Early linear growth retardation: results of a prospective study of Zambian infants

Abstract

BackgroundLinear growth retardation is the most dominant nutritional problem globally. We aimed to describe linear growth trajectory among infants under 2 years of age using the WHO growth velocity standards.MethodThis was a prospective cohort study of infants enrolled at 6 weeks of age and followed up for up to 24 months in Kamwala Urban Health Centre, Lusaka, Zambia. The study was conducted between April 2013 and March 2015. Infants were enrolled if they were 6–12 weeks of age and the mother was willing to participate voluntarily and provided informed consent. Anthropometric data were collected at scheduled clinic visits at 1 month, 2 months, 3 months, then quarterly until the infant was 24 months old. We defined linear growth velocity as the rate of change in height. We estimated linear growth velocity as the first derivative of the penalized cubic spline mixed effects model.ResultsA total of 338 children were included in the analysis. Of these, 185 (54.7%) were female, 115 (34.1%) were born to HIV positive mothers and thus classified as HIV Exposed (HE). The mean age of children at enrollment was 1.6 months (SD = 0.15). On average, the growth velocity for 3-month length increments conditional on age were 0–3 months = 2.97 cm/3mo (95%CI = 2.69, 3.25); 3–6 months = 2.62 cm/3mo (95%CI = 2.38, 2.87); 6–9 months = 1.57 cm/3mo (95%CI = 1.43, 1.71); 9–12 months = 1.18 cm/3mo (95%CI = 1.08, 1.28); 12–15 month = 1.14 cm/3mo (95%CI = 1.02, 1.27); 15–18 months = 0.87 cm/3mo (95%CI = 0.79, 0.96); 18–21 months = 0.80 cm/3mo (95%CI = 0.72, 0.89); and 21–24 months = 0.86 cm/3mo (95%CI = 0.77, 0.96). For both boys and girls, the growth velocity in our cohort were consistently below the 3rd percentile of the WHO linear growth velocity standard. The estimated mean height and the age at which growth begins to falter were 68.6 cm (95%CI = 68.0, 69.2) and 13.6 months (95%CI = 13.2, 14.1) respectively.ConclusionWe found slower rate of growth among otherwise healthy Zambian infants. The data suggests that growth retardation is universal and profound in this cohort and may have already been occurring in utero.

Nutritional status, environmental enteric dysfunction, and prevalence of rotavirus diarrhoea among children in Zambia

“…Contrary to longitudinal research from Bangladesh, we did not find evidence of associations between stunting or wasting and odds of rotavirus diarrhoea even before adjustment for EED [8]. Risk factors for stunting are multifactorial and intergenerational, with maternal and intrauterine exposures acting as leading risk factors for growth faltering in early life and postnatal exposures such as frequent enteric infections becoming increasingly important as children get older [6,24,25]. Future research examining the association between nutritional status, EED and diarrhoeal disease should therefore utilize longitudinal follow-up that incorporates measurements of maternal and intrauterine predictors of childhood nutritional status over time.…”

Growth retardation among children in southern Iran: a 7-year population based cohort study

“…During infancy, several issues cause major concerns regarding the growth of a child. These include genetic deformities, environmental hazards and nutritional factors [24]. The recruited infants in the current population-based cohort study were all apparently healthy with normal anthropometric indexes at birth.…”

“…Another cohort study has suggested that retardation in linear growth among Zambian infants is more sever at about 13 months of age. According to the authors, the suggested age is about the time which nearly all the infants have weaned off breast milk a factor which may have severely affect children's growth [24].…”

Growth Retardation among Children in Southern Iran: A 7-year Population Based Cohort Study

“…During infancy, several issues cause major concern regarding growth of the child. These include, genetic deformities, environment hazards and nutritional factors [19]. At birth, the recruited infants in the current population based cohort study were all apparently healthy with normal growth indexed at birth.…”

“…According to the authors, the suggested age is about the time which nearly all the infants have completely been weaned off breast milk. This may have severe effects on children's growth [19].…”