Abstract
Background: In Sri Lanka, poor growth of infants and pre-school children is a persistent concern with 14% of them having low weight for height. It has been observed that some infants grow well and develop successfully even in low income set-ups despite many unfavourable circumstances, a phenomenon that has not been studied adequately. Objective: To describe the non-nutritional determinants of positive growth among infants and pre-school children in low income communities in Sri Lanka. Methods: An unmatched case control study including a qualitative arm was carried out. Cases were ‘well grown’ and controls were ‘poorly grown’ infants and pre-school children in Ja-Ela Medical Officer of Health area, who were recruited from the child welfare clinic and at home. Growth was determined by weight for age using standard procedure. An interviewer-administered questionnaire obtained data from their mothers/caretakers on the potential determinants of growth. Ten of the cases were randomly selected for the qualitative study and their mothers underwent in-depth interviews. Results: A total of 51 cases and 67 controls were recruited for the study. Their average family income was Rs. 17,700 (SD=4200). Cases and controls did not differ significantly by the mode of delivery, type of pregnancy, order of pregnancy and whether pregnancy was planned or not. The only non-nutritional determinants of positive growth were: whether the child is easy to be fed (OR=3.58; 95% CI: 1.66, 7.72) and corporative with the mother (OR=3.77; 95% CI: 1.05, 13.54). The qualitative study further identified readiness to eat and preference for a wide variety of food as non-nutritional determinants of positive growth, which seemed to be intrinsic characteristics of a child rather than shared features among the siblings in a family. Conclusions: Intrinsic characteristics of a child such as readiness to eat, cooperating with the mother and preferring a variety of food partly determine good growth. Dynamics of these characteristics need further study.
Highlights
Sri Lanka is a low- and middle-income country with a per capita income of USD 3924 [1]
The required number of cases and controls fulfilling the eligibility criteria was obtained from lists of infants and pre-school children maintained by the area public health midwife (PHM)
A total of 118 infants and pre-school children who were of low socio-economic status in Ja-Ela medical officer of health (MOH) area were recruited for the study
Summary
Sri Lanka is a low- and middle-income country with a per capita income of USD 3924 [1]. Poor growth of infants and pre-school children is a persistent concern in Sri Lanka To address this issue, nutritional determinants of growth have been studied widely. It has been observed that some grow well and develop successfully even in low income set ups despite many unfavourable circumstances [10,11], pointing to the assumption that possibly non-nutritional determinants do operate on the growth of children. Identifying the underlying determinants of good growth in such communities would point to possible nutritional interventions This approach is useful for a medical officer of health (MOH) as he is expected to take pragmatic action to prevent growth faltering in low income families in his/ her area. In Sri Lanka, poor growth of infants and pre-school children is a persistent concern with 14% of them having low weight for height. It has been observed that some infants grow well and develop successfully even in low income set-ups despite many unfavourable circumstances, a phenomenon that has not been studied adequately
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