Linear Growth through 12 Years is Weakly but Consistently Associated with Language and Math Achievement Scores at Age 12 Years in 4 Low- or Middle-Income Countries.

BackgroundWhether linear growth through age 12 y is associated with language and math achievement at age 12 y remains unclear.ObjectiveOur objective was to investigate associations of linear growth through age 12 y with reading skill, receptive vocabulary, and mathematics performance at age 12 y in 4 low- or middle-income countries (LMICs).MethodsWe analyzed data from the Young Lives Younger Cohort study in Ethiopia (n = 1275), India (n = 1350), Peru (n = 1402), and Vietnam (n = 1594). Age 1, 5, 8, and 12 y height-for-age z scores (HAZ) were calculated. Language and math achievement at age 12 y was assessed with the use of country-specific adaptations of the Peabody Picture Vocabulary Test, the Early Grades Reading Assessment, and a mathematics test; all test scores were standardized by age within country. We used path analysis to examine associations of HAZ with achievement scores. Twelve models were examined at each age (3 tests across 4 countries).ResultsMean HAZ in each country was <-1.00 at all ages. Overall, linear growth through age 12 y was associated with 0.4-3.4% of the variance in achievement scores. HAZ at 1 y was positively and significantly associated with the test score in 11 of the 12 models. This association was significantly mediated through HAZ at 5, 8, and 12 y in 9 of the models. HAZ at 5, 8, and 12 y was positively and significantly associated with test scores in 8, 8, and 6 models, respectively. These associations were mediated through HAZ at older ages in 6 of the HAZ at 5-y models and in 6 of the HAZ at 8-y models.ConclusionChild relative linear growth between ages 1 and 12 y was weakly but consistently associated with language and math achievement at age 12 y in 4 LMICs

Increased Maternal Education and Knowledge of Nutrition and Reductions in Poverty are Associated with Dietary Diversity and Meal Frequency in an Observational Study of Indonesian Children

Background: Optimal infant and young child feeding during the first two years of life is essential to optimum child development and health. While the link between feeding practices and child health outcomes is well documented, little is known about the determinants of these feeding practices in Indonesia. The purpose of this study was to better understand factors associated with appropriate child feeding among Indonesian children 6–23 months of age.Methods: Interviewers conducted interviews with 1498 mothers of children 6–23 months of age to identify practices. Measures of feeding practices included dietary diversity, meal frequency, and minimum acceptable diet. Multivariate logistic regression was used to identify factors associated with dietary diversity and separately with meal frequency.Results: After adjusting for covariates, increased maternal education was associated with improved dietary diversity. Age of child [OR=1.11], knowledge of stunting [OR=1.80], and having ever received nutrition information [OR=1.89] were also associated with greater dietary diversity. Wealth [OR=0.86] and age of child [OR=0.92] were inversely associated with meal frequency. Maternal education, age of child, being a male child, knowledge of stunting, and having received nutrition information increased the odds of the child consuming a minimum acceptable diet.Conclusion: Increasing maternal education, knowledge of stunting, and knowledge of nutrition may improve dietary diversity while poverty alleviation has the potential to improve minimum meal frequency. These findings corroborate similar studies and confirm the importance of government efforts that help girls stay in school, improve families’ understanding of nutrition, and reduce poverty

Early Childhood Nutrition Knowledge of Caregivers in Tanzania

Childhood stunting is a pressing health issue in Tanzania and results from chronic infections and inadequate nutrition. Educating caregivers on the nutritional determinants, their consequences, and appropriate solutions may improve nutrition-related practices among caregivers in Tanzania. The purpose of this study was to identify factors associated with Tanzanian caregivers’ knowledge of childhood nutrition practices. Data for this study came from a cross-sectional survey of 4,095 caregivers of children under 24 months living in the Geita, Kagera, Kigoma, Mwanza, and Shinyanga regions of Tanzania. Complete responses relating to demographic and socioeconomic factors, media exposure, and early childhood nutrition knowledge were analyzed using multiple linear regression modeling techniques. Caregivers’ knowledge concerning proper early childhood nutrition practices was found to be significantly related to using a mobile banking account (p<.0001), owning a working radio with batteries (p<.0001), having watched television recently (p<.0001), residing in a southern lake region (p<.0001), affiliating with a Christian faith (p=0.0027), having more children under the age of 5 (p=0.0005), having received advice on maternal nutrition before pregnancy (p<.0001) and having received advice from a community health worker (p=0.0184). Living in a rural environment (p<.0001) and speaking a non-mainstream language (p<0.05) were significantly associated with decreased knowledge. The influences of media and technology, socio-demographic factors and traditional health education may be important in the development of accurate childhood nutrition knowledge among caregivers. These factors may be targeted for future community health worker efforts with vulnerable populations in Tanzania to prevent stunting

Cross-Sectional and Longitudinal Associations between Household Food Security and Child Anthropometry at Ages 5 and 8 Years in Ethiopia, India, Peru, and Vietnam

En: Journal of Nutrition, No. 145, pp. 1924-1933. doi:10.3945/jn.115.210229Background: Poor childhood nutritional status has lifetime effects and food insecurity is associated with dietary practices that can impair nutritional status. Objectives: We assessed concurrent and subsequent associations between food insecurity and height-for-age z scores (HAZs) and body mass index–for-age z scores (BMI-Zs); evaluated associations with transitory and chronic food insecurity; and tested whether dietary diversity mediates associations between food insecurity and nutritional status. Methods: We used data from the Young Lives younger cohort composed of children in Ethiopia (n = 1757), India (n =1825), Peru (n = 1844), and Vietnam (n = 1828) recruited in 2002 (round 1) at ;1 y old, with subsequent data collection at 5 y in 2006 (round 2) and 8 y in 2009 (round 3). Results: Children from food-insecure households had significantly lower HAZs in all countries at 5 y (Ethiopia, 20.33; India, 20.53; Peru, 20.31; and Vietnam, 20.68 HAZ; all P < 0.001), although results were attenuated after controlling for potential confounders (Ethiopia, 20.21; India, 20.32; Peru, 20.14; and Vietnam, 20.27 HAZ; P < 0.01). Age 5 y food insecurity predicted the age 8 y HAZ, but did not add predictive power beyond HAZ at age 5 y in Ethiopia, India, or Peru. Age 5 y food insecurity predicted the age 8 y BMI-Z even after controlling for the 5 y BMI-Z, although associations were not significant after the inclusion of additional confounding variables (Ethiopia, P = 0.12; India, P = 0.29; Peru, P = 0.16; and Vietnam, P = 0.51). Chronically food-insecure households had significantly lower HAZs than households that were consistently food-secure, although BMI-Zs did not differ by chronic food-insecurity status. Dietary diversity mediated 18.8–30.5% of the association between food security and anthropometry in Vietnam, but mediated to a lesser degree (8.4–19.3%) in other countries. Conclusions: In 4 countries, food insecurity at 5 y of age was associated with both HAZ and BMI-Z at age 8 y, although the association was attenuated after adjusting for other household factors and anthropometry at age 5 y, and remained significant only for the HAZ in Vietnam

Exploring the relationship between chronic undernutrition and asymptomatic malaria in Ghanaian children

<p>Abstract</p> <p>Background</p> <p>A moderate association has been found between asymptomatic parasitaemia and undernutrition. However, additional investigation using the gold standard for asymptomatic parasitaemia confirmation, polymerase chain reaction (PCR), is needed to validate this association. Anthropometric measurements and blood samples from children less than five years of age in a rural Ghanaian community were used to determine if an association exists between chronic undernutrition and PCR-confirmed cases of asymptomatic malaria.</p> <p>Methods</p> <p>This was a descriptive cross-sectional study of 214 children less than five years of age from a community near Kumasi, Ghana. Blood samples and anthropometric measurements from these children were collected during physical examinations conducted in January 2007 by partners of the Barekuma Collaborative Community Development Programme.</p> <p>Results</p> <p>Findings from the logistic model predicting the odds of asymptomatic malaria indicate that children who experienced mild, moderate or severe stunting were not more likely to have asymptomatic malaria than children who were not stunted. Children experiencing anaemia had an increased likelihood (OR = 4.15; 95% CI: 1.92, 8.98) of asymptomatic malaria. Similarly, increased spleen size, which was measured by ultrasound, was also associated with asymptomatic malaria (OR = 2.17; 95% CI: 1.44, 3.28). Fast breathing, sex of the child, and age of the child were not significantly associated with the asymptomatic malaria.</p> <p>Conclusions</p> <p>No significant association between chronic undernutrition and presence of asymptomatic malaria was found. Children who experience anaemia and children who have splenomegaly are more likely to present asymptomatic malaria. Programmes aimed at addressing malaria should continue to include nutritional components, especially components that address anaemia.</p

Stunting in Infancy Is Associated with Decreased Risk of High Body Mass Index for Age at 8 and 12 Years of Age123

Background: Effects of early-life stunting on adiposity development later in childhood are not well understood, specifically with respect to age in the onset of overweight and obesity. Objectives: We analyzed associations of infant stunting with prevalence of, incidence of, and reversion from high body mass index–for-age z score (BMIZ) later in life. We then estimated whether associations of infant stunting with BMIZ varied by sex, indigenous status, and rural or urban residence. Methods: Data were collected from 1942 Peruvian children in the Young Lives cohort study at ages 1, 5, 8, and 12 y. Multivariable generalized linear models estimated associations of stunting (height-for-age z score 1 and BMIZ > 2 prevalence, incidence (moving above a BMIZ threshold between ages), and reversion (moving below a BMIZ threshold between ages) at later ages. Results: After adjustment for covariates, stunting at age 1 y was associated with a lower prevalence of BMIZ > 1 at age 8 y (RR: 0.81; 95% CI: 0.66, 1.00; P = 0.049) and 12 y (RR: 0.75; 95% CI: 0.61, 0.91; P = 0.004), as well as a lower prevalence of BMIZ > 2 at age 8 y. Stunting was not associated with incident risk of BMIZ > 1 or BMIZ > 2. Stunting was positively associated at age 5 y with risk of reversion from BMIZ > 1 (RR: 1.22; 95% CI: 1.05, 1.42; P = 0.008) and BMIZ > 2. We found evidence that the association of stunting with prevalent and incident BMIZ > 1 was stronger for urban children at ages 5 and 8 y, and for nonindigenous children at age 8 y. Conclusions: Stunting predicted a lower risk of prevalent BMIZ > 1 and BMIZ > 2, even after controlling for potential confounders. This finding may be driven in part by a higher risk of reversion from BMIZ > 1 by age 5 y. Our results contribute to an understanding of how nutritional stunting in infancy is associated with BMIZ later in life

PhD

dissertationUnderNutrition; affects the health and development of children. More than half of childhood deaths are attributed to underNutrition;. Additionally, underNutrition; can lead to delayed mental development and poor school performance. Using data from Ghana and Peru, we completed two studies exploring consequences of underNutrition;. Blood samples and anthropometric measurements from 214 children less than five years of age from a rural Ghanaian community were collected during physical exams. Data were used to determine if an association exists between stunting and presence of asymptomatic malaria. Results indicated that children who experienced mild, moderate or severe stunting were not more likely to have asymptomatic malaria than children who experienced no stunting. Anemia and spleen size were associated with presence of asymptomatic malaria. Based on these findings, we recommend stunting not be used as a screening measure for children with asymptomatic malaria and that Nutrition;-based programs in malaria endemic areas focus on addressing iron deficiency. Longitudinal data from 1674 Peruvian children were evaluated to investigate the relationships between early (6-18 months) and concurrent stunting (4.5-6 years) on cognition at age 5. We also compared children who experience catch-up growth after early stunting to children who never experienced stunting to determine whether they have lower scores on two cognitive assessments. Children who experienced early or concurrent stunting were more likely to score lower on verbal and quantitative assessments. Children who experienced catch-up growth did not score significantly lower on either assessment than children who never experienced stunting. Children who lived in cities, attended preschool, had grandparents at home, had better educated mothers and experienced less severe stunting at one year of age were more likely to demonstrate catch-up growth. These findings document the need for upstream investments in infrastructure, education, and family planning services as well as evidence-based Nutrition;al interventions to reduce cognitive deficits stemming from underNutrition;. Nutrition;al interventions that focus primarily on the first 2 years of life should consider the impact of catch-up growth as well. Such programs should begin early and continue past the first 2 years of life

Understanding female and male empowerment in Burkina Faso using the project-level Women’s Empowerment in Agriculture Index (pro-WEAI): A longitudinal study

Background: Achieving gender equality and women’s empowerment is a major global priority. The purpose of this study was to determine whether the Building the Resilience of Vulnerable Communities in Burkina Faso (BRB) project, an agricultural development program, improved women’s empowerment, as measured by the project-level Women’s Empowerment in Agriculture Index (pro-WEAI). Methods: This study used a longitudinal, quasi-experimental study design. Participants included both treatment and comparison groups (total N = 751) comprising female members of savings groups and their husbands or main male household member in Burkina Faso. All participants completed the pro-WEAI questionnaire at both baseline and endline. The treatment group received a comprehensive intervention package consisting of agriculture loans and services, microenterprise loans, and education, nutrition education, and women’s empowerment programs including gender-based discussions designed to facilitate personalized changes in gender relations. Results: The proportion of the treatment group achieving empowerment did not change from baseline for women, but improved substantially for men. Women from the comparison group saw an increase in empowerment at endline while men saw a substantial decrease. Gender parity was high for women in both groups at baseline and increased slightly at endline. Women were more likely to have adequate empowerment in input in productive decisions, group membership, and membership in influential groups than men while men were more likely to have adequate empowerment in attitudes about domestic violence, control over use of income, and work balance than women. Participants from the treatment group reported an increase in the average number of empowerment indicators that they were adequate in while the comparison group saw a decrease in average adequacy over time (p = 0.002) after controlling for age, sex, and level of education. Conclusion: Despite starting at an empowerment disadvantage, the treatment group experienced gains in individual indicators of empowerment while the comparison group men and women experienced mixed results, with the women gaining, and the men losing empowerment. This research suggests that the BRB intervention may have provided some protection for the treatment group when they faced an economic down-turn prior to the endline, indicative of household resilience. Future research should consider and strengthen relationships between resilience and empowerment.PRIFPRI3; CRP4; G Cross-cutting gender theme; GAAP; Women’s Empowerment in Agriculture Index; ISIEPTD; A4NHCGIAR Research Programs on Agriculture for Nutrition and Health (A4NH

What difference can fathers make?: early paternal absence compromises peruvian children’s growth

Una evidencia considerable sugiere que la ausencia del padre en el hogar tiene un impacto negativo a corto y largo plazo en la salud de los niños, el desarrollo psicosocial, la cognición y la experiencia educativa. Evaluamos el impacto de presencia del padre durante la infancia y la infancia en el puntaje z de altura para la edad de los niños (ZAC) a los 5 años de edad. Nosotros realizó un análisis secundario de datos de un estudio de cohorte de 15 años (Young Lives) enfocándose en uno de cuatro jóvenes. Cuando se compara con niños que vieron a sus padres diariamente o semanalmente durante la infancia y la niñez, los niños que no vieron a sus padres regularmente en ninguno de los períodos tuvieron menores puntajes después de ajustar por edad materna, riqueza y otros factores contextuales. Los resultados también sugieren que los niños que vieron a sus padres durante la infancia (pero no en la infancia) tuvieron mejores puntuaciones que los niños que vieron a sus padres en la infancia y la infancia. Hallazgos de análisis de niños resilientes (aquellos que no vieron a sus padres en ninguna ronda pero muestran que las posibilidades de un niño de no tener retraso en el crecimiento a pesar de la ausencia paterna a los 1 y 5 años fueron considerablemente mayores si él o ella vivía en un área urbana, y vivía en un ambiente seguro para los alimentos. Las intervenciones diseñadas para reducir la malnutrición deben basarse en una comprensión más completa de cómo la ausencia paterna pone a los niños en riesgo de fallas de crecimiento

What difference can fathers make?: early paternal absence compromises peruvian children’s growth

Una evidencia considerable sugiere que la ausencia del padre en el hogar tiene un impacto negativo a corto y largo plazo en la salud de los niños, el desarrollo psicosocial, la cognición y la experiencia educativa. Evaluamos el impacto de presencia del padre durante la infancia y la infancia en el puntaje z de altura para la edad de los niños (ZAC) a los 5 años de edad. Nosotros realizó un análisis secundario de datos de un estudio de cohorte de 15 años (Young Lives) enfocándose en uno de cuatro jóvenes. Cuando se compara con niños que vieron a sus padres diariamente o semanalmente durante la infancia y la niñez, los niños que no vieron a sus padres regularmente en ninguno de los períodos tuvieron menores puntajes después de ajustar por edad materna, riqueza y otros factores contextuales. Los resultados también sugieren que los niños que vieron a sus padres durante la infancia (pero no en la infancia) tuvieron mejores puntuaciones que los niños que vieron a sus padres en la infancia y la infancia. Hallazgos de análisis de niños resilientes (aquellos que no vieron a sus padres en ninguna ronda pero muestran que las posibilidades de un niño de no tener retraso en el crecimiento a pesar de la ausencia paterna a los 1 y 5 años fueron considerablemente mayores si él o ella vivía en un área urbana, y vivía en un ambiente seguro para los alimentos. Las intervenciones diseñadas para reducir la malnutrición deben basarse en una comprensión más completa de cómo la ausencia paterna pone a los niños en riesgo de fallas de crecimiento