Long-term effects of severe acute malnutrition during childhood on adult cognitive, academic and behavioural development in African fragile countries: The Lwiro cohort study in Democratic Republic of the Congo

Abstract

Introduction Little is known about the outcomes of subjects with a history of severe acute malnutrition (SAM). We therefore sought to explore the long-term effects of SAM during childhood on human capital in adulthood in terms of education, cognition, self-esteem and health-related disabilities in daily living. Methodology We traced 524 adults (median age of 22) in the eastern Democratic Republic of the Congo, who were treated for SAM during childhood at Lwiro hospital between 1988 and 2007 (median age 41 months). We compared them with 407 community controls of comparable age and sex. Our outcomes of interest were education, cognitive function [assessed using the Mini Mental State Examination (MMSE) for literate participants, or its modified version created by Ertan et al. (MMSE-I) for uneducated participants], self-esteem (measured using the Rosenberg Self-Esteem Scale) and health-related social and functional disabilities measured using the World Health Organization Disability Assessment Schedule (WHODAS). For comparison, we used the Chi-squared test along with the Student’s t-test for the proportions and means respectively. Results Compared with the community controls, malnutrition survivors had a lower probability of attaining a high level of education (p < 0.001), of reporting a high academic performance (p = 0.014) or of having high self-esteem (p = 0.003). In addition, malnutrition survivors had an overall mean score in the cognitive test that was lower compared with the community controls [25.6 compared with 27.8, p = 0.001 (MMSE) and 22.8 compared with 26.3, p < 0.001(MMSE-I)] and a lower proportion of subjects with a normal result in this test (78.0% compared with 90.1%, p < 0.001). Lastly, in terms of health-related disabilities, unlike the community controls, malnutrition survivors had less social disability (p = 0.034), but no difference was observed as regards activities of daily living (p = 0.322). Conclusion SAM during childhood exposes survivors to low human capital as regards education, cognition and behaviour in adulthood. Policy-deciders seeking to promote economic growth and to address various psychological and medico-social disorders must take into consideration the fact that appropriate investment in child health as regards SAM is an essential means to achieve this.

Food Systems Transformation for Child Health and Well-Being: The Essential Role of Dairy

“…These issues manifest in various ways, such as impairments to visual processing, attention, memory, motor skills, and overall intelligence. While many of these early impairments can have lifelong effects [ 36 ], many others can be minimized or reversed with early life dietary improvements [ 2 ]. Taken together, these factors highlight the massive impacts that early childhood nutrition can have on physical and mental health and show that a global shift towards healthier diets could greatly reduce our population’s current and future disease burden.…”

Human Milk output among mothers previously treated for severe acute malnutrition in childhood in Democratic Republic of Congo

“…Also subjects exposed to SAM during childhood had an overall higher risk of developing metabolic syndrome, carbohydrate metabolism disorder and a higher prevalence of diabetes and hypertension [ 10 , 11 ]. SAM survivors also had a low socioeconomic level and reduced cognitive abilities compared to subjects not exposed to SAM [ 12 ] .…”

Demographic and Social-Economic Determinants of Malnutrition among Children (0-23 Months Old) in Kenya

“…For example, stunting in early childhood is associated with poor physical and mental development, increased susceptibility to infections, increased morbidity and mortality, and increased risk of overweight and obesity in adulthood [1]. Similarly, severe acute malnutrition (SAM) during childhood has shown long-term negative effects on cognitive function resulting in children being less competitive academically as well as having lower self-esteem [2]. In particular, malnutrition during the first 1000 days of life -the period from conception to 2 years -is very critical as this period is considered the most important for neurological development [3].…”