Progression of stunting and its predictors among school-aged children in western Kenya

Abstract

Objectives: The objectives of this study were (1) to assess whether a cohort of school-aged children experiences progression of stunting over a 2-y-period of observation and (2) to identify baseline nutritional and body composition risk factors for the progression of stunting. Methods: As part of a large-scale, randomized controlled trial assessing the impact of insecticide-treated bednets (ITNs) on nutritional status, we longitudinally followed a cohort of school-aged children over a 2-y-period in western Kenya. Anthropometric measurements were made at four time points from which Z-scores for height-for-age (HAZ), weight-for-age (WAZ), and body mass index (BMIZ) were calculated. Two measures of body composition, upper arm fat area and upper arm muscle area, were derived from mid-upper arm circumference (MUAC) and triceps skinfold thickness. Results: Subjects experienced a mean change in HAZ from baseline to 9 months of À0.16 [À0.19, À0.13], from baseline to 16 months of À0.18 [À0.22, À0.15], and from baseline to 24 months of À0.36 [À0.41, À0.31]. Thus, the average individual's change in HAZ at the three follow-up time points is significantly less than zero, meaning that, on average, the cohort is deviating further from NCHS reference medians over time. The baseline nutritional measure that explained the greatest amount of variance in the progression of stunting was the upper arm muscle area Z-score (F ¼ 8.1; P ¼ 0.005). Conclusions: This longitudinal study provides further evidence from a distinct ecological setting regarding the progression of undernutrition during middle childhood in the developing world. It suggests that school-aged children in the developing world do not experience catch-up growth or remain stable. Rather, they continue to deviate from NCHS standards, accruing greater height deficits with age. In addition, absolute lean body mass explained the most variability in the progression of stunting, which supports cross-sectional findings from other studies.

Stunting among primary-school children: a sample from Baghdad, Iraq

“…Thus, children who have become stunted are likely to remain stunted into adulthood [6,18]. Results from our work demonstrate the progression of height deficit in accordance with the increasing age of the children, with prevalence across age groups fluctuating from 7.7% to 22.4% below -2 z-scores.…”

“…In girls, the prevalence of stunting peaked at age 11 years, whereas in boys it rose steadily up to age 12 years. A similar age pattern was reported in studies demonstrating an increasing prevalence of stunting with age [6,11,13,16,18,20,23,24].…”

“…However, school enrolment and dropout patterns may differ in stunted and non-stunted children, creating a spurious picture of stunting by age among children who attend school. Studies in Sub-Saharan Africa suggest that the prevalence of undernutrition may be greater in children not enrolled in school; therefore, the proportions found in this school-based sample are likely to under-٢٠٠9 ،٢ ‫العدد‬ ‫عرش،‬ ‫اخلامس‬ ‫املجلد‬ ‫العاملية،‬ ‫الصحة‬ ‫منظمة‬ ‫املتوسط،‬ ‫لرشق‬ ‫الصحية‬ ‫املجلة‬ estimate the degree of undernutrition in this age group [6]. On the other hand, there remains controversy over whether reference data from the United States of America are appropriate for children in other countries, who may have a different genetic potential for growth [13,18,19], and when we include the differences in the maturation rate of poorly nourished children compared with reference healthy populations, it is clear that the interpretation of growth data in this age range is problematic [20].…”

“…However, data on the growth of school-age children, generated in a consistent manner across countries and over time, is difficult to find [3][4][5][6].…”

Nutritional Status of Adolescent Girls from Rural Communities of Tigray, Northern Ethiopia

“…Limited studies conducted across a range of ecologic settings in the developing world demonstrate that children enter middle childhood having already accumulated significant deficits in nutritional status (6,7,8). However, adolescents have been considered a low risk group for poor health and nutrition and often receive scant attention.…”