[Psychosomatics and psychoanalysis; apropos of infant and child nutrition disorders].
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Homeless children in families are increasing in numbers across the country and have been noted to have frequent health problems. The health status of homeless children was assessed on multiple dimensions through parental report in a survey conducted with 196 homeless families in 10 shelters in Los Angeles and 194 housed poor families after March 1987 through January 1988. During the month before the survey, the homeless and housed poor children experienced high rates of illness symptoms, disability, and bed days. Homeless and housed poor children were frequently rated by their parents to be in fair or poor health (17% vs 13%, P = .14). Homeless children, however, were reported to have more behavior problems and school failure [30% vs 18%, P = .06] than housed poor children. Homeless children also had high rates of other health problems such as developmental delay (9%) and overweight (13%). The diets of homeless children were frequently imbalanced, dependent on food from "fast-food" restaurants, and characterized by repeated periods of deprivation. Family problems were more common among homeless families, especially among single-parent homeless families compared with single-parent housed families (spousal abuse, 68% vs 41%, P less than .01; parental drug and alcohol abuse, 60% vs 39%, P less than .01). It is concluded that homeless children have significant child behavior and developmental problems and disorders of nutrition and growth, which are associated with multiple risk factors in their environment.
Children with juvenile rheumatoid arthritis (JRA) often experience nutrition related concerns. Growth abnormalities are common. Protein-calorie malnutrition and inadequate intake of other nutrients result from aspects of the disease process, treatment (including drug treatment), and dietary choices. Mechanical feeding difficulties can also compromise adequate intake. Because nursing assessments usually explore eating habits and family issues, the registered nurse is in a good position to identify nutrition concerns, to provide intervention recommendations, or to act as a referral source.
The nutritional status of preschool-age children (0-59 months) in the Littoral Province of Cameroon was studied in a representative sample of the population of this age group in rural and urban areas, with a total of 2011 children. The nutritional indicators weight-for-height, weight-for-age, and height-for-age were compared with reference data from the United States National Center for Health Statistics. A high prevalence of stunting (15.2% in urban and 21.8% in rural areas, P < 0.0008) was found among the children. The prevalence of wasting was 4.0% in urban and 6.5% in rural areas (P < 0.03). In all age groups, rural children were shorter than urban children with no significant difference between the sexes. The increase in the prevalence of acute malnutrition (8.4%) since the last nutritional survey in 1978 (0.7%), which is probably due to a deterioration in the economic situation in recent years, indicates that urgent measures should be taken to improve the nutritional situation of these children, especially in the villages. The findings of the study could serve as baseline data for the evaluation of the effectiveness of future nutrition programmes.
By pooling the results from five previously published prospective studies, we have obtained estimates of the relative risks of mortality among young children 6-24 months after they had been identified as having mild-to-moderate or severe malnutrition. These risk estimates, along with global malnutrition prevalence data, were then used to calculate the total number of young-childhood deaths "attributable" to malnutrition in developing countries. Young children (6-60 months of age) with mild-to-moderate malnutrition (60-80% of the median weight-for-age of the reference population) had 2.2 times the risk of dying during the follow-up period than their better nourished counterparts (> 80% of the median reference weight-for-age). Severely malnourished young children (< 60% of the reference median weight-for-age) had 6.8 times the risk of dying during the follow-up period than better nourished children. Each year approximately 2.3 million deaths of young children in developing countries (41% of the total for this age group) are associated with malnutrition. The comparability of studies, methods used to derive pooled values, potentially confounding factors that may influence risk estimates, and the validity of the results are discussed. Child survival programmes should assign greater priority to the control of childhood malnutrition.
This article examines trends in the nutritional status of children in EI Salvador between 1988 and 1993 (before and after the signing of a peace accord that ended the civil war.) The data derive from two national surveys, each of which included measurements of the height and weight of children aged 3-59 months. The prevalence of low weight-for-age (< -2 SD) dropped from 15% in 1988 to 10.5% in 1993. The prevalence of low weight-for-height (< -2 SD) was minimal in both surveys: falling from 3.9% to 2.9%. The prevalence of low height-for-age (< -2 SD) fell from 28.1% to 22%. These declines in malnutrition indicators resulted from an upward shift in the distributions of weight and height of children, not from thinner lower tails of the distributions. The quality of anthropometric data appears to be high for both surveys: < 1% of surveyed children had heights or weights outside the expected range. This analysis demonstrates the value of repeated surveys of nutritional status.
In a rural cohort of 625 children registered from 1981 to 1983 in 10 villages of K.V. Block, Varanasi, 196 children were assessed for physical growth, development, intelligence and concept development between 1 and 3 years of age. Home environment was also assessed using Caldwell Home inventory. These rural children remained below 3rd centile of NCHS standard for weight, height, skull and mid-arm circumferences throughout the study. Malnourished children scored poorly in all the areas of development, i.e., motor, adaptive, language and personal social, 9% in Grade I and 16.6% children in Grade II + III had IQ less than 79 (inferior). Concept for color shape and size was poorly developed in malnourished children. Maternal involvement and stimulation was strongly associated with better behavior development and intelligence. Multiple regression analysis showed that the effect of home environment on development and intelligence was of a higher magnitude as compared to status and family variables and nutritional status during 1-3 years of age.
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The objective of this study was to determine the evolution of the nutritional status of the population under five years of age during the period 1975-1990. Several conditioning factors were also assessed. The information was evaluated through time series analysis by using the AREG procedure. This procedure allows for the estimation of a regression model correcting by the autocorrelation of errors. Results indicates a significant trend to decreased undernutrition rates (p < 0.0001). A seasonal effect on undernutrition was observed, being higher the prevalences in summer. Analysis of selected conditioning factors, as well as the familiar buying capacity remained stable during the period. An exception to the lack of association among undernutrition and the conditioning factors evaluated, was seen during the period 1975-1982 when clear inverse relationship was evidenced. In conclusion, the decrease of infant undernutrition in Chile during the period 1975-1990 was not related to the changes observed in certain socioeconomic indices.
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Cross-sectional surveys were conducted to assess prevalence of night-blindness and dietary habits prior to intervention (in 1986), after 3 years of intervention (in 1989) and 3 years after the termination of active intervention (in 1992), in the northern part of Bangladesh. The prevalence of night-blindness per thousand children decreased from 1986 to 1989 (during intervention) and rose from 1989 to 1992, but remained significantly lower in 1992 than the 1986 prevalence. Household income declined from 1989 to 1992, and lower consumption of beta-carotene rich food, protein items and vitamin A capsules was registered in 1992 despite almost the same level of awareness relating to the prevention of night-blindness in the community during the period 1989-1992. The results indicate that the long-term impact of a health education programme to prevent night-blindness is uncertain. Improvement in socioeconomic conditions, in addition to relevant knowledge, is probably a precondition for maintaining a sustainable impact of health education.
To assess dietary habits and nutritional state in drought-prone areas of southern Ethiopia, we studied 334 households in a pastoral and 282 in an agricultural community. Milk and cereals were the main sources of food among children of the pastoral Boran in Dubluk, while cereals with limited supplements of animal products or legumes formed the main sources of food among children of the agricultural population of Elka in the Rift valley. Of the children in Elka, 54.9% were stunted, as compared with 19.5% among children in Dubluk. Also, stunting occurred at an earlier age among the Elka children. Prevalences of wasting were less than 5% in both communities. Improvement in the state of nutrition of the pastoral children followed soon after the main rains, but occurred later and after the main harvest among the agricultural children. In contrast to arm circumference, the weight-for-height measure showed marked seasonal variation. Socio-economic factors, such as family wealth and crowding, significantly influenced the state of nutrition among the children. Nutritional recovery following the prolonged drought among the agricultural children was slow and associated with families acquiring more wealth.
Evaluation of the responsiveness of weight and length to supplementary feeding shows that the two periods of greatest response coincide with weaning (ages 3-6 mo) and peak incidence and duration of diarrheal disease (ages 9-12 mo). Analyses were done for seven consecutive nonoverlapping intervals comparing children randomly assigned to receive supplemental feeding from birth to age 36 mo or to serve as control subjects. Absolute responsiveness was greatest between ages 3-6 mo; supplemented infants grew 0.61 cm more and gained 162 g more than did unsupplemented infants (p less than 0.005). Relative to rates of growth, responsiveness was greatest between ages 9 and 12 mo (the period of peak diarrheal prevalence), followed by ages 3-6 mo (the period of weaning). Responsiveness to supplementation is thus directly related to age-dependent risk patterns for malnutrition. Targeting supplementation programs to coincide with periods of high nutritional risk should maximize their effectiveness in reducing malnutrition, though caution should be exercised to avoid disruption of breast-feeding.
The Tallstick is a new, simplified anthropometric field tool which allows immediate visual interpretation of height-for-age. This tool was field tested in community-based programmes in Managua, Nicaragua, and the rural community of Los Zarzales, screening 1004 children aged 0-60 months for nutritional stunting. Overall sensitivity and specificity analysis comparing HAZ scores and Tallstick results revealed that the Tallstick correctly identified 83-85 per cent of severely stunted children (HAZ < -2.5) and two-thirds of those with HAZ of -2 and below. It also had good positive predictive value for the mildly stunted. As a screening tool for low weight-for-age, the Tallstick performed better than arm circumference. The best of the community volunteers trained with the Tallstick could use it as well as their trainers. Progressive stunting was found in the 280 children in the sample who did not receive any form of milk. The advantages of the Tallstick for community-level screening and the importance of sustained linear growth are discussed.