Growth faltering in rural Gambian children after four decades of interventions: a retrospective cohort study

Abstract

SummaryBackgroundGrowth faltering remains common in children in sub-Saharan Africa and is associated with substantial morbidity and mortality. Due to a very slow decline in the prevalence of stunting, the total number of children with stunting continues to rise in sub-Saharan Africa. Identification of effective interventions remains a challenge.MethodsWe analysed the effect of 36 years of intensive health interventions on growth in infants and young children from three rural Gambian villages. Routine growth data from birth to age 2 years were available for 3659 children between 1976 and 2012. Z scores for weight-for-age, length-for-age, weight-for-length, mid-upper-arm circumference, and head circumference were calculated using the WHO 2006 growth standards. Seasonal patterns of mean Z scores were obtained by Fourier regression. We additionally defined growth faltering as fall in Z score between 3 months and 21 months of age.FindingsWe noted secular improvements in all postnatal growth parameters (except weight-for-length), accompanied by declines over time in seasonal variability. The proportion of children with underweight or stunting at 2 years of age halved during four decades of the study period, from 38·7% (95% CI 33·5–44·0) for underweight and 57·1% (51·9–62·4) for stunting. However, despite unprecedented levels of intervention, postnatal growth faltering persisted, leading to poor nutritional status at 24 months (length-for-age Z score −1·36, 95% CI −1·44 to −1·27, weight-for-age Z score −1·20, −1·28 to −1·11, and head circumference Z score −0·51, −0·59 to −0·43). The prevalence of stunting and underweight remained unacceptably high (30·0%, 95% CI 27·0–33·0, for stunting and 22·1%, 19·4 to 24·8, for underweight).InterpretationA combination of nutrition-sensitive and nutrition-specific interventions has achieved a halving of undernutrition rates, but despite these intensive interventions substantial growth faltering remains. We need to understand the missing contributors to growth faltering to guide development of new interventions.FundingUK Medical Research Council, UK Department for International Development.

Adaptation of the Mullen Scales of Early Learning for use among infants aged 5‐ to 24‐months in rural Gambia

“…Rates of exclusive breastfeeding are high, and infants are predominantly breastfed until the age of 24‐months (Eriksen et al., ). Weaning foods are commonly nutritionally insufficient, leading to widespread growth faltering (Nabwera, Fulford, Moore, & Prentice, ).…”

“…The MRC provides a wide range of nutrition‐specific interventions, antenatal and child care. These have led to a significant decrease in infant mortality, but undernutrition remains highly prevalent (Nabwera et al., ). While English is the official language in The Gambia, almost 80% of the population in the West Kiang region have Mandinka as their primary language (Hennig et al., ).…”

“…Weaning foods are commonly nutritionally insufficient, leading to widespread growth faltering (Nabwera, Fulford, Moore, & Prentice, 2017).…”

“…The MRC provides a wide range of nutrition-specific interventions, antenatal and child care. These have led to a significant decrease in infant mortality, but undernutrition remains highly prevalent (Nabwera et al, 2017).…”

Habituation and novelty detection fNIRS brain responses in 5‐ and 8‐month‐old infants: The Gambia and UK

“…The longitudinal design includes nine data collection phases; antenatal (32–36 weeks gestation), and postnatal—1–3, 7–14 days, 1, 5, 8, 12, 18 and 24 months of age. In the full‐scale BRIGHT study, the cohort size in The Gambia was selected—to provide adequate power to support within‐cohort comparisons—on the assumption that approximately 25%–30% of the cohort will be stunted (z‐score of length‐for‐age <2 standard deviations below the WHO reference) by 2 years of age (Nabwera et al, ). While a second cohort within The Gambia (i.e.…”