The relationship between growth, development and social milieu - a longitudinal study involving preschool Coloured children in Cape Town

A prospective longitudinal study was carried out to establish the relationship between growth, development and social milieu in Coloured pre-school children in Cape Town. This population was selected because, on the basis of previous studies, a wide range of nutritional status as well as a spectrum of socio-economic conditions were known to exist. A pilot study was conducted to establish the feasibility of obtaining information about factors to be included in the study as well as to determine the most suitable sampling methods. A cohort of 1 000 consecutive Coloured infants born in the Cape Town municipal area and notified to the Cape Town City Council was identified. A random sample of 187 was selected from the cohort for long-term study. Anthropometric data were documented from birth until 5 years and compared to the NCHS reference values. Developmental data consisted of milestones recorded during infancy, language assessment on the Reynell Language Scale at 2½ years carried out by the Logopaedics Department, University of Cape Town, and at 5 years, a specially constructed developmental assessment designed to assess gross motor function, fine motor development including visuo-motor skills and language, both comprehension and expression as well as basic colour and number concepts. Social data were collected during home visits by two experienced, full-time research social workers, who were both integrally involved in the planning of the study. At birth infants were relatively light and short for gestational age. Size at birth correlated with social class. A rapid post-natal weight gain rendered them relatively overweight between 3 and 6 months. Thereafter they again became lighter and shorter than the NCHS reference values and this persisted during the pre-school period. Mother's weight was related to weight at birth, 12 months and 30 months. The genetic influence on growth was reflected in a correlation between parental height and child's length from 12 months onwards. Environmental influences as assessed by social class by occupational grading of the breadwinner, income and family stability were also correlated with growth from 12 months onwards. Infant development as indicated by milestones was very similar to internationally reported studies. Motor development was not associated with social class by occupational grading of the breadwinner but with father's education, mother's personality and family stability. It was also highly correlated with growth during infancy. Early language milestones were associated with the child's micro-environment as indicated by marital status, family unit, setting and stability. Language development at 30 months reflected a general lag in verbal skills and was correlated with parental education and family stability. At five years there was a good correlation between growth, development and social milieu, although the social variables accounted for far more of the variation in development than did growth. Social class by occupation grading of the breadwinner and income reflected the general socio-economic status and there was a good cross-correlation between the social variables. Approximately one third of the families lived in a middle cl ass environment. However, poor maternal education, low incomes and over-crowding were prevalent and must constitute risk factors in child rearing. Sixty five percent of the mothers were not educated further than primary school level and over half of the families were living below an effective minimum level of income. Similarly, over half the families lived in grossly overcrowded conditions. In conclusion, therefore, during infancy developmental milestones were similar to those reported in the literature. Later, however, there was a fall-off in development and this coincided with a greater association with social circumstances. Just prior to school entry social factors far outweighed growth indices as predictors of developmental variation. Social stability of the family a composite evaluation based on a number of social characteristics, was most consistently associated with development. The implications for intervention are that this would need to be broad based and aimed at improving incomes, housing, family cohesion and child centredness and eliminating social pathology. Such intervention would require a concerted effort from a variety of sources which should include administrators, community workers and health professionals

The factor structure of the Edinburgh Postnatal Depression scale in a South African peri-urban settlement

The factor structure of the Edinburgh Postnatal Depression scale (EPDS) and similar instruments have received little attention in the literature. The researchers set out to investigate the construct validity and reliability of the EPDS amongst impoverished South African women. The EPDS was translated into isiXhosa (using Brislin's back translation method) and administered by trained interviewers to 147 women in Khayelitsha, South Africa. Responses were subjected to maximum likelihood confirmatory factor analysis. A single factor structure was found, consistent with the theory on which the EPDS was based. Internal consistency was satisfactory (a =0.89)

Mediating and Moderating Effects of Iron Homeostasis Alterations on Fetal Alcohol-Related Growth and Neurobehavioral Deficits

We have previously demonstrated prenatal alcohol exposure (PAE)-related alterations in maternal and infant iron homeostasis. Given that early iron deficiency and PAE both lead to growth restriction and deficits in recognition memory and processing speed, we hypothesized that PAE-related iron homeostasis alterations may mediate and/or moderate effects of PAE on growth and neurobehavior. We examined this hypothesis in a prenatally recruited, prospective longitudinal birth cohort [87 mother-infant pairs with heavy prenatal alcohol exposure (mean = 7.2 drinks/occasion on 1.4 days/week); 71 controls], with serial growth measures and infant neurobehavioral assessments. PAE was related to growth restriction at 2 weeks and 5 years, and, in infancy, poorer visual recognition memory, slower processing speed, lower complexity of symbolic play, and higher emotionality and shyness on a parental report temperament scale. Lower maternal hemoglobin-to-log(ferritin) ratio, which we have shown to be associated with PAE, appeared to exacerbate PAE-related 2-week head circumference reductions, and elevated maternal ferritin, which we have shown to be associated with PAE, appeared to exacerbate PAE-related visual recognition memory deficits. In causal inference analyses, PAE-related elevations in maternal ferritin and hemoglobin:log(ferritin) appeared to statistically mediate 22.6–82.3% of PAE-related growth restriction. These findings support potential mechanistic roles of iron homeostasis alterations in fetal alcohol spectrum disorders (FASD)

Development and validation of a quantitative choline food frequency questionnaire for use with drinking and non-drinking pregnant women in Cape Town, South Africa

Background Although animal and human studies have demonstrated interactions between dietary choline and fetal alcohol spectrum disorders, dietary choline deficiency in pregnancy is common in the US and worldwide. We sought to develop and validate a quantitative food frequency questionnaire (QFFQ) to estimate usual daily choline intake in pregnant mothers. Methods A panel of nutrition experts developed a Choline-QFFQ food item list, including sources with high choline content and the most commonly consumed choline-containing foods in the target population. A data base for choline content of each item was compiled. For reliability and validity testing in a prospective longitudinal cohort, 123 heavy drinking Cape Coloured pregnant women and 83 abstaining/light-drinking controls were recruited at their first antenatal clinic visit. At 3 prenatal study visits, each gravida was interviewed about alcohol, smoking, and drug use, and administered a 24-hour recall interview and the Choline-QFFQ. Results Across all visits and assessments, > 78% of heavy drinkers and controls reported choline intake below the Dietary Reference Intakes adequate intake level (450 mg/day). Women reported a decrease in choline intake over time on the QFFQ. Reliability of the QFFQ across visits was good-to-acceptable for 2 of 4 group-level tests and 4 of 5 individual-level tests for both drinkers and controls. When compared with 24-hr recall data, validity of the QFFQ was good-to-acceptable for 3 of 4 individual-level tests and 3 of 5 group-level tests. For controls, validity was good-to-acceptable for all 4 individual-level tests and all 5 group-level tests. Conclusions To our knowledge, this is the first quantitative choline food frequency screening questionnaire to be developed and validated for use with both heavy and non-drinking pregnant women and the first to be used in the Cape Coloured community in South Africa. Given the high prevalence of inadequate choline intake and the growing evidence that maternal choline supplementation can mitigate some of the adverse effects of prenatal alcohol exposure, this tool may be useful for both research and future clinical outreach programs

Social factors and postpartum depression in Khayelitsha, Cape Town

Social factors, including poverty, are known risk factors for depression. In a previous study conducted in Khayelitsha, a very poor peri-urban settlement near Cape Town, a 34.7% prevalence rate for postpartum depression was found, roughly three times the expected rate internationally. This article is a report on a logistical regression analysis, showing that the odds ratios for the probability of maternal depression at two months were: for the infant being unwanted, OR=4.33, 95% Cl: (1.75; 11.60); for the father's negative attitude towards the infant, OR=6.03, 95% Cl: (2.01; 20.09); and for the mother cohabiting with (as opposed to not living with) a male partner, OR=2.77, 95% Cl: (1.08; 7.69). The odds ratios for the probability of the mother being insensitive towards the infant at two months were: for the mother aged 20 to 24 years, OR=0.40, 95% Cl: (0.10; 1.42); for the mother aged 25 to 29 years, OR=0.24, 95% Cl: (0.06; 0.77); for the mother aged 30 years or older, OR=0.27, 95% CI: (0.07; 0.90); and for the mother receiving no help from her partner, OR=2.12, 95% CI: (1.05; 4.33). Since data were collected cross-sectionally, it is not possible to draw conclusions about causal pathways. The findings support further investigation into the precursors of, and risk factors for, postpartum depression amongst poor South African women