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Abstract
This birth cohort study compared the infant growth curve estimates in São Tomé Island to the WHO growth standards. Despite this island belonging to a lower-middle-income country, there were several factors favorable for growth that were present. Four-hundred and seventy-five full-term singleton appropriate for-gestational-age infants were enrolled and followed-up to 24 months of age. Weight-for-age, length-for-age, weight-for-length, body mass index-for-age, head circumference-for-age, weight velocity, and length velocity curves were estimated and compared to the WHO standards. In the first 6 months of age, the weight gain was adequate in the presence of a high prevalence of exclusive breastfeeding. Thereafter, weight trajectories tracked close to the WHO standards, except for a progressive decline in the infants growing in higher percentiles, especially in girls. Median length at birth was below the median WHO standards, followed by an early postnatal velocity spurt, which probably reflected the transition from an unfavorable to a more favorable postnatal environment. Thereafter, linear growth faltering was observed without relevant deterioration up to 24 months of age, which was probably due to the presence of protective factors. These results may be useful to implement strategies to further approximate infant growth in São Tomé Island to the WHO standards.
Highlights
A recent birth cohort study published by our team [4] assessed the association between enteric parasitic infections and growth faltering in the infants in São Tomé Island, which belongs to the Republic of São Tomé and Príncipe, an African lower-middle-income country
Compared to other lower-middle-income countries (LMICs), we identified that this cohort of infants was under conditions that were favorable for growth, similar to those used by the World Health Organization (WHO) Multicenter Growth Reference Study to construct the standard growth charts [1,3]
The same methodology used by the WHO [6] was adopted in our cohort study, which allowed the obtained results to be compared to the WHO standards [7]. This birth cohort study suggests that, despite living in suboptimal socioeconomic conditions, the infants in São Tomé Island have satisfactory growth, as reflected by the estimates of the weight curves, especially those of the body mass index (BMI), which is likely due to the presence of several conditions that are favorable for growth
Summary
The main identified determinants that affect growth in lower-middle-income countries (LMICs) include maternal and fetal undernutrition, low prevalence of breastfeeding, adverse social and economic factors, and morbidity due to infectious diseases [1,2,3]. A recent birth cohort study published by our team [4] assessed the association between enteric parasitic infections and growth faltering in the infants in São Tomé Island, which belongs to the Republic of São Tomé and Príncipe, an African lower-middle-income country. We found that the great majority of the infants were asymptomatic. Res. Public Health 2019, 16, 1693; doi:10.3390/ijerph16101693 www.mdpi.com/journal/ijerph
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