Risk of linear growth retardation during the first two years of life: a new approach

Vulnerability in maternal, new-born, and child health in low- and middle-income countries: Findings from a scoping review

Objectives

To identify and synthesise prevailing definitions and indices of vulnerability in maternal, new-born and child health (MNCH) research and health programs in low- and middle-income countries.

Design and setting

Scoping review using Arksey and O’Malley’s framework and a Delphi survey for consensus building.

Participants

Mothers, new-borns, and children living in low- and middle-income countries were selected as participants.

Outcomes

Vulnerability as defined by the authors was deduced from the studies.

Results

A total of 61 studies were included in this scoping review. Of this, 22 were publications on vulnerability in the context of maternal health and 40 were on new-born and child health. Definitions used in included studies can be broadly categorised into three domains: biological, socioeconomic, and environmental. Eleven studies defined vulnerability in the context of maternal health, five reported on the scales used to measure vulnerability in maternal health and only one study used a validated scale. Of the 40 included studies on vulnerability in child health, 19 defined vulnerability in the context of new-born and/or child health, 15 reported on the scales used to measure vulnerability in child health and nine reported on childhood vulnerability indices. As it was difficult to synthesise the definitions, their keywords were extracted to generate new candidate definitions for vulnerability in MNCH.

Conclusion

Included studies paid greater attention to new-born/ child vulnerability than maternal vulnerability, with authors defining the terms differently. A definition which helps in improving the description of vulnerability in MNCH across various programs and researchers was arrived at. This will further help in streamlining research and interventions which can influence the design of high impact MNCH programs.

Scoping review registration

The protocol for this review was registered in the open science framework at the registered address (https://osf.io/jt6nr).

Prenatal exposure to the major DDT metabolite 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) and growth in boys from Mexico

Recent data suggest that prenatal exposure to p,p'-DDE may reduce height and increase body mass index (BMI) in childhood, thus potentially raising the risk of adult health problems. The association between prenatal DDE exposure and growth was evaluated in 788 boys from Chiapas, an area of Mexico where DDT was recently used. The median DDE levels in maternal serum at birth (2002-2003) were 2.7 microg/g lipid. 2633 measurements of height (cm) and weight (kg) were obtained in 2004-2005. The median age of the children during follow-up was 18 months (quartiles 14 and 22 months). Height and body mass index (kg/m(2)) were age-standardized and expressed as standard deviation scores (SDS). Multivariate random-effect models for longitudinal data were fitted and predicted height and BMI SDS were estimated from the adjusted models. Overall, associations between prenatal DDE level and height or BMI SDS at any given age were not observed. For example, the predicted values showed that children with the highest exposure (DDE: >9.00 microg/g) compared to those least exposed (DDE: <3.01 microg/g) grew similarly and they had a BMI SDS similar to the referent group. The results do not support the prior findings of an association of DDE exposure with childhood height or BMI.

Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa

Objectives

To determine the prevalence of stunting, wasting and overweight and their determinants in 3-year-old children in the Central Region of Limpopo Province, South Africa.

Design

Prospective cohort study.

Setting

Rural villages in the Central Region of the Limpopo Province, South Africa.

Subjects

One hundred and sixty-two children who were followed from birth were included in the study. Anthropometric measurements and sociodemographic characteristics of the children were recorded.

Results

Height-for-age Z-scores were low, with a high prevalence of stunting (48%). The children also exhibited a high prevalence of overweight (22%) and obesity (24%). Thirty-one (19%) children were both stuntedandoverweight. Gaining more weight within the first year of life increased the risk of being overweight at 3 years by 2.39 times (95% confidence interval (CI) 1.96–4.18) while having a greater length at 1 year was protective against stunting (odds ratio (OR) 0.41; 95% CI 0.17–0.97). Having a mother as a student increased the risk for stunting at 3 years by 18.21 times (95% CI 9.46–34.74) while having a working mother increased the risk for overweight by 17.87 times (95% CI 8.24–38.78). All these factors also appeared as risks or as being protective in children who were both overweight and stunted, as did living in a household having nine or more persons (OR 5.72; 95% CI 2.7–12.10).

Conclusion

The results of this study highlight the importance of evaluating anthropometric status in terms of both stunting and overweight. Furthermore, it is important to realise the importance of normal length and weight being attained at 1 year of age, since these in turn predict nutritional status at 3 years of age.

Eating behavior disorders in Chilean infants

Eating behavior disorders (EBD) are often observed in children. Most of the related research, however, has been performed in developed countries. In countries like Chile, characterization of food disorders during the first years of life is unknown.

OBJECTIVE

The goal of the current study is to characterize the EBD of Chilean children during the first 2 years of life.

METHODS

We studied 67 children (mean age = 5.4 months; range = 4-24 months). The study group (SG; according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders) consisted of 34 children with EBD whose mothers spontaneously consulted for difficulties for feeding and the control group (CG) included 33 healthy children. A structured recall was applied to their mothers.

RESULTS

EBD onset was observed more frequently during the first semester of life and was associated with new foods. The children in the SG presented with lower birth weight (SG: 3,000 +/- 500 g; CG: 3,400 +/- 500 g; p < .001), weight/length (-0.4 +/- 1.0 vs. 0.8 +/- 1.1; p = .0001), and length/age z scores (-0.7 +/- 1.0 vs. -0.1 +/- 0.8; p = .007) than children in the CG. Early weaning before 4 months of age was more frequently found in the SG (44.1% vs. 12.1%; p = .04). The logistic regression showed as variables those associated with EBD, that is, birth weight and maternal history of EDB during her infancy (chi(2), p = .0003). Mothers of children in the SG felt that their maternal role was more difficult and less satisfactory than mothers of children in the CG (chi(2), p = .03).

DISCUSSION

EBDs in Chilean infants are observed during the first months of life and are associated with a lower birth weight, shortened exclusive breast-feeding, maternal history of EBD during their infancy, and lower physical growth. Mothers of children with EBD frequently feel that their maternal role is difficult and unsatisfactory.