Sally M. Grantham-McGregor

School performance, nutritional status and trichuriasis in Jamaican schoolchildren

Severe infections by the geohelminth Trichuris trichiura detrimentally affect young childrens growth and development. There is concern that mild to moderate infections may affect older childrens school performance and nutritional status. We therefore examined the relationship between varying intensities of infection and school achievement, attendance and nutritional status in 616 schoolchildren. A total of 409 children with Trichuris infection of intensities greater than 1200 eggs per gram of stool (epg) were first identified, then for every 2 infected children in a class, an uninfected child was selected. After controlling for socioeconomic status, gender, age, school and the presence of Ascaris infections, the uninfected children had higher reading and arithmetic scores than children with infections of more than 4000 epg and were taller than those with intensities greater than 2000 epg. However, there were no significant differences in spelling, school attendance and body mass index. Although a treatment trial is needed to determine causation, these results indicate that moderate levels of infection are associated with poor school achievement and growth.

Trichuris trichiura infection and cognition in children : results of a randomized clinical trial

The effects of mild to moderate infections of Trichuris trichiura on cognitive functions were investigated in Jamaican children aged 7 to 10 years. In all, 189 infected children and 100 uninfected classmates were studied. The infected children were randomly assigned to receive treatment (albendazole) or a placebo. All children were given cognitive tests on enrolment and 14 weeks later. These included verbal fluency (generation of ideas), digit span (working memory), number choice (speed of processing of visual stimuli), visual search (sustained attention) and a French Vocabulary test (paired-associate learning). At baseline, the infected children had lower scores than the uninfected ones in fluency (P = 0.01), search (P = 0.02) and French (P = 0.01). Treatment effects were examined among infected children and there was no significant treatment effect for any of the tests. However, there was a significant treatment by weight-for-age interaction in fluency (P < 0.05). The children with low weight-for-age (Z-score < -1) improved with treatment while there was no improvement with treatment among the other children. We concluded that treatment of children with mild to moderate T. trichiura infections using albendazole produces little benefit in cognition if they are adequately nourished; however, undernourished children are more likely to benefit.

Treatment effects in Trichuris dysentery syndrome

Heavy infection with the geohelminth Trichuris trichiura causes the Trichuris dysentery syndrome (TDS). Growth retardation and anaemia are characteristic of TDS and both are associated with poor development. We have examined the growth and developmental responses to treatment in 19 children aged 27–84 months with TDS. Developmental levels (DQ) were measured with the Griffiths mental development scales. Compared with a control group matched for age, gender and neighbourhood, the TDS children initially had serious deficits in DQ (24 points, p < 0.001). After a year of anthelmintic treatment, the TDS children showed improvement in locomotor development (p < 0.001) compared with the controls. The TDS children also had initial deficits in height‐for‐age, weight‐for‐height, mid‐upper arm circumference and haemoglobin levels. They caught up rapidly in indices of wasting (weight‐for‐height and mid‐upper arm circumference) and showed steady improvement in height‐for‐age and haemoglobin levels. Catch‐up in height was comparable to that of children recovering from coeliac disease. The importance of continuing prevention after initial treatment is highlighted.

Stunting and mental development in children

Stunting is the nutritional indicator most consistently correlated with childrens mental development. In Third World countries stunting is usually associated with poor development in young children, and delayed neurosensory integration, low IQ and school achievement in older children. Moreover, stunting in young children predicts poor later development. Generally, when social background is controlled for, the association between stunting and poor development remains. In a recent Jamaican study, nutritional supplementation given to stunted children for 2 years produced an improvement in psychomotor development. Supplementation and linear growth had shared and independent effects on change in development. There was also a significant relationship between change in development and growth over the 2 year period. It is therefore probably that at least part of the poor development found in stunted children is due to poor nutrition.

Adolescent Kingston girls' school achievement: nutrition, health and social factors

Dans de nombreux pays en dCveloppement on a peu d’information sur 1’Ctat nutritionnel des adolescents et sur la maniere dont celui-ci peut affecter leurs rCsultats scolaires. Nous avons CtudiC 1’Ctat nutritionnel et les comportements lids B la santC chez des adolescentes de familles a faibles revenus de Kingston, Jamaique. Nous avons ensuite dCterminC les relations entre ces variables et les rCsultats scolaires, ainsi que l’abandon scolaire. L‘Cchantillon comprenait 452 filles de 13-14 ans, choisies, par randomisation parmi celles de toutes les 8emes classes Cligibles (la 4&me en France) de la ville de Kingston. Ont CtC mesurks la taille des enfants, leur poids, et le pli cutan6 du triceps et du sous-scapulaire; on a calculk leur taille pour iige et l’indice de masse corporelle (BMI). Le statut en fer a CtC CvaluC en dosant l’hkmoglobine, la ferritine serique et la protoporphyrine des Crythroctyes libres, et un questionnaire a CtC administrk pour obtenir des informations sur les comportements liCs B la sante, les experiences de faim et le contexte social. Les rtsultats scolaires des enfants ont CtC Cvalues par le Wide Range Achievement Test. La taille et le BMI des filles Ctaient semblables ? I ceux de la population de rCfCrence amkricaine; cependant le pli cutanC Ctait plus petit, mCme si on le comparait aux donnCes concernant les noirs seulement. La faim sur de courtes pCriodes Ctait un probleme pour un certain nombre de ces enfants, ainsi 33% allaient se coucher en ayant faim, et 36% venaient a 1’Ccole sans avoir pris de petit-dCjeuner au moins une fois par semaine. Seize pour cent de ces filles Ctaient anCmiCes (Hb <115 gA), et 17% avaient des niveaux de ferrine bas. Le dkroulement de la menstruation Ctait associC au statut en fer. Au moment de l’entretien quatre-vingt-dix filles (20%) ont dCclarC avoir eu des relations sexuelles. Un contexte de violence B la maison, a 1’Ccole et dans la communaute, et des chatiments corporels par les parents et les professeurs etaient courants. Trente-sept pour cent des filles avaient CtC impliqudes dans des bagarres au cours de 1’annCe scolaire. Bien que ces filles aient ete en 85me classe, la moyenne de leurs resultats scolaires n’Ctait que de 5.1 (ET 2-1). La taille pour age, l’hemoglobine et la faim Ctaient corrClCes avec les rCsultats scolaires. Dans les analyses a regression multiple plusieurs variables sociales et de comportement Ctaient associCes‘ avec les resultats scolaires. Dans rCsultats meilleurs etaient associb avec la possession de matCriel scolaire (stylos ou crayons, cahiers et manuels scolaires), un indice de stimulation de la lecture (livres a la maison autres que des manuels scolaires, journaux et utilisation de bibliotheques), et la

The effect of nutritional supplementation and stunting on morbidity in young children: the Jamaican study

Infection and undernutrition in young children are thought to act synergistically. However, studies of the relationship between low height-for age (stunting) and morbidity in young children have had inconsistent findings and there are few adequate data on the effects of nutritional supplementation on morbidity. 129 stunted and 21 non-stunted children aged between 9 and 24 months, from poor Kingston neighbourhoods, identified from a house-to-house survey, were studied. The stunted children were randomly assigned to supplementation or no supplementation. Every week for 24 months the mothers were asked about the occurrence of any symptoms of illness. Supplementation had no consistent effect on the incidence or duration of symptoms. The stunted children had significantly more attacks of diarrhoea, fever, anorexia and apathy than the non-stunted children. The differences remained after controlling for social background and previous attacks of diarrhoea. There was also some indication of more severe illness in the stunted than in the non-stunted children.

Effects of a hurricane on growth and morbidity in children from low-income families in Kingston, Jamaica

This is the first report of the effects of a hurricane on childrens health and nutritional status in which data were available preceding and following the event. When Hurricane Gilbert struck Jamaica in 1988, a longitudinal study was in progress in which childrens weights and heights were recorded every 2 months and their morbidity histories taken every week. The investigation included 127 stunted (low height-for-age) and 32 non-stunted children aged 23-44 months, living in poor areas of Kingston. The data from the 4 months before and after the hurricane were compared. There was an increase in the occurrence of respiratory symptoms including rapid or difficult breathing (P < 0.04), coughs (P < 0.001) and nasal discharges (P < 0.001) during the first 2-month period after the hurricane. However there was no significant effect on the occurrence of diarrhoea and injuries. Deficits were also found in height gain (P < 0.001) during the same period. These adverse effects were found in spite of the large amount of food aid received and the aggressive health education programme implemented after the hurricane.