The first 1000 days of life: prenatal and postnatal risk factors for morbidity and growth in a birth cohort in southern India

Abstract

ObjectiveTo estimate the burden and assess prenatal and postnatal determinants of illnesses experienced by children residing in a semiurban slum, during the first 1000 days of life.DesignCommunity-based birth cohortSettingSouthern IndiaParticipantsFour hundred and ninety-seven children of 561 pregnant women recruited and followed for 2 years with surveillance and anthropometry.Main outcome measureIncidence rates of illness; rates of clinic visits and hospitalisations; factors associated with low birth weight, various illnesses and growth.ResultsData on 10 377.7 child-months of follow-up estimated an average rate of 14.8 illnesses/child-year. Gastrointestinal and respiratory illnesses were 20.6% and 47.8% of the total disease burden, respectively. The hospitalisation rate reduced from 46/100 child-years during infancy to 19/100 child-years in the second year. Anaemia during pregnancy (OR=2.3, 95% CI=1.08 to 5.18), less than four antenatal visits (OR=6.8, 95% CI=2.1 to 22.5) and preterm birth (OR=3.3, 95% CI=1.1 to 9.7) were independent prenatal risk factors for low birth weight. Female gender (HR=0.88, 95% CI=0.79 to 0.99) and 6 months of exclusive breast feeding (HR=0.76, 95% CI=0.66 to 0.88) offered protection against all morbidity. Average monthly height and weight gain were lower in female child and children exclusively breast fed for 6 months.ConclusionsThe high morbidity in Indian slum children in the first 1000 days of life was mainly due to prenatal factors and gastrointestinal and respiratory illness. Policymakers need disease prevalence and pathways to target high-risk groups with appropriate interventions in the community.

Linear growth trajectories in Zimbabwean infants

“…Although the maternal educational level is very commonly associated with stunting, the causal mechanism is not known; this variable may be a proxy for socioeconomic status or a determinant of the maternal-infant interaction, use of health services, or maternal diet. Finally, boys have shown higher rates of clinical illness in early life (61–63), potentially because of differences in inflammatory and immune responses compared with girls, as has been suggested by sex differences in the immune response to vaccination (64) and infectious diseases (63). It has also been suggested that natural selection may favor maximizing reproductive fitness, thereby resulting in higher morbidity and mortality rates in male infants to compensate for greater male birth rates (65, 66).…”

Risk Factors for Cryptosporidiosis Among Children in a Semi Urban Slum in Southern India: A Nested Case-Control Study

“…that investigated symptomatic and asymptomatic cryptosporidial infections in 497 children during the first 3 years of their life through biweekly followup visits. 35 Ethical approvals for both studies were obtained from the Institutional Review Boards of Christian Medical College, Vellore and Tufts University Health Sciences Campus, Boston. Written informed consent was provided by parents or legal guardians of all participating children, before enrollment.…”

Brief Report

“…16–18 The studies were approved by the Institutional Review Boards of the Christian Medical College, Vellore, India and Tufts University Health Sciences campus, Boston, USA. The data set includes 982 children who were followed weekly or twice-weekly from birth to 3 years of age.…”