Does early linear growth failure influence later school performance? A cohort study in Karonga district, northern Malawi

Schooling, C. M., Sunny, B. S., DeStavola, B., Dube, A., Kondowe, S., Crampin, A. C. and Glynn, J. R. (2018) Does early linear growth failure influence later school performance? A cohort study in Karonga district, northern Malawi. PLoS ONE, 13(11), e0200380. (doi: 10.1371/journal.pone.0200380) (PMID:30395573) (PMCID:PMC6218019)

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Abstract

Introduction: Stunting or linear growth retardation in childhood is associated with delayed cognitive development due to related causes (malnutrition, illness, poor stimulation), which leads to poor school outcomes at later ages, although evidence of the association between the timing and persistence of stunting and school outcomes within the sub-Saharan African context is limited. Methods: Anthropometric data around birth (0–4 months), early (11–16 months) and late childhood (ages 4–8 years) along with school outcomes up until the age of 11 were analysed for a cohort of 1,044 respondents, born between 2002–2004 in Karonga district, northern Malawi. The schooling outcomes were age at school enrolment, grade repetition in Standard 1 and age-for-grade by age 11. Height-for-Age Z-scores (HAZ) and growth trajectories were examined as predictors, based on stunting (<-2SD HAZ) and on trajectories between early and late childhood (never stunted, improvers, decliners or persistently stunted). Multinomial and logistic regression were used to estimate the association between stunting/trajectories and schooling, adjusted for socioeconomic confounders. Results: The effects of stunting on schooling were evident in early childhood but were more pronounced in late childhood. Children who were stunted in early childhood (9.3%) were less likely to be underage at enrolment, more likely to repeat Standard 1 and were 2–3 times more likely to be overage for their grade by the age of 11, compared to their non-stunted peers. Those persistently stunted between early and late childhood (7.3%) faced the worst consequences on schooling, being three times as likely to enrol late and 3–5 times more likely to be overage for their grade by the age of 11, compared to those never stunted. Compared to improvers, those persistently stunted were three times as likely to be overage by two or more years by the age of 11, with no effect on enrolment or repetition. Conclusion: Our findings confirm the importance of early childhood stunting on schooling outcomes and suggest some mitigation by improvements in growth by the age of starting school. The nutritional and learning needs of those persistently stunted may need to be prioritised in future interventions.

Item Type:Articles
Additional Information:Data collection was funded by The Wellcome Trust (grant numbers 079828/Z/06/C and 098610/Z/12/Z). The analysis and write-up was funded by the UK Economic and Social Research Council (grant number ES/L013967/1).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Crampin, Professor Mia
Creator Roles:
Crampin, A. C.Data curation, Funding acquisition, Project administration, Resources, Supervision, Writing – review and editing
Authors: Schooling, C. M., Sunny, B. S., DeStavola, B., Dube, A., Kondowe, S., Crampin, A. C., and Glynn, J. R.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:PLoS ONE
Publisher:Public Library of Science
ISSN:1932-6203
ISSN (Online):1932-6203
Copyright Holders:Copyright © 2018 Sunny et al.
First Published:First published in PLoS ONE 13(11):e0200380
Publisher Policy:Reproduced under a Creative Commons License

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