicerídeos/sangueRESUMO
BACKGROUND: Stunting in early childhood is common in developing countries and is associated with poorer cognition and school achievement in later childhood. The effect of stunting on children's behaviours is not as well established and is examined here. METHOD: Children who were stunted at age 9 to 24 months and had taken part in a 2-year intervention programme of psychosocial stimulation with or without nutritional supplementation were reexamined at age 11-12 years and compared with non-stunted children from the same neighbourhoods. Their school and home behaviours were assessed using the Rutter Teacher and Parent Scales and school achievement was measured using the Wide Range Achievement Test (WRAT) and the Suffolk Reading Scales. RESULTS: No significant intervention effects were found among the stunted groups. Thus data from the four intervention groups were aggregated for subsequent analyses, comparing all 116 stunted children with 80 non-stunted children. Controlling for social background variables, the stunted group had more conduct difficulties (p < .05) as rated by their parents. They also had significantly lower scores in arithmetic, spelling, word reading and reading comprehension than the non-stunted children (all p < .001). Conduct difficulties and hyperactivity were related to poorer school achievement. Controlling for the children's IQ, the stunted children's arithmetic scores remained significantly lower than those of the non-stunted children, but reading and spelling scores were not different. CONCLUSIONS: Previously stunted children had more conduct difficulties at home, regardless of their social background, than non-stunted children. Their educational attainment was also poorer than non-stunted children and these results are suggestive of a specific arithmetic difficulty. Children with behaviour problems performed less well at school.
Assuntos
Logro , Transtornos do Comportamento Infantil/epidemiologia , Transtornos Cognitivos/epidemiologia , Área Programática de Saúde , Criança , Países em Desenvolvimento , Feminino , Seguimentos , Humanos , Jamaica/epidemiologia , Masculino , Testes Neuropsicológicos , Leitura , Inquéritos e QuestionáriosRESUMO
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%CI 3.97, 5.83). Birth weight predicted systolic blood pressure (beta = -1.28 mm Hg/SD change in birth weight, 95% 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 weight 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.
Assuntos
Peso ao Nascer/fisiologia , Pressão Sanguínea/fisiologia , Transtornos do Crescimento/fisiopatologia , Antropometria , Índice de Massa Corporal , Criança , Feminino , Seguimentos , Crescimento/fisiologia , Humanos , Recém-Nascido , Masculino , Obesidade/fisiopatologia , Estudos Prospectivos , Análise de Regressão , Aumento de Peso/fisiologiaRESUMO
OBJECTIVES: (1) To determine whether benefits to growth and cognition remain after intervention in growth-restricted children who received psychosocial stimulation and nutritional supplementation in early childhood. (2) To investigate the extent of the differences in IQ and cognition at age 11 to 12 years between growth-restricted and non-growth-restricted children. STUDY DESIGN: Growth-restricted and non-growth-restricted children were identified at age 9 to 24 months, at which time the growth-restricted children participated in a 2-year randomized trial of nutritional supplementation and psychosocial stimulation. Eight years after the interventions ended, the children's growth, IQ, and cognitive functions were measured. RESULTS: There were no significant benefits from supplementation to growth or cognition. Children who had received stimulation had higher scores on the Weschler Intelligence Scales for Children-Revised full-scale (IQ) and verbal scale and tests of vocabulary and reasoning (all P <.05). The growth-restricted children had significantly lower scores than the non-growth-restricted children on 10 of 11 cognitive tests. CONCLUSIONS: Psychosocial stimulation had small but significant long-term benefits on cognition in growth-restricted children. Growth-restricted children had significantly poorer performance than non-growth-restricted children on a wide range of cognitive tests, supporting the conclusion that growth restriction has long-term functional consequences.
Assuntos
Cognição , Suplementos Nutricionais , Transtornos do Crescimento/terapia , Apoio Social , Criança , Análise Fatorial , Feminino , Seguimentos , Humanos , Lactente , Inteligência , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores SocioeconômicosRESUMO
Three thousand, eight hundred and eighty-two (3,882) children in grades 2-5, attending 16 rural primary and all-age schools in central Jamaica were weighed and their weight-for-age standard deviation scores calculated using the World Health Organization/National Center for Health Statistics (WHO/NCHS) references. Heights were also measured in a random sample of the grade 5 children (n = 793) and height-for-age and body mass index (BMI-kg/m2) calculated. Sixty-nine per cent of the total sample were of normal weight-for-age, 2% were moderately undernourished (weight-for-age > -3 Z-score, < or = -2 Z-score), and a further 24% mildly undernourished (weight-for-age > -2 Z-score, < or = -1 Z-score). Few children were overweight. The frequency distribution of weight-for-age was similar in girls and boys. In the subsample of children in whom heights were measured, 25.8% were < or = -1 Z-score height-for-age, and of these 4.9% were < -2 Z-score. Compared with a survey conducted in a similar rural area in the 1960s, the children's mean weights for age group categories were 1.1 to 3.7 kg heavier. Children who were older than appropriate for their grade were more likely to be undernourished (Odds ratio 3.94, 95% CI 3.21, 4.83), which suggests that undernourished children may be more likely to repeat a grade or start school later.
Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Saúde da População Rural , Constituição Corporal , Criança , Feminino , Humanos , Jamaica , MasculinoRESUMO
Three thousand, eight hundred and eighty-two (3,882) children in grades 2-5, attending 16 rural primary and all-age schools in central Jamaica were weighed and their weight-for-age standard deviation scores calculated using the World Health Organization/National Center for Health Statistics (WHO/NCHS) references. Heights were also measured in a random sample of the grade 5 children (n = 793) and height-for-age and body mass index (BMI-kg/m2) calculated. Sixty-nine per cent of the total sample were of normal weight-for-age, 2were moderately undernourished (weight-for-age > -3 Z-score, -2 Z-score, < or = -1 Z-score). Few children were overweight. The frequency distribution of weight-for-age was similar in girls and boys. In the subsample of children in whom heights were measured, 25.8were < or = -1 Z-score height-for-age, and of these 4.9were < -2 Z-score. Compared with a survey conducted in a similar rural area in the 1960s, the children's mean weights for age group categories were 1.1 to 3.7 kg heavier. Children who were older than appropriate for their grade were more likely to be undernourished (Odds ratio 3.94, 95CI 3.21, 4.83), which suggests that undernourished children may be more likely to repeat a grade or start school later.
Assuntos
Humanos , Masculino , Feminino , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Saúde da População Rural , Constituição Corporal , JamaicaRESUMO
Hunger during school may prevent children in developing countries from benefiting from education. Although many countries have implemented school feeding programs, few programs 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 < or = -1 SD of the National Center for Health Statistics references) and the adequately nourished group comprised 407 children matched for school and class (weights-for-age >-1 SD). Both groups were stratified by class and school, then randomly assigned to breakfast or control groups. After the initial measurements, breakfast was provided every school day for 1 school year. Children in the control group were given one-quarter of an orange and the same amount of attention as children in the 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 schools' registers. Compared with the control group, height, weight, and attendance improved significantly in the breakfast group. 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's nutritional status, school attendance, and achievement. Greater improvements may occur in more undernourished populations; however, the massive problem of poor achievement levels requires integrated programs including health and educational inputs as well as school meals.
Assuntos
Serviços de Alimentação , Aprendizagem , Fenômenos Fisiológicos da Nutrição , População Rural , Instituições Acadêmicas , Absenteísmo , Logro , Estatura , Peso Corporal , Criança , Feminino , Humanos , Jamaica , Masculino , Estado NutricionalRESUMO
OBJECTIVES: To describe food consumption during the school day of rural Jamaican children and participation in two government school feeding programmes. To determine factors which were related to these. DESIGN: Cross sectional. SETTING: 16 primary schools in rural Jamaica. SUBJECTS: 415 children in grades 2 and 5 (ages 7 and 10 years). RESULTS: Consumption of sweets, sweet drinks and snacks was high. Mean intakes at lunch were: energy 1537 kJ (SD 756), protein 10.4 g (SD 7.6) and iron 1.5 mg (SD 1.2). The mean energy intake was 17-20% of the daily requirement for this age group. Two types of school feeding programmes were available in the schools, one provided a cooked meal and the other a bun and milk. Median availability of school meals (as a percentage of children enrolled in the schools) over three terms was 24.6% (range 0-85.4%). Twenty per cent of the children participated in one or other programme. Poorer children were more likely to participate in the bun and milk programme (odds ratio 2.1, 95% CI 1.3-3.5) but children with more money to purchase food participated in the more costly cooked meal programme (odds ratio 2.4, 95% CI 1.3-4.6). CONCLUSIONS: Energy intakes at lunch in Jamaican children were somewhat below optimal levels and the reliance on sweets and snacks is an area of concern. Programme characteristics such as meal cost, may affect access to school feeding by poor children.
Assuntos
Transtornos da Nutrição Infantil/prevenção & controle , Preferências Alimentares , Serviços de Alimentação , Programas Governamentais , Instituições Acadêmicas , Análise de Variância , Criança , Custos e Análise de Custo , Estudos Transversais , Ingestão de Energia , Feminino , Serviços de Alimentação/economia , Humanos , Jamaica , Masculino , Valor Nutritivo , Razão de Chances , Análise de RegressãoRESUMO
OBJECTIVE: To determine whether nutritional status, anaemia and geohelminth infections were related to school achievement and attendance in Jamaican children. DESIGN: A cross-sectional study using a randomly selected sample. SUBJECTS: Eight hundred children aged 9-13 y randomly selected from those enrolled in grade 5 in 16 primary schools in rural Jamaica. RESULTS: The mean height-for-age of the children was -0.37 z-score +/- 1.0 s.d. with 4.9% having heights-for-age < -2 s.d. of the NCHS references. Anaemia (Hb < 11 g/dl) was present in 14.7% of the children, 38.3% were infected with Trichuris trichiura and 19.4% with Ascaris lumbricoides. Achievement levels on the Wide Range Achievement Test were low, with children performing at grade 3 level. In multilevel analyses, controlling for socioeconomic status, children with Trichuris infections had lower achievement levels than uninfected children in spelling, reading and arithmetic (P < 0.05). Children with Ascaris infections had lower scores in spelling and reading (P < 0.05) Height-for-age (P < 0.01) was positively associated with performance in arithmetic. Ascaris infection (P < 0.001) and anaemia (P < 0.01) predicted poorer school attendance. CONCLUSION: Despite mild levels, undernutrition and geohelminth infections were associated with achievement, suggesting that efforts to increase school achievement levels in developing countries should include strategies to improve the health and nutritional status of children.
PIP: The association of nutritional status, anemia, and geohelminth infection with school attendance and performance was investigated in a cross-sectional study of 800 primary school students 9-13 years of age (mean age, 10.8 years) from 4 rural parishes in Jamaica. 4.9% of the children had heights-for-age less than 2 standard deviations of the US National Center for Health Statistics references and 14.7% were anemic; 38.3% were infected with Trichuris trichiura and 19.4% with Ascaris lumbricoides. Multivariate analyses, controlled for socioeconomic status, indicated children with Trichuris infection had significantly lower achievement levels than uninfected children in spelling, reading, and arithmetic, while those with Ascaris infection had significantly lower scores in spelling and reading. Height-for-age was positively associated with performance in arithmetic. Ascaris infection and anemia predicted poorer school attendance. The associations demonstrated in this study are not necessarily causal. However, these findings indicate that efforts to increase school achievement levels in developing countries should include strategies to address the health and nutritional status of rural children.
Assuntos
Anemia/complicações , Ascaríase/complicações , Escolaridade , Estado Nutricional , Tricuríase/complicações , Adolescente , Antropometria , Criança , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Jamaica , Masculino , Distribuição Aleatória , População Rural , Fatores SocioeconômicosRESUMO
It is not known whether nutritional supplementation in early childhood has long-term benefits on stunted children's mental development. We followed up 127 7-8-y old children who had been stunted in early childhood and received supplementation, stimulation, or both. At 9-24 mo of age, the children had been randomly assigned to four treatment groups: nutritional supplementation, stimulation, both treatments, and control. After 2 y, supplementation and stimulation had independent benefits on the children's development and the effects were additive. The group receiving both treatments caught up to a matched group of 32 nonstunted children. Four years after the end of the 2-y intervention 97% of the children were given a battery of cognitive function, school achievement, and fine motor tests. An additional 52 nonstunted children were included. Factor analyses of the test scores produced three factors: general cognitive, perceptual-motor, and memory. One, the perceptual-motor factor, showed a significant benefit from stimulation, and supplementation benefited only those children whose mothers had higher verbal intelligence quotients. However, each intervention group had higher scores than the control subjects on more tests than would be expected by chance (supplemented and both groups on 14 of 15 tests, P = 0.002; stimulated group in 13 of 15 tests, P = 0.01), suggesting a very small global benefit. There was no longer an additive effect of combined treatments at the end of the intervention. The stunted control group had significantly lower scores than the nonstunted children on most tests. Stunted children's heights and head circumferences on enrollment significantly predicted intelligence quotient at follow-up.
Assuntos
Deficiências do Desenvolvimento/dietoterapia , Alimentos Fortificados , Antropometria , Criança , Deficiências do Desenvolvimento/psicologia , Humanos , Lactente , Inteligência , Jamaica , Inquéritos e QuestionáriosRESUMO
The long-term benefits of early childhood supplementation and the extent to which catch-up growth occurs following linear growth retardation remain controversial. Stunted children (height-for-age < -2 SD of NCHS references, n = 122) recruited from a survey of poor neighborhoods in Kingston, Jamaica, participated in a 2-yr randomized, controlled trial of supplementation beginning at ages 9-24 mo. A group of 32 non-stunted children from the same neighborhoods was also followed. Four years after the intervention ended, when children were 7 to 8 y old, there were no effects of supplementation on any anthropometric measure. From the end of the trial until follow-up, the children who had been supplemented gained 1.2 cm less (P < 0.05) than the non-supplemented children, approximately the same amount as they had gained during the trial compared with the non-supplemented children. After adjustment for regression to the mean, the height-for-age of stunted children (supplemented and non-supplemented combined) increased from enrollment to follow-up by 0.31 Z-score (95% CI 0.17, 0.46). The height-for-age of the non-stunted children also increased (0.96 Z-score; 95% CI 0.70, 1.22). Our results suggest that some catch-up growth is possible even when children remain in poor environments. Long-term benefits of supplementation to growth may not be achieved when intervention begins after age 12 mo in children who have already become undernourished.
Assuntos
Alimentos Fortificados , Transtornos do Crescimento/dietoterapia , Crescimento , Antropometria , Transtornos da Nutrição Infantil/complicações , Pré-Escolar , Feminino , Humanos , Lactente , Jamaica , Estudos Longitudinais , Masculino , Pobreza , Análise de RegressãoRESUMO
Height-for-age and weight-for-height are commonly used indicators of nutritional status; however, their precise interrelationship remains unclear. We examined the relationship between weight-for-height and linear growth in 127 stunted Jamaican children aged 9-24 months. The children were measured every 6 months over a 2-year period. The initial weight-for-height status was positively associated with linear growth in the following 6-month interval. The change in weight-for-height in the preceding interval was a better predictor of linear growth in the next interval than attained weight-for-height at the beginning of the interval. The results suggest that variations in weight-for-height may influence the rate of linear growth.
Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Insuficiência de Crescimento/diagnóstico , Crescimento , Avaliação Nutricional , Desnutrição Proteico-Calórica/diagnóstico , Síndrome de Emaciação/diagnóstico , Fatores Etários , Estatura , Peso Corporal , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Valor Preditivo dos Testes , Prognóstico , Análise de RegressãoRESUMO
It is frequently assumed that undernutrition in young children leads to poor development through reduced activity. 3 groups of 26 1-year-old stunted children were studied: nutritional supplementation, supplementation with psychosocial stimulation, and controls. 26 nonstunted comparison children were also studied. Activity levels were measured by extensive observation in the homes, and development using 4 subscales of the Griffith's Mental Development Scales. Initially, stunted children were less active than nonstunted ones (p < .01), but after 6 months they caught up regardless of treatment. The mental ages of the stunted children were lower than those of the nonstunted children initially, and improved with either treatment. Initially, activity levels made a significant contribution to the variance in the locomotor subscale only, but not 6 months later. Activity did not predict change in development over 6 or 12 months, nor did change in activity over 6 months predict change in development over 12 months.
Assuntos
Transtornos do Comportamento Infantil/psicologia , Países em Desenvolvimento , Nanismo/psicologia , Alimentos Fortificados , Atividade Motora , Desnutrição Proteico-Calórica/psicologia , Transtornos do Comportamento Infantil/dietoterapia , Terapia Combinada , Nanismo/dietoterapia , Intervenção Educacional Precoce , Feminino , Seguimentos , Humanos , Lactente , Jamaica , Masculino , Desnutrição Proteico-Calórica/dietoterapia , Meio SocialRESUMO
The relationship between physical growth and change in mental development on the Griffiths mental development scales was investigated in 127 stunted Jamaican children over a 2-year period. The role of nutritional supplementation in this relationship was examined. There were no consistent associations between changes in weight-for-height or head circumference and developmental change. Height gain over 2 years was significantly associated with change in mental age, and locomotor and hearing and speech subscale scores. Height gain in the first year predicted change in mental age, and hearing and speech in the second year. Some of the effect of supplementation on development was shared with linear growth. Therefore, nutrition probably explains part of the relationship between growth and development. However, supplementation also had effects on development independent of growth. The benefits of supplementation on development and the extent to which they were shared with growth varied among the subscales.
Assuntos
Desenvolvimento Infantil , Alimentos Fortificados , Transtornos do Crescimento/dietoterapia , Crescimento , Estatura , Feminino , Transtornos do Crescimento/fisiopatologia , Humanos , Lactente , Jamaica , Masculino , Fenômenos Fisiológicos da Nutrição , Análise de RegressãoRESUMO
There is concern that geohelminthiasis may adversely affect the growth and development of children. The relevance of this in the Caribbean is unclear since in many territories the prevalence of geohelminths is unknown. We report the results of three surveys conducted in Jamaican primary schools located in areas at high risk for geohelminthiasis. The first was conducted in 12 Kingston schools and comprised children in grades 2 to 5 (aged 7 to 10 years). The second and third surveys were conducted in rural areas with children in grades 2 to 5 and grades 4 and 5, respectively. Overall, 9244 children provided stool samples for analysis. The prevalence of Trichuris trichiura ranged from 42% to 47% among the surveys while that for Ascaris lumbricoides ranged from 15% to 37%. Children in grades 2 and 3 had lower T. trichiura prevalences than those in grades 4 and 5 in the first and second surveys (p < 0.05 and p < 0.005, respectively). In the second survey only, children in grades 2 and 3 had a lower prevalence of A. lumbricoides than those in grades 4 and 5 (p < 0.005). Most infections were light with approximately 1% of the sample having heavy egg densities.