Stunting, age at school entry and academic performance in developing countries: A systematic review and meta-analysis

Impact of Harvest Lentil Vegetable Blend and Nutrition Education on Child Growth, Caregivers' Nutrition Knowledge, and WASH Practices

OBJECTIVE

To assess the changes in child nutrition status, caregivers' knowledge, and water, sanitation, and hygiene (WASH) practices following the provision of Harvest Lentil Vegetable Blend to children and a nutrition education intervention to their caregivers.

DESIGN

Three-week pretest-posttest study.

SETTING

Turkana, Kenya.

PARTICIPANTS

Children aged 6-59 months (n = 162) and their caregivers (n = 127) completed the intervention, representing > 70% retention.

INTERVENTIONS

Provision of Harvest Lentil Vegetable Blend to children and nutrition education intervention for caregivers on child feeding and WASH practices.

MAIN OUTCOMES MEASURES

Children's anthropometric measurements, caregivers' nutrition knowledge, and WASH practices.

ANALYSIS

Wilcoxon signed rank and McNemar tests.

RESULTS

At baseline, 19%, 24%, and 35% of children were stunted, underweight, and wasted, respectively. At the endpoint, the weight-for-age z-scores increased by 0.61 (P = 0.04) for children 6-12 months and by 0.31 (P = 0.03) for children 13-47 months. Weight-for-height z-scores increased by 0.84 (P = 0.04) among children 6-12 months and by 0.42 (P = 0.04) among children 13-47 months. The proportion of caregivers who reported washing hands after defecation and before cooking increased by 37% and 26%, respectively (P = 0.001).

CONCLUSIONS AND IMPLICATIONS

An on-site feeding program that used nutrient-dense supplemental food was associated with positive changes in children's nutrition status within a short duration. Nutrition education intervention increased the proportion of caregivers who practiced some key WASH practices.

Stunting and academic trajectory in urban settings of Burkina Faso

BACKGROUND

Impaired growth in childhood can lead to poor cognitive development and low school performance. However, literature on the effects of stunting on school trajectory is very limited. The primary objective of this research was to estimate the age at which children start school according to levels of height-for-age z-score (stunting). A second objective was to estimate the gain in terms of age at school entry associated with an improvement in height-for-age z-score. A third objective was to explore the relationship between stunting, grade repetition, and school dropout.

METHODS

We used longitudinal data from the Ouagadougou (Burkina Faso) Health and Demographic Surveillance System. Data from a 2010 health survey of children under 5 years of age were merged with subsequent longitudinal schooling data. The study included 767 children globally who participated in the health and education surveys. Education data allowed us to apprehend academic trajectory measured by age at school entry, repetition, and dropout. The health survey gathered anthropometric information that was used to measure stunting. The adjusted age at school entry was estimated using a Poisson model. The gain represents the difference in adjusted age at school entry for different values of height-for-age. The relationship between stunting and grade repetition and dropout was studied using a discrete-time survival model.

RESULTS

Results showed that children entered school on average at 5.7 years old, and the incidence of grade repetition and dropout was 17.7 and 6.6 per 100 persons-years, respectively. The adjusted age at school entry of severely stunted children was 6.2 years [95% confidence intervals (CI): 6.1; 6.3] compared to 5.1 years [95% CI: 5.0; 5.3] for children who had normal growth. The difference (gain) in adjusted age at school entry between severely and non-stunted children was thus 1.06 [95% CI: 0.87; 1.25] years. If a child's growth changed from severe stunting to normal growth, their risk of repeating a grade decreased by 5.0 [95% CI: 0.0; 9.0] per 100 persons-years. We did not observe a relationship between height-for-age and dropout.

CONCLUSION

The results show that schooling is affected in several ways for children who are stunted. The age at school entry of stunted children is more likely to be delayed. Also, being stunted is associated with higher incidence of grade repetition. However, the relationship between stunting and dropout was inconclusive.

The effect of school-entry age on health is understudied in low- and middle-income countries: A scoping review and future directions for research

Background

Substantive literature has assessed the impact of starting school at younger ages relative to peers on health in high-income countries (HICs), but there is little evidence from low- and middle-income countries (LMICs). Conclusions drawn from HICs may not apply to different education contexts and health threats. This study maps the empirical evidence on the effect of school-entry age on health in LMICs and identifies directions for future research.

Methods

We conducted a scoping review between August and September 2022 by systematically searching the health sciences, education, economics, psychology, and general sciences literature and included quantitative and qualitative studies. The exposure of interest was relative age for grade defined as starting or progressing through school at a younger or older age compared to peers who are in the same grade. We extracted key characteristics of included studies and summarized their findings. We categorized results into broad health domains which emerged a posteriori from our analyses of included studies, including neurodevelopment and mental health, sexual and reproductive health, non-communicable diseases, and nutrition.

Findings

We identified 8 studies from middle-income countries published between 2017 and 2022. Among those studies, we identified 3 quasi-experimental studies using data from Brazil, Mexico, and Vietnam, and 5 observational studies primarily from Türkiye. Children starting school earlier had an increased risk of being diagnosed with attention deficit hyperactivity disorder, earlier sexual debut and cohabitation, adolescent pregnancy, adolescent marriage, and engaged more frequently in risky behavior compared to children who started school later. Pregnant women who started school younger also had fewer prenatal care visits and experienced more pregnancy complications. Although most studies identified negative health consequences from starting school earlier, the evidence for nutritional outcomes, such as overweight and stunting, was mixed. No studies were identified from low-income countries.

Conclusions

Little is known about the health consequences of school-entry age in low-resource settings. Additional research is needed to investigate the impact of relative age for grade, whether and how these effects persist into adulthood, and to inform strategies that can offset potential disadvantages stemming from school-entry cut-off dates.

The Role of Mealtimes in Fostering Language Development and Aligning Home and School Learning: Protocol for a Multi-Method Study of Preschool Children in Rural Kenya and Zambia (Preprint)

Background

Objective

Methods

Results

Conclusions

International Registered Report Identifier (IRRID)