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Early child health in Lahore, Pakistan: XI. Growth
J Karlberg1, R N Ashraf, M Saleemi
1Department of Paediatrics, Queen Mary Hospital, University of Hong Kong.
Insights
This study provides infant growth references for Pakistan, revealing significant stunting in poorer areas. Socio-economic factors, not seasonality, heavily influence child growth and development.
Area of Science:
- Pediatric Nutrition
- Growth Monitoring
- Public Health in Developing Countries
Background:
- Establishing accurate infant growth references is crucial for monitoring child health.
- Socio-economic disparities significantly impact child development, particularly in low- and middle-income countries.
- Understanding growth patterns in diverse populations is essential for targeted interventions.
Purpose of the Study:
- To establish growth reference values for infants aged 0-24 months in Pakistan.
- To assess growth rates and identify factors affecting growth, including socio-economic status and seasonality.
- To compare growth patterns between an upper-middle-class reference group and infants from poorer areas.
Main Methods:
- Development of growth reference values based on an upper-middle-class infant cohort in Pakistan.
- Analysis of growth rates over various intervals.
- Assessment of stunting incidence and anthropometric measurements (length, weight) in different socio-economic settings.
- Evaluation of age- and season-dependent growth variations.
Main Results:
- Significant differences in stunting incidence were observed across socio-economic groups, with higher rates in peri-urban and village settings compared to urban slums.
- Reduced linear growth was most pronounced between 6 and 18 months of age.
- Weight gain was reduced in the first 12 months, followed by a catch-up period.
- Seasonal variations, particularly heat during summer, affected weight but not length in infants from poorer areas; the reference group showed no seasonality.
- Socio-economic factors were identified as the primary drivers of reduced growth.
Conclusions:
- Infant growth in Pakistan is significantly influenced by socio-economic disparities, leading to high rates of stunting in vulnerable populations.
- Growth patterns exhibit age- and season-dependent characteristics, with critical periods for intervention identified.
- The findings underscore the need for context-specific growth monitoring and public health strategies addressing socio-economic determinants of child health.
Abstract:
This work gives growth reference values at birth to 24 months of age for Pakistan based on upper middle class infants. Growth rate reference values are also included and they are given for various interval lengths. The growth was differently affected in infants living in three poorer areas; the stunting incidence at 24 months of age was 63% in periurban slum, 54% in the village and 26% in the urban slum. Less differences could be seen between the areas in weight for length. There was an age dependency in the incidence of reduced growth; a normal length gain was seen at birth to about six months of age, but they were highly reduced at 6 to 18 months of age. The weight gain was to some degree reduced during the first 12 months of life, followed by a catch-up growth period. The seasonal influence was also age dependent; weight was highly affected during the summer at birth to 24 months of age, but not in the winter. The seasonal effect in length was marginal at birth to 6 months, little at 6 to 12 months (although, constant below the normal) and large at 12 to 24 months of age. We did not see any seasonality of growth in the reference group. The incidence of reduced growth reflects the socio-economic differences in one restricted geographic area, i.e., in the city of Lahore, Pakistan.