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Diarrhoea and growth faltering in rural Zimbabwe
R J Moy1, T F de C Marshall, R G Choto
1Institute of Child Health, University of Birmingham, UK.
Objective:
To assess the evidence that diarrhoea is an important cause of growth faltering in young children in developing countries.
Design:
Prospective, longitudinal cohort study.
Setting:
Worker's compounds on commercial farms in Shamva, rural Zimbabwe.
Subjects:
204 children < 12 months old were enrolled, 73 from birth. The median age at enrolment was 4 months. Eleven children died and 39 were lost to follow-up.
Interventions:
Prospective weekly diarrhoea surveillance by farm health workers and monthly anthropometry.
Results:
Growth faltering was severe, but there was little difference in average rates of growth between children with frequent diarrhoea and infrequent diarrhoea. The results of an interval-based data analysis were consistent with there being only a transient effect of diarrhoea on weight gain. Estimation of weight faltering following episodes of diarrhoea and the rate of return to the trend in the 9-14 month age range, indicated that weight loss associated with each episode was small (approximately 2%) and return to the child's trend was 90% complete within a month. At older ages than this, weight loss appeared to be less, and estimates were not statistically significant.
Conclusions:
These observations lend weight to the hypothesis that recurrent episodes of diarrhoea are not a potent cause of growth faltering in early childhood except in a small minority of largely catastrophic cases. Inadequate food intake is a more plausible explanation.