Undernutrition In Young Children Research Articles

Undernutrition in young children with congenital heart disease undergoing cardiac surgery in a low-income environment

BackgroundMalnutrition (undernutrition) in children with congenital disease (CHD) is a notable concern, with preoperative and persistent growth failure post-cardiac surgery contributing to poorer outcomes. Poor growth in children with CHD in low-income environments is exacerbated by feeding difficulties, poverty, delayed diagnosis, and late corrective surgery. This study describes and compares the growth of young children with CHD undergoing cardiac surgery in central South Africa from before to 6-months after cardiac surgery.MethodsChildren 30 months and younger, with their mothers, were included in this prospective observational descriptive study. Weight- height-, and head circumference-for-age z-scores were used to identify children who were underweight, stunted and microcephalic. Z-scores for growth indices were compared from baseline to 3-months and 6-months post-cardiac surgery. Changes in growth over time were calculated using a 95% confidence interval on the difference between means. Linear regression was used to determine the association between growth and development, health-related quality of life and parenting stress respectively.ResultsForty mother-child pairs were included at baseline. Most children (n = 30) had moderate disease severity, with eight children having cyanotic defects. A quarter of the children had Down syndrome (DS). Twenty-eight children underwent corrective cardiac surgery at a median age of 7.4 months. Most children (n = 27) were underweight before cardiac surgery [mean z-score − 2.5 (±1.5)], and many (n = 18) were stunted [mean z-score − 2.2 (±2.5)]. A quarter (n = 10) of the children had feeding difficulties. By 6-months post-cardiac surgery there were significant improvements in weight (p = 0.04) and head circumference (p = 0.02), but complete catch-up growth had not yet occurred. Malnutrition (undernutrition) was strongly associated (p = 0.04) with poorer motor development [Mean Bayley-III motor score 79.5 (±17.5)] before cardiac surgery. Growth in children with cyanotic and acyanotic defects, and those with and without DS were comparable.ConclusionMalnutrition (undernutrition) is common in children with CHD in central South Africa, a low-income environment, both before and after cardiac surgery, and is associated with poor motor development before cardiac surgery. A diagnosis of CHD warrants regular growth monitoring and assessment of feeding ability. Early referral for nutritional support and speech therapy will improve growth outcomes.

Effect of mothers’ use of information and communication technologies on dietary quality and undernutrition in young children in Kenya

Effect of mothers’ use of information and communication technologies on dietary quality and undernutrition in young children in Kenya

Physico-Chemical and Sensory Evaluation of Maize-Pigeon Pea Based Complementary Foods Fortified with Milk and Fish powder

Undernutrition among young children during the complementary feeding is high. Quality cereallegume based complementary food fortified with fish or milk would contribute towards reduction of undernutrition in young children. There is need for information on the animal source food that confers the best nutritional value on cereal-legume based complementary foods. This study assessed the physicochemical and sensory characteristics of maize-pigeon pea based complementary foods fortified with either milk or fish. Two complementary foods fortified with milk (COMPIM) and fish (COMPIF), were formulated from germinated maize, fermented pigeon pea, carrot and date powder using NutriSurvey application. The formulated diets were evaluated for nutrients, anti-nutrients, functional and sensory properties using standard methods and compared with commercial complementary food (CCF) and maize gruel (HCF). Data was analysed using Analysis of variance (ANOVA) and significant means were separated via Duncan’s multiple range test at p<0.05. COMPIF AND COMPIM were comparable in nutrient contents except in beta-carotene, lysine and methionine. Both formulated diets compared favourably with the commercial complementary food in crude protein, ash and moisture contents but had significantly (p<0.05) lower calcium and iron values. COMPIF had the highest lysine (0.57%) and methionine (0.21%) contents as well as lower anti-nutrients content compared to COMPIM. COMPIF had lower Water Absorption Capacity (WAC) and viscosity than COMPIM (86.67 mg/100 g; 9.50 ml/s vs 93.75%; 13.30 ml/s). COMPIM was rated higher than COMPIF in terms of taste, aroma and overall acceptability. The maize-pigeon pea complementary food fortified with fish was better than the one fortified with milk in terms of beta-carotene, lysine, methionine, functional and anti-nutritional properties but was less accepted. Further work is needed to improve the organoleptic properties of complementary foods fortified with fish.

Household Food Insecurity is a Predictor of Acute Malnutrition but Not Chronic Malnutrition among Children (6-59 Months Old): A Cross-Sectional in Tamale South Constituency

Background: The influence of household food insecurity on poor child growth has been widely studied. However, there is a lack of clarity in such relationships therefore, more studies are required. Hence, the present study evaluated household food insecurity and sciodemographic determinants of undernutrition in young children (6-59 months old) in Ghana. Materials and methods: This cross-sectional study was conducted in Tamale South using 240 mother-child pairs. Mothers and their children (6-59 months old) were recruited from child welfare clinics within the Constituency. Data were collected from face-to-face interviews using a structured questionnaire. Child anthropometric data were measured (weight and height/length) based on World Health Organization’s prescribed procedures. Child anthropometric Z-scores for the determination of acute and chronic malnutrition were generated using WHO Anthroplus 1.0.4. Household food insecurity access scale (HFIAS) was used to estimate household food insecurity. Binary logistics regression models were run using Statistical Product and Service Solutions version 24.0 to estimate the odds of acute and chronic malnutrition following the independent variables (HFIAS and sciodemographic factors). Results: The prevalence of acute malnutrition (wasting) was 7.5%. Also, the prevalence of chronic malnutrition (stunting) was 29.2%. In multiple binary logistics regressions model, there was a significant relationship between higher scores of HFIAS and the odds of acute malnutrition [1.34(1.07-1.68); P=0.010]. In the study, children aged 6-23 months had lower odds for chronic malnutrition [0.36 (1.20-0.66); P=0.001] compared with their colleagues (24-59 months old). Conclusions: In the study, we found a medium and a high prevalence of acute and chronic malnutrition, respectively. Also, HFIAS was a significant predictor of acute malnutrition but not chronic malnutrition. Further, children less than 24 months old compared with those aged 24-59 months old had lower odds for chronic malnutrition. To reduce the odds for acute malnutrition, nutrition and health authorities in the Tamale South Constituency ought to intensify education on strategies to increase household food security status.

Situational analysis of undernutrition and selected infant and young child feeding practices (IYCF) in young children of Somanath Gir, Gujarat

: Undernutrition in young children is a cause of concern, maternal education, and IYCF practices, lack of nutrition knowledge are some of the key aspects for poor nutritional status of young children.To assess themagnitude of under nutrition and IYCF practices of young children (3-5 Y) of Somnath gir, Gujarat.: 120 mother and child pairs were randomly enrolled from the selected Anganwadi centers and preschool oSomnath gir f . Information on socioeconomic aspects,IYCF practices were elicited from mothers of young children through pre tested semi structured questionnaire. Height and weight and MUAC of these children were measured using standard methods.nutritional status was assessed using WHO growth standard 2006. Sixteen percent of the households had Below Poverty Card (BPL) 70.8% were other backward class. The educational attainment was limited for respondent mothers. Around 2.5 percent of the surveyed mothers never attended schools, and 45.8 percent had attended until grade 7. 57 % of the children were male. The overall stunting prevalence among children less than 60 months of age in the survey areas was 11.1 percent (<-2SD). As per MUAC cut-off for children, only 1.39% are at higher risk between 37-60 months of age. (MUAC <11.5cm). One-half of the children were breastfed immediately after the birth, and 48.3% children were breastfed within one hour of the birth. Only 64.2% children were given colostrum (yellow milk) which is known as “Immunity booster for the child”. Eighteen percent of the children were fed with pre-lacteals. Breastfeeding till the completion of 6 months were attained by 95.8% children. 78.3% children mothers’ reported the initiation of complementary feeding at right age i.e. after completion of 6 months of age. Conclusion: Under nutrition in young children needs to be prevented. Mothers of young children needs to be sensitized for optimal IYCF practices.

Effectiveness and Suitability of Oyster Mushroom in Improving the Nutritional Value of Maize Flour Used in Complementary Foods.

Complementary foods based on habitual cereals such as maize have been linked with the promotion of undernutrition in young children. Blending the starchy-rich maize with nutritious-rich indigenous food such as oyster mushroom could improve the nutritional composition of complementary foods. This study investigated the effectiveness and suitability of oyster mushrooms in improving the nutritional value of maize flour commonly used as a bulk ingredient in complementary foods. Flour made of well-cleaned and sun-dried oyster mushroom was blended with maize flour at 0% (control), 30%, 40%, and 50%. Proximate composition, mineral density, and sensory evaluation were determined using standard procedures. Significant improvement in the nutritional quality of formulated flour blends with all proportions of mushroom flour was obtained . Blending maize flour with 30%, 40%, or 50% oyster mushroom flour improved the protein content of formulated flour blends from 8.63% to 18.20%, 8.63% to 20.37% and 8.63% to 22.75%, respectively. The increase in ash and fiber content ranged between 82.52% to 84.16% and 50.69% to 58.35%, respectively. Mineral content of formulated flour blends was improved from 62.89% to 64.72% (iron), 7.63% to 22.69% (zinc), 77.48% to 78.02% (calcium), and 67.55% to 67.64% (potassium). Sensory scores of porridges prepared from formulated flour blends showed good acceptance for the colour, flavour, and aroma of the porridges from three formulated flour blends. Overall, this study recommends blending oyster mushroom with maize flour to improve the nutritional content of formulated flour blend for young children who rely on maize porridge as their complementary food.

Growth and Development of Preschool Children (12-60 Months): A Review of the Effect of Dairy Intake.

Undernutrition in young children is a global health issue. The ability to meet energy and nutrient needs during this critical stage of development is necessary, not only to achieve physical and mental potential but also socio-economic achievement later in life. Given ongoing discussions regarding optimization of dietary patterns to support achievement of the Sustainable Development Goals established by the United Nations, it is important to identify foods/food groups that have shown efficacy in reducing the negative impacts of undernutrition in young children. This narrative review addresses the impact of dairy intake, with a focus on linear growth, cognitive development and weight gain in early childhood (12–60 months). The impact of country economic status is also examined, to help elucidate regional specific recommendations and/or future research needs. Overall, the body of research addressing this age group is somewhat limited. Based on the data available, there is a positive association between dairy intake and linear growth. The impact of milk or dairy products on cognitive development is less clear due to a lack of evidence and is a gap in the literature that should be addressed. Regarding the impact on body weight, the majority of evidence suggests there is either no association or an inverse association between milk intake by preschool children on overweight and obesity later in life. This evidence is exclusively in high income countries, however, so additional work in lower income countries may be warranted.

Prevalence and predictors of undernutrition among under -5 children in slum of Gwalior city

Background: Under-nutrition in young children has long-term negative effects on physical and cognitive development. Under nutrition problems are affecting overall development of the country. Aim and Objectives: This study was undertaken to assess the prevalence and to examine predictors of undernutrition among children of less than 5 years of age in urban slum of Gwalior district. Materials and Methods: A community based cross sectional study was conducted on 550 children with age group 6 months to 5 years residing in urban slum. Chi square test and logistic regression were performed to see association and to predict risk factors. Results: Undernutrition was prevalent among 68% children. Unreserved category(UR) was found to be at lesser risk as compared to SC/ST (OR: 0.238 ;CI : 0.133-0.423).Nuclear families had more risk for undernutrition as compared to Joint families (OR:1.947;CI: 1.352-2.803),Illiterate mothers showed more risk (OR:5.696 ,CI:2.791-11.625) ,Similar results were obtained for illiterate fathers (OR: 3.950; CI:1.868-8.353) as compared to fathers having qualification of at least graduation. Females with one parity were protective for undernutrition (OR: 0.411; CI: 0.182-0.928).Low birth weight (OR: 1.996; CI: 1.332-2.991) and total member in family also played a significant role. Conclusion: Poverty and education predispose undernutrition in slum children. There is a need to undertake intervention through community education regarding breastfeeding, ANC, birth spacing and to adopt practices that favour good nutrition of child.

Prevalence and Correlates of Undernutrition in Young Children Living in Urban Slums of Mumbai, India: A Cross Sectional Study.

Background: Young children living in urban slums are vulnerable to malnutrition and subsequently poor health outcomes, but data on the correlates of stunting, underweight, wasting, and anemia specifically among 10–18 month-old children in India remain limited.Objective: In this analysis, we sought to describe the prevalence of and examine correlates for different markers of undernutrition, including stunting, underweight, and anemia among 10–18 month-old children living in urban slums, an understudied vulnerable group.Methods: Children and their mothers (n = 323) were screened for anthropometry, demographics, and complete blood counts for hemoglobin concentration between March and November 2017 (Clinicaltrials.gov ID: NCT02233764). Correlates included child and mother's age, sex, birth order, birth weight, illness episodes, hemoglobin concentration, family income, maternal height, and maternal education level. Risk ratios (RR, 95% CI) for binary outcomes (stunting, underweight, wasting and anemia) and mean differences (β, 95% CI) for continuous outcomes (anthropometric Z-scores, hemoglobin concentration) were calculated using multivariate binomial and linear regression (SAS 9.4).Results: The prevalence of stunting was 31.2%, underweight 25.1%, wasting (9.0%), and anemia (76%) among all children. Male children had a higher prevalence of poor growth indices and lower anthropometric Z-scores than females. Male sex, low birthweight, shorter maternal height, report of ≥1 episodes of illness within the past month, older maternal age, and birth order ≥2 were also associated with poor growth and anemia in multivariate models. Correlates of undernutrition were different among females and males. Female children had a 40% (20, 60%) higher risk of anemia associated with diarrhea, and male children who were firstborn had a 20% (0, 70%) lower risk of anemia.Conclusions: These results show that poor growth and anemia among young children is prevalent in urban slums of Mumbai, and that sex of the child may play an important role in informing interventions to address undernutrition.

Mother's nutrition-related knowledge and child nutrition outcomes: Empirical evidence from Nigeria.

BackgroundNutrition outcomes among young children in Nigeria are among the worse globally. Mother’s limited knowledge about food choices, feeding, and health care seeking practices contributes significantly to negative nutrition outcomes for children in most developing countries. Much less is known about the relationship between mother’s nutrition-related knowledge and child nutritional outcomes in rural Nigeria. This paper investigates therefore: (i) the association of mother’s nutrition-related knowledge with nutrition outcomes of young children living in rural Nigeria, where access to education is limited, and (ii) whether mother’s education has a complementary effect on such knowledge in producing positive child nutrition outcomes in such settings.MethodsUsing the Demographic and Health Survey data for Nigeria, we employ both descriptive and regression analyses approaches in analyzing the study’s objectives. In particular, we apply ordinary least square (OLS) to investigate the association of mother’s nutrition-related knowledge with child HAZ and WHZ while controlling for maternal, child, household and regional characteristics. An index was constructed for mother’s nutrition-related knowledge using information on dietary practices, disease treatment and prevention, child immunization, and family planning.ResultsWe found that mother’s knowledge is independently and positively associated with HAZ and WHZ scores in young children. Higher levels of mother’s education, typically above primary, have a significant, positive association with child HAZ and WHZ scores. We argue that mother’s knowledge of health and nutrition may substitute for education in reducing undernutrition in young children among populations with limited access to formal education. However, the present level of mother’s education in rural Nigeria appears insufficient to reinforce knowledge in producing better nutrition outcomes for children.ConclusionsThis study suggests promotion of out-of-school (informal) education, such as adult literacy and numeracy classes where women without formal education can gain health and nutrition knowledge, and practices that could enhance child nutrition outcomes in Nigeria.

Study of the Determinants of Chronic Malnutrition in Northern Nigeria: Quantitative Evidence from the Nigeria Demographic and Health Surveys International Food Policy Research Institute (IFPRI) Working Paper 45 (September 2017).

Close to half of all children younger than 5 years in the Northeast and Northwest geopolitical zones were estimated to be stunted in their growth for their age in 2013 compared to 22% of children in the rest of Nigeria. We examine the drivers of chronic child undernutrition in northern Nigeria and how those drivers differ from other areas of the country. Both a standard child-level regression-based approach and decomposition analysis were used to address the determinants of stunting and decompose how drivers differ between northern Nigeria and other areas of the country using 2008 and 2013 Nigeria DHS data. There are strong differences in the levels of the determinants of undernutrition in young children between the 2 parts of the country. However, equally important, the decomposition analysis shows that there are significant differences between northern Nigeria and other areas of Nigeria in the effect of the same determinant of nutritional status in accelerating or retarding the linear growth of young children. A national program to address child undernutrition must recognize this heterogeneity in its design. To impose across Nigeria, a single set of approaches to address the factors which results in stunted children is likely to fail for large numbers of children if these strong geographical differences in how these determinants operate to affect child nutritional status are not considered. Solutions need to be developed within northern Nigeria to more closely reflect the way the determinants of nutritional status operate in this area of the country.

Implementation of strategies to improve programme effectiveness lead to an improvement in maternal and child health outcomes in South Africa

Over the last few years, the South African (SA) National Department of Health has led the design, implementation and monitoring of key strategies to improve maternal, newborn, and child health outcomes. The strategies have resulted in the reduction of maternal, under-5 and infant mortality rates in SA. Here, we examine the strategies using a framework to understand the determinants and actions that influence the quality of care, coverage and resultant programme effectiveness in saving the lives of mothers and children. Three case studies from the field, namely, the Essential Steps In Managing Obstetric Emergencies, undernutrition in young children and breastfeeding are illustrated through applying the framework and demonstrating how improved quality of care and coverage achieved better health outcomes for pregnant women and children under 5 years of age. These case studies highlight different aspects of the framework, including improving healthcare workers’ skills, ensuring implementation of standard protocols and strengthening management accountability within facilities and across the districts. We also highlight how these aspects collectively improved the overall programme impact. The paper concludes that the framework would be strengthened through addition of critical cross-cutting aspects related to targeting and sustainability of actions.

Examining the changing profile of undernutrition in the context of food price rises and greater inequality

This paper examines how the profile of undernutrition among children in two African countries (Ethiopia and Nigeria) changed over the period of the 2007/08 food, fuel and financial crisis. Using the Composite Index of Anthropometric Failure (CIAF), an indicator which allows for a comprehensive assessment of undernutrition in young children, we examine what changes occurred in the composition of undernutrition, and how these changes were distributed amongst children in different socio-economic groups. This is important as certain combinations of anthropometric failure (AF), especially the experience of multiple failures (dual and triple combinations of AF) are associated with higher morbidity and mortality risks, and are also related to poverty. Our hypothesis is that increases in food prices during the crisis contributed to an increase in inequality, which may have resulted in concurrent increases in the prevalence of more damaging forms of undernutrition amongst poorer children. While both countries witnessed large increases in food prices, the effects were quite different. Ethiopia managed reduce the prevalence of multiple anthropometric failure between 2005 and 2011 across most groups and regions. By contrast, in Nigeria prevalence increased between 2008 and 2013, and particularly so in the poorer, northern states. The countries studied applied quite different policies in response to food price increases, with the results from Ethiopia demonstrating that protectionist public health and nutrition interventions can mitigate the impacts of price increases on poor children.

Association between economic growth and early childhood undernutrition: evidence from 121 Demographic and Health Surveys from 36 low-income and middle-income countries.

Economic growth is widely regarded as a necessary, and often sufficient, condition for the improvement of population health. We aimed to assess whether macroeconomic growth was associated with reductions in early childhood undernutrition in low-income and middle-income countries. We analysed data from 121 Demographic and Health Surveys from 36 countries done between Jan 1, 1990, and Dec 31, 2011. The sample consisted of nationally representative cross-sectional surveys of children aged 0-35 months, and the outcome variables were stunting, underweight, and wasting. The main independent variable was per-head gross domestic product (GDP) in constant prices and adjusted for purchasing power parity. We used logistic regression models to estimate the association between changes in per-head GDP and changes in child undernutrition outcomes. Models were adjusted for country fixed effects, survey-year fixed effects, clustering, and demographic and socioeconomic covariates for the child, mother, and household. Sample sizes were 462,854 for stunting, 485,152 for underweight, and 459,538 for wasting. Overall, 35·6% (95% CI 35·4-35·9) of young children were stunted (ranging from 8·7% [7·6-9·7] in Jordan to 51·1% [49·1-53·1] in Niger), 22·7% (22·5-22·9) were underweight (ranging from 1·8% [1·3-2·3] in Jordan to 41·7% [41·1-42·3] in India), and 12·8% (12·6-12·9) were wasted (ranging from 1·2% [0·6-1·8] in Peru to 28·8% [27·5-30·0] in Burkina Faso). At the country level, no association was seen between average changes in the prevalence of child undernutrition outcomes and average growth of per-head GDP. In models adjusted only for country and survey-year fixed effects, a 5% increase in per-head GDP was associated with an odds ratio (OR) of 0·993 (95% CI 0·989-0·995) for stunting, 0·986 (0·982-0·990) for underweight, and 0·984 (0·981-0·986) for wasting. ORs after adjustment for the full set of covariates were 0·996 (0·993-1·000) for stunting, 0·989 (0·985-0·992) for underweight, and 0·983 (0·979-0·986) for wasting. These findings were consistent across various subsamples and for alternative variable specifications. Notably, no association was seen between per-head GDP and undernutrition in young children from the poorest household wealth quintile. ORs for the poorest wealth quintile were 0·997 (0·990-1·004) for stunting, 0·999 (0·991-1·008) for underweight, and 0·991 (0·978-1·004) for wasting. A quantitatively very small to null association was seen between increases in per-head GDP and reductions in early childhood undernutrition, emphasising the need for direct health investments to improve the nutritional status of children in low-income and middle-income countries. None.

Overlooking undernutrition? Using a composite index of anthropometric failure to assess how underweight misses and misleads the assessment of undernutrition in young children

In light of current international interest in the Millennium Development Goals, this short report examines the suitability of one of the primary indicators being used to assess progress. Using anthropometric data on 46,784 children aged 0–35 months in seven developing countries, we show how the weight for age (underweight) indicator is problematic but not for the reasons conventionally cited. We show that the information it provides about the degree and direction of change in undernutrition over time sometimes contradicts that provided by other conventional indicators. We demonstrate the potential of an alternative indicator, the composite index of anthropometric failure (CIAF), which can be used to show the overall extent of undernutrition among children, and which provides an unequivocal statement on the direction and degree of change in undernutrition over time. Given the fundamental importance of undernutrition to child survival and health, the issues raised will be of interest to and have implications for policy makers and planners alike.

Assessment of 24 years of infant growth monitoring in a rural area of Senegal (1969-1992)

Undernutrition in young children in developing countries is associated with an increased risk of death. But in several studies, a decrease in mortality was not associated with any decrease in the prevalence of undernutrition. A rural population of Casamance (Senegal) has been under yearly demographic surveillance by The French National Institute of Demographic Studies (INED) since 1985. Between 1960-1964 and 1990-1994, under-5 and child (1-4 years) mortality rates dropped from 312 to 127 and from 201 to 68 per 1,000, respectively. Since 1961, French Catholic nuns who are also professional nurses have been in charge of a private village dispensary located in a rural area of Casamance. This dispensary delivers permanent, high quality service and is widely attended. GROWTH MONITORING PROGRAMME: A growth-monitoring programme, supported by Cathwell, was initiated in 1969 for 0-5-year-old children (0-3 from 1985). Children were weighed wearing light clothes to the nearest 10g. Weights were recorded in a register that also contained information concerning identity (name, sex, date of birth) and address. All weights were plotted on growth charts kept by the mothers. During the sessions, the nurses provided nutrition education messages (i.e., preparation of high-energy and nutrient-dense infant gruels using local foods), advice on illness management (oral rehydration during diarrhoea) and hygiene (well and water-jar disinfection, construction of pit-latrines), importance of vaccination. From 1975, they also distributed free chloroquine during the malaria transmission season (May-November) for prevention and early presumptive treatment. Most likely thanks to this programme, infant and child mortality reached a low level at the end of the 1980s. In 1990, plasmodium resistance to chloroquine appeared, increasing malaria mortality. All weight measurements taken in 1969-1994 were entered into a database. This paper presents an analysis of weight measurements taken at 3-23 months of age from 1969-1992. A total of 4,636 infants were weighed at least once, but only 3,912 infants (1,983 boys and 1,929 girls) were available for the analysis, 724 being excluded due to missing data. The average coverage of the programme during the month of February was 88% for infants aged 3-23 months. Mean weight was examined at three target ages: 5, 11 and 15 months. Not only did the nutritional status not improve between 1969 and 1989, it even deteriorated in some years for all three age-cohorts. The nutritional status of infants in this community did not differ significantly from that of 12-23 month-old Senegalese children in the 1992-1993 Demographic and Health Survey (DHS). Seasonal differences in mean weight and the prevalence of underweight became significant in the rainy season since 1975. Underweight for the 15-month-old children increased over time during the rainy season. These findings were unexpected, since malaria morbidity is thought to be at least partially responsible for seasonal variations in the nutritional status of young children, and despite the fact that the nurses began a malaria control programme in 1975. The rapid transition towards lower childhood mortality observed in this rural area of Casamance (Senegal), was not concomitant with any improvement in infants' nutritional status from 1969 through 1992. Focused public health interventions such as vaccinations and malaria prevention probably did not improve the nutritional status. Paradoxically, growth monitoring may have been more helpful in improving health than growth. Targeted specific nutritional interventions are needed to significantly improve growth of children in this community.

Is obesity replacing or adding to undernutrition? Evidence from different social classes in Brazil.

To describe time trends in under- and overnutrition in different regional and income strata of the child and adult population of Brazil. Nation-wide surveys conducted in 1975, 1989 and 1996/7 in probabilistic samples of 1-4-year-old children and adults 20 years and over. Time trends refer to stunting, wasting and overweight prevalences among children and age-adjusted underweight and obesity prevalences among adults (95% confidence intervals included). Individuals examined by each survey in each age group ranged from 1796 young children in 1996 to 78031 adults in 1975. North-eastern and south-eastern regions of Brazil. Undernutrition indicators declined intensively and continuously among children and adults in all region and income strata. Obesity remained low and relatively stable among children, but increased intensively and continuously in all regions and income strata among adult males. Obesity also increased intensively and continuously among adult women from the less economically developed region of Brazil (the north-eastern region) and among lower-income women from the more developed region (the south-eastern region). Higher-income women from the more developed region had a significant increase in obesity from 1975 to 1989, followed by a significant decline from 1989 to 1997. Undernutrition in young children is being controlled in Brazil without evidence of increasing obesity. However, obesity is rapidly replacing undernutrition in most gender, region and income strata of the adult population. Adult obesity is already more frequent than adult undernutrition in the more economically developed region, among all higher-income groups, and also among lower-income women living in the more developed region. These lower-income women are significantly more exposed than their higher-income counterparts to both undernutrition and obesity.

Activity and Behavioral Development in Stunted and Nonstunted Children and Response to Nutritional Supplementation

It is frequently assumed that undernutrition in young children leads to poor development through reduced activity. 3 groups of 26 1-year-old stunted children were studied: nutritional supplementation, supplementation with psychosocial stimulation, and controls. 26 nonstunted comparison children were also studied. Activity levels were measured by extensive observation in the homes, and development using 4 subscales of the Griffith's Mental Development Scales. Initially, stunted children were less active than nonstunted ones (p < .01), but after 6 months they caught up regardless of treatment. The mental ages of the stunted children were lower than those of the nonstunted children initially, and improved with either treatment. Initially, activity levels made a significant contribution to the variance in the locomotor subscale only, but not 6 months later. Activity did not predict change in development over 6 or 12 months, nor did change in activity over 6 months predict change in development over 12 months.

The effect of nutritional supplementation and stunting on morbidity in young children: the Jamaican study

Infection and undernutrition in young children are thought to act synergistically. However, studies of the relationship between low height-for age (stunting) and morbidity in young children have had inconsistent findings and there are few adequate data on the effects of nutritional supplementation on morbidity. 129 stunted and 21 non-stunted children aged between 9 and 24 months, from poor Kingston neighbourhoods, identified from a house-to-house survey, were studied. The stunted children were randomly assigned to supplementation or no supplementation. Every week for 24 months the mothers were asked about the occurrence of any symptoms of illness. Supplementation had no consistent effect on the incidence or duration of symptoms. The stunted children had significantly more attacks of diarrhoea, fever, anorexia and apathy than the non-stunted children. The differences remained after controlling for social background and previous attacks of diarrhoea. There was also some indication of more severe illness in the stunted than in the non-stunted children.