Long-term morbidity and mortality following hypoxaemic lower respiratory tract infection in Gambian children.
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Acute lower respiratory infections (ALRI) are the main cause of death in young children worldwide. We report here the results of a study to determine the long-term survival of children admitted to hospital with severe pneumonia. The study was conducted on 190 Gambian children admitted to hospital in 1992-94 for ALRI who survived to discharge. Of these, 83 children were hypoxaemic and were treated with oxygen, and 107 were not. On follow-up in 1996-97, 62% were traced. Of the children with hypoxaemia, 8 had died, compared with 4 of those without. The mortality rates were 4.8 and, 2.2 deaths per 100 child-years of follow-up for hypoxaemic and non-hypoxaemic children, respectively (P = 0.2). Mortality was higher for children who had been malnourished (Z-score < -2) when seen in hospital (rate ratio = 3.2; 95% confidence interval (CI) = 1.03-10.29; P = 0.045). Children with younger siblings experienced less frequent subsequent respiratory infections (rate ratio for further hospitalization with respiratory illness = 0.15; 95% CI = 0.04-0.50; P = 0.002). Children in Gambia who survive hospital admission with hypoxaemic pneumonia have a good prognosis. Survival depends more on nutritional status than on having been hypoxaemic. Investment in oxygen therapy appears justified, and efforts should be made to improve nutrition in malnourished children with pneumonia. (+info)
Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood.
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Undernutrition in infancy and early childhood is thought to adversely affect cognitive development, although evidence of lasting effects is not well established. With the use of data from the Cebu Longitudinal Health and Nutrition Study, we assesshere the relationship between stunting in the first 2 y of life and later cognitive development, focusing on the significance of severity, timing and persistence of early stunting. The sample included > 2000 Filipino children administered a cognitive ability test at ages 8 and 11 y. Stunting status was determined on the basis of anthropometric data collected prospectively between birth and age 2 y. Children stunted between birth and age 2 y had significantly lower test scores than nonstunted children, especially when stunting was severe. The shortfall in test scores among children stunted in the first 2 y was strongly related to reduced schooling, which was the result of a substantial delay in initial enrollment as well as higher absenteeism and repetition of school years among stunted children. Interactions between stunting and schooling were not significant, indicating that stunted and nonstunted children benefitted similarly from additional schooling. After multivariate adjustment, severe stunting at age 2 y remained significantly associated with later deficits in cognitive ability. The timing of stunting was also related to test performance, largely because children stunted very early also tended to be severely stunted (chi(2) P = 0.000). Deficits in children's scores were smaller at age 11 y than at age 8 y, suggesting that adverse effects may decline over time. Results emphasize the need to prevent early stunting and to provide adequate schooling to disadvantaged children. (+info)
Relationship between health services, socioeconomic variables and inadequate weight gain among Brazilian children.
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This ecological analysis assessed the relative contribution of behavioural, health services and socioeconomic variables to inadequate weight gain in infants (0-11 months) and children (12-23 months) in 140 municipalities in the State of Ceara, north-east Brazil. To assess the total effect of selected variables, we fitted three unique sets of multivariate linear regression models to the prevalence of inadequate weight gain in infants and in children. The final predictive models included variables from the three sets. Findings showed that participation in growth monitoring and urbanization were inversely and significantly associated with the prevalence of inadequate weight gain in infants, accounting for 38.3% of the variation. Female illiteracy rate, participation in growth monitoring and degree of urbanization were all positively associated with prevalence of inadequate weight gain in children. Together, these factors explained 25.6% of the variation. Our results suggest that efforts to reduce the average municipality-specific female illiteracy rate, in combination with participation in growth monitoring, may be effective in reducing municipality-level prevalence of inadequate weight gain in infants and children in Ceara. (+info)
Nutritional and health status of Tibetan children living at high altitudes.
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BACKGROUND: Children living at high altitudes often have delayed growth, but whether growth retardation is related to altitude or to other factors is not known. METHODS: A multicultural health care team assessed 2078 Tibetan children 0 to 84 months of age for anthropometric and clinical signs of malnutrition. The children lived in 11 counties, which contained more than 50 diverse urban and nonurban (nomadic, agricultural, or periurban) communities in the Tibet Autonomous Region of China. The height and weight of the children were compared with those of U.S. children. Height and weight were expressed as z scores (the number of standard deviations from the median of the age- and sex-specific reference group). RESULTS: The mean z score for height fell from -0.5 to -1.6 in the first 12 months of life and generally ranged from -2.0 to -2.4 in older children. Overall, of 2078 children, 1067 (51 percent) had moderately or severely stunted growth, as defined by a z score of -2.0 or lower. Of the 1556 children 24 months of age or older, 871 (56 percent) had stunted growth, which was severe (z score, -3.0 or lower) in 380 (24 percent). Among the children in this age group, 787 of the 1313 nonurban children (60 percent) had stunting, as compared with 84 of the 243 urban children (35 percent). Stunting was associated with clinical conditions such as rickets, abdominal distention, hair depigmentation, and skin lesions and with a maternal history of hepatitis or goiter. Stunting was not associated with altitude, after adjustment for the type of community. CONCLUSIONS: In Tibetan children, severe stunting due to malnutrition occurs early in life, and morbidity is high. (+info)
Retinol binding protein as a surrogate measure for serum retinol: studies in vitamin A-deficient children from the Republic of the Marshall Islands.
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BACKGROUND: Serum retinol is transported by retinol binding protein (RBP), which has one high-affinity binding site for retinol; consequently, the molar ratio of retinol to RBP in the circulation is approximately 1 to 1. In vitamin A deficiency (VAD), both serum retinol and RBP decline. However, the retinol-RBP relation has not been well studied in populations with a high incidence of severe VAD. OBJECTIVE: The purpose of this study was to determine whether RBP is a good surrogate for serum retinol at the very low retinol concentrations encountered in VAD. DESIGN: The stoichiometric relation between retinol and RBP was studied in 239 Marshallese children: 65 with severe VAD (< or = 0.35 micromol retinol/L), 94 with moderate VAD (0.36-0.70 micromol retinol/L), and 80 with vitamin A sufficiency (> 0.70 micromol retinol/L). RESULTS: Excellent correlation between retinol and RBP (r = 0.94) was observed across all retinol concentrations. Severe VAD was predicted with 96% sensitivity and 91% specificity on the basis of an RBP cutoff of < or = 0.48 micromol/L, whereas moderate VAD was predicted with 87% sensitivity and 98% specificity on the basis of an RBP cutoff of < or = 0.70 micromol/L. CONCLUSIONS: The use of RBP results in the classification of essentially the same children with VAD as does retinol, and RBP is an excellent surrogate for serum retinol. Considering the relative ease of measuring RBP with immunodiagnostic kits compared with that of serum retinol by HPLC, the use of RBP concentrations to assess VAD may be particularly advantageous in field settings. Consequently, measuring RBP concentrations may be a practical alternative to measuring serum retinol in population surveys assessing the prevalence of VAD. (+info)
Introduction. Symposium: Obesity in developing countries: biological and ecological factors.
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Over the past decade there has been an increasing concern about the impact of chronic, noncommunicable diseases on the health of developing world populations. Traditionally, major causes of illness and death in developing countries have been linked to infectious diseases and undernutrition, and these are still major public health problems in several regions of the world. But recent projections indicate that in 20 y noncommunicable diseases will account for over 60% of the disease burden and mortality in the developing world. Obesity is recognized as an underlying risk factor for many of these chronic conditions. As in developed societies, the risk for obesity in developing countries is also strongly influenced by diet and lifestyle, which are changing dramatically as a result of the economic and nutrition transition. This symposium discusses key aspects of the phenomenon of obesity in the developing world and provides some specific examples from countries facing increasing prevalence of that condition. (+info)
Early nutrition and later adiposity.
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The objective was to review whether nutrition during pregnancy and the first 3 y of life predisposes individuals to be fatter as adults. The roles of undernutrition, overnutrition and breastfeeding were considered. The evidence that poor nutrition in early life is a risk factor for increased fatness later in life is inconclusive. Overnutrition, as proxied by high birthweight or gestational diabetes, on the other hand, is associated with subsequent fatness. Two large, well-conducted studies in developed countries suggest that breastfeeding has a protective effect. Nutrition in early life has a demonstrable but small impact on adult obesity. (+info)
Severe malnutrition among young children--Georgia, January 1997-June 1999.
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In October 1999, the Georgia Department of Human Resources (GDHR) was notified of two cases of severe malnutrition in toddlers. Both cases were associated with the use of commercial alternative milk. In response, GDHR and CDC reviewed Georgia hospital records to assess the frequency and cause of hospitalized cases of rickets and protein energy malnutrition (PEM). The findings of this review indicated that, although no new cases were associated with milk alternatives, three children had PEM and six had vitamin D deficiency rickets. The children with rickets had been breast fed for approximately 6 months while receiving no vitamin D supplementation. Rickets is preventable through the adequate intake of vitamin D. The American Academy of Pediatrics (AAP) is examining vitamin D supplementation among breast-fed infants. (+info)