Dataset Information

Wasting and Stunting in Infants and Young Children as Risk Factors for Subsequent Stunting or Mortality: Longitudinal Analysis of Data from Malawi, South Africa, and Pakistan.

ABSTRACT:

Background

Few studies have had sufficient longitudinal data to track how different malnourished states relate to mortality at different ages and interrelate over time.

Objectives

This study aims to describe the RRs and proportions of mortality associated with wasting and stunting and the pathways into and out of these nutritional states.

Methods

Longitudinal growth data sets collected for children ages 0-24 months from Malawi, South Africa, and Pakistan were combined (n = 5088). Children were classified as deceased, wasted (weight for height < -2 SD; 1-4%), stunted (length < -2SD; 20-47%), or wasted and stunted (WaSt; 2-5%) at ages 3, 6, 9, 12, 18, and 24 months. Mixed-effects Cox models were used to study the association between nutritional status and mortality.

Results

By age 3 months, 20% of children were already stunted, rising to 49% by 24 months, while wasting (4.2% and 2.2% at 3 months, respectively) and WaSt (0.9% and 3.7% at 24 months, respectively) were less common. The HR for mortality in WaSt was 9.5 (95% CI, 5.9-15), but 60% of WaSt-associated mortality occurred at 3-6 months. Wasting or WaSt was associated with 10-23% of deaths beyond 6 months, but in the second year over half of deaths occurred in stunted, nonwasted children. Stunting persisted in 82% of children and wasting persisted in 44%. Wasted children were more likely than nonwasted, nonstunted children to become stunted (RR, 1.93; 95% CI, 1.7-2.2), but 94% of children who progressed to stunting had not been wasted in the prior period.

Conclusions

WaSt greatly increased the risk of death, particularly in very young infants, but more deaths overall were associated with stunting. Most stunting appeared to be either intrauterine in origin or arose in children without prior wasting. Either stunting and wasting represent alternative responses to restricted nutrition, or stunting also has other, nonnutritional causes.

SUBMITTER: Wright CM

PROVIDER: S-EPMC8245889 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Publications

Wasting and Stunting in Infants and Young Children as Risk Factors for Subsequent Stunting or Mortality: Longitudinal Analysis of Data from Malawi, South Africa, and Pakistan.

Wright Charlotte M CM Macpherson John J Bland Ruth R Ashorn Per P Zaman Shakila S Ho Frederick K FK

The Journal of nutrition 20210701 7

<h4>Background</h4>Few studies have had sufficient longitudinal data to track how different malnourished states relate to mortality at different ages and interrelate over time.<h4>Objectives</h4>This study aims to describe the RRs and proportions of mortality associated with wasting and stunting and the pathways into and out of these nutritional states.<h4>Methods</h4>Longitudinal growth data sets collected for children ages 0-24 months from Malawi, South Africa, and Pakistan were combined (n = ...[more]

PMID: 33830247

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Project description:BackgroundThe double burden of malnutrition among children remains a public health challenge in South Africa. In response, the government of South Africa developed the National Health Policy and Implementation Guidelines for school-going children in 2003. This policy was subsequently upgraded to 'The Integrated School Health Programme' in 2012. An element of the programme is the provision of a meal to school-going children on school days. However, evidence suggests that one-third of school-going children continue to have nutritional deficiencies. This study investigated the sociodemographic as well as the nutritional characteristics of school-going children participating in a school health initiative in KwaZulu-Natal Province, South Africa.MethodsThis was a retrospective descriptive cross-sectional study involving 1,275 children (50.3% females and 49.7% males) aged 3 to 15 years. Epidemiological data on the screening of the children's nutritional characteristics by school health nurses and school health nutritionists under the integrated school health programme (ISHP) was reviewed and analysed for the study.ResultsNearly half (50.3%) and 49.7% of the population were females and males, respectively. The average age of participants was 8.4 years old. 'Underweight' (p = 0.000), 'overweight' (p = 0.000), 'at risk of overweight' (p = 0.000),'stunting' (p = 0.000),'severe stunting' (p = 0.005), 'wasting' (p = 0.010), and 'obesity' (p = 0.037) were associated with the 'schools that children attended'. School-going children' living conditions were significantly associated with 'normal weight' (p = 0.000), 'underweight' (p = 0.000), and 'underweight' (p = 0.028). However, the social grant to parents/guardians had some positive effects on the percentage of children who reported 'normal weight' (55.4%), 'wasting' (1.0%), 'underweight' (4.0%), and 'at risk of overweight' (20.2%).ConclusionChronic nutritional deficiencies persist among children. Therefore, ISHP implementation must retarget specific regions of the country to ensure that national goals and gains on school-going children nutrition, are met and maintained. Indeed, considering the positive impact of the government's social grant programme on the nutritional status of the children in this study, we recommend policy reforms that will increase parents' and carers' access to means of subsistence in order to meet the health and nutritional needs of children in the study communities.

Project description:The first 1,000 days from conception to 24 months is a critical period for healthy growth and development. In South Africa, stunting (weight-for-length below -2SD from the WHO reference mean) is a major public health issue with significant health consequences. We determined associations between demographic, health, and anthropometric indicators of mothers and their infants. A cross-sectional study was conducted in the Northern Cape. All mothers with 5- to 7-week-old babies visiting PHC facilities were invited to participate. A questionnaire was completed in a structured interview with each mother. Age and length of the baby at 6 weeks were used to determine stunting, while the weight and height of the mother were measured for body mass index (BMI). Eight hundred questionnaires were completed in 92 facilities. The median age of mothers was 26 years (IQR 20-30 years) and 44.9% were married. Only 40.1% had completed school or tertiary education and almost 40% relied on a government grant as the main source of income. Two-thirds (64.9%) had not planned the pregnancy and 17% were on antiretroviral therapy (ART). More than a quarter (26.1%) smoked cigarettes or used snuff during pregnancy, while 9.4% drank alcohol. At 6 weeks, 31% of boys and 14% of girls had a length-for-age below the WHO reference values, while 25.4% of mothers were classified as obese and 24.6% as overweight. More than 70% had a waist circumference above 80 cm. Significantly more mothers with stunted babies weighed less [-6 kg; -1 kg] and were shorter [-4 cm; -1 cm] than mothers with babies who were not stunted. Compared to babies who were not stunted, significantly more babies of mothers who lived in informal housing [-19.7%; -3.2%], relied on a grant [-19.7%; -3.2%], smoked/ snuffed [7.6%; 23.5%], and used alcohol during pregnancy [0.3%; 11.5%] were stunted. The following factors significantly increased the risk of having a stunted baby at 6 weeks: living in informal housing vs. formal housing (RR: 0.68, 95% CI [0.5; 0.9]); smoking or using snuff during pregnancy (RR: 1.74, 95% CI [1.3; 2.3]); using alcohol during pregnancy (RR: 1.5, 95% CI [1.1; 2.2]); both smoking and using alcohol during pregnancy (RR: 1.97, 95% CI [1.4; 2.9]). We confirmed the coexistence of under- and over-nutrition among mothers and their babies, possibly indicating that stunting in childhood may predispose to overweight and obesity in adulthood in a vicious cycle that affects generation after generation. Interventions aimed at poverty alleviation and encouraging healthy lifestyles with an emphasis on healthy eating, smoking cessation and abstaining from alcohol before pregnancy are urgently required.

Dataset Information

Wasting and Stunting in Infants and Young Children as Risk Factors for Subsequent Stunting or Mortality: Longitudinal Analysis of Data from Malawi, South Africa, and Pakistan.

Background

Objectives

Methods

Results

Conclusions

Publications

Wasting and Stunting in Infants and Young Children as Risk Factors for Subsequent Stunting or Mortality: Longitudinal Analysis of Data from Malawi, South Africa, and Pakistan.

Similar Datasets

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