• 1.

    World Health Organization , 2020. UNICEF/WHO/The World Bank Group Joint Child Malnutrition Estimates: Levels and Trends in Child Malnutrition: Key Findings of the 2020 Edition. Geneva, Switzerland: WHO.

    • Search Google Scholar
    • Export Citation
  • 2.

    Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM, 2002. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet 359: 564571.

    • Search Google Scholar
    • Export Citation
  • 3.

    Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM, 2007. Early childhood stunting is associated with poor psychological functioning in late adolescence and effects are reduced by psychosocial stimulation. J Nutr 137: 24642469.

    • Search Google Scholar
    • Export Citation
  • 4.

    Tarleton JL, Haque R, Mondal D, Shu J, Farr BM, Petri WA Jr, 2006. Cognitive effects of diarrhea, malnutrition, and Entamoeba histolytica infection on school age children in Dhaka, Bangladesh. Am J Trop Med Hyg 74: 475481.

    • Search Google Scholar
    • Export Citation
  • 5.

    Checkley W et al., 1997. Asymptomatic and symptomatic cryptosporidiosis: their acute effect on weight gain in Peruvian children. Am J Epidemiol 145: 156163.

    • Search Google Scholar
    • Export Citation
  • 6.

    Lee G et al., 2013. Symptomatic and asymptomatic Campylobacter infections associated with reduced growth in peruvian children. PLoS Negl Trop Dis 7: e2036.

    • Search Google Scholar
    • Export Citation
  • 7.

    Lee G et al., 2014. Effects of Shigella-, Campylobacter- and ETEC-associated diarrhea on childhood growth. Pediatr Infect Dis J 33: 10041009.

  • 8.

    George CM et al., 2018. Enteric infections in young children are associated with environmental enteropathy and impaired growth. Trop Med Int Health 23: 2633.

    • Search Google Scholar
    • Export Citation
  • 9.

    Guerrant RL, Oriá RB, Moore SR, Oriá MO, Lima AA, 2008. Malnutrition as an enteric infectious disease with long-term effects on child development. Nutr Rev 66: 487505.

    • Search Google Scholar
    • Export Citation
  • 10.

    GBD-Collaborators , 2017. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 17: 909948.

    • Search Google Scholar
    • Export Citation
  • 11.

    MacIntyre J, McTaggart J, Guerrant RL, Goldfarb DM, 2014. Early childhood diarrhoeal diseases and cognition: are we missing the rest of the iceberg? Paediatr Int Child Health 34: 295307.

    • Search Google Scholar
    • Export Citation
  • 12.

    Prado EL, Dewey KG, 2014. Nutrition and brain development in early life. Nutr Rev 72: 267284.

  • 13.

    Ajjampur SS et al., 2011. Effect of cryptosporidial and giardial diarrhoea on social maturity, intelligence and physical growth in children in a semi-urban slum in south India. Ann Trop Paediatr 31: 205212.

    • Search Google Scholar
    • Export Citation
  • 14.

    Guerrant DI, Moore SR, Lima AA, Patrick PD, Schorling JB, Guerrant RL, 1999. Association of early childhood diarrhea and cryptosporidiosis with impaired physical fitness and cognitive function four-seven years later in a poor urban community in northeast Brazil. Am J Trop Med Hyg 61: 707713.

    • Search Google Scholar
    • Export Citation
  • 15.

    Pinkerton R et al., 2016. Early childhood diarrhea predicts cognitive delays in later childhood independently of malnutrition. Am J Trop Med Hyg 95: 10041010.

    • Search Google Scholar
    • Export Citation
  • 16.

    de Onis M, Onyango AW, 2008. WHO child growth standards. Lancet 371: 204.

  • 17.

    Fernald LC, Kariger P, Hidrobo M, Gertler PJ, 2012. Socioeconomic gradients in child development in very young children: evidence from India, Indonesia, Peru, and Senegal. Proc Natl Acad Sci USA 109 (Suppl 2): 1727317280.

    • Search Google Scholar
    • Export Citation
  • 18.

    Tofail F et al., 2018. Effect of water quality, sanitation, hand washing, and nutritional interventions on child development in rural Bangladesh (WASH Benefits Bangladesh): a cluster-randomised controlled trial. Lancet Child Adolesc Health 2: 255268.

    • Search Google Scholar
    • Export Citation
  • 19.

    Fernald LC, Kariger P, Engle P, Raikes A, 2009. Examining Early Child Development in Low-Income Countries: A Toolkit for the Assessment of Children in the First Five Years of Life. Washington, DC: World Bank.

    • Search Google Scholar
    • Export Citation
  • 20.

    Fischer Walker CL et al., 2012. Does childhood diarrhea influence cognition beyond the diarrhea-stunting pathway? PLoS One 7: e47908.

  • 21.

    Sigman M, McDonald MA, Neumann C, Bwibo N, 1991. Prediction of cognitive competence in Kenyan children from toddler nutrition, family characteristics and abilities. J Child Psychol Psychiatry 32: 307320.

    • Search Google Scholar
    • Export Citation
  • 22.

    Galler JR, Ramsey F, Solimano G, Lowell WE, 1983. The influence of early malnutrition on subsequent behavioral development. II. Classroom behavior. J Am Acad Child Psychiatry 22: 1622.

    • Search Google Scholar
    • Export Citation
  • 23.

    De Onis M, Onyango AW, Borghi E, Garza C, Yang H, Group WMGRS, 2006. Comparison of the World Health Organization (WHO) child growth standards and the national center for health statistics/WHO international growth reference: implications for child health programmes. Public Health Nutr 9: 942947.

    • Search Google Scholar
    • Export Citation
  • 24.

    de Onis M, Blössner M, World Health Organization, 1997. WHO Global Database on Child Growth and Malnutrition. Geneva, Switzerland: WHO.

 
 

 

 

 

 

 

 

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

View More View Less
  • 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
  • | 2 Food for the Hungry, Food for the Hungry, Bukavu, Democratic Republic of the Congo;
  • | 3 International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka 1000, Dhaka District, Bangladesh

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.

Save