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Early linear growth retardation: results of a prospective study of Zambian infants

Roma Chilengi¹, Mah Asombang¹, Jillian L Kadota¹

¹Research Division, Centre for Infectious Disease Research in Zambia, Plot # 34620, Off Alick Nkhata Road, PO Box 34681, Lusaka, Zambia.

BMC Public Health

|January 16, 2019

Insights

Linear growth retardation is a global issue. This study found that Zambian infants exhibit slower growth rates, indicating potential in-utero growth faltering and universal growth retardation.

Area of Science:

Pediatrics
Global Health
Nutritional Science

Background:

Linear growth retardation is a significant global nutritional challenge.
Infant growth trajectories are crucial indicators of overall health and development.
Understanding growth patterns in vulnerable populations is essential for public health interventions.

Purpose of the Study:

To describe the linear growth trajectory of infants under two years of age in Lusaka, Zambia.
To compare infant growth velocity against the World Health Organization (WHO) growth velocity standards.
To identify potential factors contributing to growth faltering in the study cohort.

Main Methods:

A prospective cohort study involving 338 infants enrolled at 6-12 weeks of age and followed for up to 24 months.
Anthropometric data, including height, were collected at regular intervals.
Linear growth velocity was estimated using penalized cubic spline mixed-effects models.

Main Results:

Infant growth velocities in the cohort were consistently below the 3rd percentile of WHO standards.
The age at which growth began to falter was estimated at 13.6 months.
Slower growth rates were observed in both male and female infants, suggesting a universal issue.

Conclusions:

The study indicates a profound and universal rate of growth retardation among Zambian infants.
Growth faltering may commence before birth, potentially during the in-utero period.
These findings highlight the need for targeted nutritional and health interventions in early life.

Read full analysis

Abstract

Background:

Linear growth retardation is the most dominant nutritional problem globally. We aimed to describe linear growth trajectory among infants under 2 years of age using the WHO growth velocity standards.

Method:

This was a prospective cohort study of infants enrolled at 6 weeks of age and followed up for up to 24 months in Kamwala Urban Health Centre, Lusaka, Zambia. The study was conducted between April 2013 and March 2015. Infants were enrolled if they were 6-12 weeks of age and the mother was willing to participate voluntarily and provided informed consent. Anthropometric data were collected at scheduled clinic visits at 1 month, 2 months, 3 months, then quarterly until the infant was 24 months old. We defined linear growth velocity as the rate of change in height. We estimated linear growth velocity as the first derivative of the penalized cubic spline mixed effects model.

Results:

A total of 338 children were included in the analysis. Of these, 185 (54.7%) were female, 115 (34.1%) were born to HIV positive mothers and thus classified as HIV Exposed (HE). The mean age of children at enrollment was 1.6 months (SD = 0.15). On average, the growth velocity for 3-month length increments conditional on age were 0-3 months = 2.97 cm/3mo (95%CI = 2.69, 3.25); 3-6 months = 2.62 cm/3mo (95%CI = 2.38, 2.87); 6-9 months = 1.57 cm/3mo (95%CI = 1.43, 1.71); 9-12 months = 1.18 cm/3mo (95%CI = 1.08, 1.28); 12-15 month = 1.14 cm/3mo (95%CI = 1.02, 1.27); 15-18 months = 0.87 cm/3mo (95%CI = 0.79, 0.96); 18-21 months = 0.80 cm/3mo (95%CI = 0.72, 0.89); and 21-24 months = 0.86 cm/3mo (95%CI = 0.77, 0.96). For both boys and girls, the growth velocity in our cohort were consistently below the 3rd percentile of the WHO linear growth velocity standard. The estimated mean height and the age at which growth begins to falter were 68.6 cm (95%CI = 68.0, 69.2) and 13.6 months (95%CI = 13.2, 14.1) respectively.

Conclusion:

We found slower rate of growth among otherwise healthy Zambian infants. The data suggests that growth retardation is universal and profound in this cohort and may have already been occurring in utero.

Keywords:

Children Growth retardation Growth trajectory Growth velocity Linear growth Prospective study

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