Linear Growth Faltering Is Associated with Subsequent Adverse Child Cognitive Developmental Outcomes in the Democratic Republic of the Congo (REDUCE Program)

Christine Marie George Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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Jamie Perin Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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Jennifer Kuhl Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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Camille Williams Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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Nicole Coglianese Food for the Hungry, Food for the Hungry, Bukavu, Democratic Republic of the Congo;

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Elizabeth D. Thomas Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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Sarah Bauler Food for the Hungry, Food for the Hungry, Bukavu, Democratic Republic of the Congo;

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Ruthly François Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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Angela Ng Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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Yunhee Kang Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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Amani Sanvura Presence Food for the Hungry, Food for the Hungry, Bukavu, Democratic Republic of the Congo;

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Bisimwa Rusanga Jean Claude Food for the Hungry, Food for the Hungry, Bukavu, Democratic Republic of the Congo;

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Fahmida Tofail International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka 1000, Dhaka District, Bangladesh

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Patrick Mirindi Food for the Hungry, Food for the Hungry, Bukavu, Democratic Republic of the Congo;

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Lucien Bisimwa Cirhuza Food for the Hungry, Food for the Hungry, Bukavu, Democratic Republic of the Congo;

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ABSTRACT.

Globally, 140 million children under 5 years of age are estimated to be stunted. Previous studies have found an association between stunting and poor cognitive outcomes. However, there is limited evidence of this association in sub-Saharan African settings, such as the Democratic Republic of the Congo (DRC). This prospective cohort study of 286 children under 5 years was conducted in rural DRC to investigate the association between diarrhea prevalence, child growth, and child cognitive developmental outcomes. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem-solving, and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 6-month follow-up visit. Height and weight were measured at baseline and a 6-month follow-up. Diarrhea prevalence was assessed through surveillance visits. Diarrhea prevalence was not associated with follow-up combined EASQ Z-scores at the 6-month follow-up (coefficient: −0.06 [95% CI: −0.29, 0.17]). Each additional standard deviation (SD) increase in height-for-age Z-scores from baseline to the 6-month follow-up increased combined EASQ Z-scores by 0.22 (95%: 0.14, −0.31) SDs. Each additional SD increase in weight-for-age Z-scores from baseline to the 6-month follow-up increased combined EASQ Z-scores by 0.21 (95%: 0.10, −0.32) SDs. Linear growth faltering and reduced weight gain were associated with reduced cognitive developmental outcomes among children residing in rural DRC. Interventions are urgently needed for this susceptible pediatric population to improve child growth and cognitive developmental outcomes.

Author Notes

Address correspondence to Christine Marie George, Associate Professor, Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205-2103. E-mail: cmgeorge@jhu.edu

Authors’ addresses: Christine Marie George, Jamie Perin, Jennifer Kuhl, Camille Williams, Elizabeth D. Thomas, Ruthly Francois, Angela Ng, and Yunhee Kang, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: cmgeorge@jhu.edu, jperin@jhu.edu, jennifer.m.kuhl@gmail, cwill302@jhmi.edu, liz.thomas@jhu.edu, ruthlyfrancois@gmail.com, angelang1201@gmail.com, presencesanvura@gmail.com, jcbisrus@gmail.com, and ykang12@jhu.edu. Nicole Coglianese, Sarah Bauler, Amani Sanvura Presence, Bisimwa Rusanga Jean Claude, Patrick Mirindi, and Lucien Bisimwa Cirhuza, Food for the Hungry, Phoenix, AZ, E-mails: nicole.coglianese@gmail.com, sarahbauler@gmail.com, presencesanvura@gmail.com, jcbisrus@gmail.com, patrick.mirindi@gmail.com, and lucienbis86@gmail.com. Fahmida Tofail, International Centre for Diarrhoeal Disease Research, Bangladesh, Child Development unit, Dhaka 1000, Bangladesh, E-mail: ftofail@icddrb.org.

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