Title: Risk factors for adverse outcomes in developing countries [letter]

POPLINE Document Number: 314476

Author(s):

Moore SR
Lorntz B
Lima AA
Guerrant RL

Source citation:

Lancet, 2007 Mar 10;369(9564):824-825.

Abstract:

In their child development series article, Susan Walker and colleagues cite two of our recent pub lications: "Two small Brazilian studies suggest an association between incidence of diarrhoea in the first 2 years of life and impaired cognitive performance in later childhood. However, a larger cohort study in Peru with control for confounders saw no independent association..." Our Brazilian birth cohort studies examined several confounders including education, income, helminthiases, and anaemia. After controlling for these, early childhood diarrhoea and nutritional status still predicted cognitive function, but not independently of each other. Early childhood diarrhoea was a good, if not better, predictor of cognitive function than nutritional status. Much research on child development in developing countries addresses undernutrition, but fails to capture the effect that repeated dehydrating, malnourishing episodes of diarrhoea in the first years of life can have on cognitive potential--an effect that can persist despite catchup growth. Indeed, our follow-up studies show that early childhood diarrhoea and height-for-age Z scores at age 2 years predict impaired school performance. The message is that diarrhoea impairs nutritional status, and that both signal adverse risks for child development. Both warrant effective interventions, be they nutrition, sanitation, or treatment. We wholeheartedly agree with Walker and colleagues that intervention studies are needed to clarify these associations. Such studies are under way with trials of vitamin A, zinc, and glutamine among high-risk children in Brazil. Further work on the prevention and treatment of repeated enteric infections and nutritional shortfalls is badly needed. (full text)

Keywords:

Brazil
Children
Nutrition
Health Services
Child Development
Diarrhea
Anemia
Treatment
Socioeconomic Status
Sanitation
Developing Countries
South America, Eastern
South America
Latin America
Americas
Youth
Age Factors
Population Characteristics
Demographic Factors
Population
Health
Delivery of Health Care
Biology
Diseases
Medical Procedures
Medicine
Socioeconomic Factors
Economic Factors
Public Health