Risk factors associated with malnutrition in one-year-old children living in the Peruvian Amazon
Serene A Joseph1, Martín Casapía2, Brittany Blouin1
1McGill University, Department of Epidemiology and Biostatistics, Montréal, Québec, Canada; Research Institute of the McGill University Health Centre, Division of Clinical Epidemiology, Montréal, Québec, Canada.
Insights
Soil-transmitted helminth (STH) infections are linked to malnutrition and lower development in young children. Integrated interventions are crucial to reduce disease and malnutrition burdens in this vulnerable population.
Area of Science:
- Pediatric Health
- Infectious Diseases
- Developmental Pediatrics
Background:
- Children under two are in a critical growth and development window.
- This age group faces increased risk of soil-transmitted helminth (STH) infections in tropical/subtropical areas.
- The link between malnutrition and STH infection in infants is understudied.
Purpose of the Study:
- To investigate the association between malnutrition (stunting, underweight) and STH infection in infants.
- To identify child, maternal, and household risk factors for malnutrition and STH infection.
- To analyze the relationship between STH infection, malnutrition, and developmental outcomes.
Main Methods:
- A nested cross-sectional survey was conducted in 12-13 month old children in Iquitos, Peru.
- Data collected included socio-demographics, anthropometry (length, weight), and developmental assessments (Bayley Scales).
- Stool specimens were analyzed for STH presence using the Kato-Katz method; multivariable Poisson regression was used for analysis.
Main Results:
- Prevalence of stunting was 24.2% and underweight was 8.6% at baseline.
- Any STH infection prevalence was 14.5% in analyzed specimens.
- STH infection (aRR=1.37) and lower development scores (aRR=0.97) were risk factors for stunting; lower development scores (aRR=0.92) were a risk factor for underweight.
Conclusions:
- High prevalence of malnutrition, especially stunting, is associated with STH infection and poorer development in young children.
- Findings highlight the vulnerability of this age group to combined disease and malnutrition burdens.
- Integrated, cost-effective interventions are needed to address these intertwined health issues.
Background:
Children under two years of age are in the most critical window for growth and development. As mobility increases, this time period also coincides with first exposure to soil-transmitted helminth (STH) infections in tropical and sub-tropical environments. The association between malnutrition and STH infection, however, has been understudied in this vulnerable age group.
Methodology/Principal Findings:
A nested cross-sectional survey was conducted in 12 and 13-month old children participating in a deworming trial in Iquitos, an STH-endemic area of the Peruvian Amazon. An extensive socio-demo-epi questionnaire was administered to the child's parent. Length and weight were measured, and the Bayley Scales of Infant and Toddler Development were administered to measure cognition, language, and fine motor development. Stool specimens were collected to determine the presence of STH. The association between malnutrition (i.e. stunting and underweight) and STH infection, and other child, maternal, and household characteristics, was analyzed using multivariable Poisson regression. A total of 1760 children were recruited between September 2011 and June 2012. Baseline data showed a prevalence of stunting and underweight of 24.2% and 8.6%, respectively. In a subgroup of 880 randomly-allocated children whose specimens were analyzed by the Kato-Katz method, the prevalence of any STH infection was 14.5%. Risk factors for stunting in these 880 children included infection with at least one STH species (aRR = 1.37; 95% CI 1.01, 1.86) and a lower development score (aRR = 0.97; 95% CI: 0.95, 0.99). A lower development score was also a significant risk factor for underweight (aRR = 0.92; 95% CI: 0.89, 0.95).
Conclusions:
The high prevalence of malnutrition, particularly stunting, and its association with STH infection and lower developmental attainment in early preschool-age children is of concern. Emphasis should be placed on determining the most cost-effective, integrated interventions to reduce disease and malnutrition burdens in this vulnerable age group.
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