EClinicalMedicine (Apr 2024)
Childhood growth during recovery from acute illness in Africa and South Asia: a secondary analysis of the childhood acute illness and nutrition (CHAIN) prospective cohortResearch in context
- Celine Bourdon,
- Abdoulaye Hama Diallo,
- Abu Sadat Mohammad Sayeem Bin Shahid,
- Md Alfazal Khan,
- Ali Faisal Saleem,
- Benson O. Singa,
- Blaise Siézanga Gnoumou,
- Caroline Tigoi,
- Catherine Achieng Otieno,
- Chrisantus Odhiambo Oduol,
- Christina L. Lancioni,
- Christine Manyasi,
- Christine J. McGrath,
- Christopher Maronga,
- Christopher Lwanga,
- Daniella Brals,
- Dilruba Ahmed,
- Dinesh Mondal,
- Donna M. Denno,
- Dorothy I. Mangale,
- Emmanuel Chimwezi,
- Emmie Mbale,
- Ezekiel Mupere,
- Gazi Md Salauddin Mamun,
- Issaka Ouédraogo,
- James A. Berkley,
- James M. Njunge,
- Jenala Njirammadzi,
- John Mukisa,
- Johnstone Thitiri,
- Judd L. Walson,
- Julie Jemutai,
- Kirkby D. Tickell,
- Lubaba Shahrin,
- Macpherson Mallewa,
- Md Iqbal Hossain,
- Mohammod Jobayer Chisti,
- Molline Timbwa,
- Moses Mburu,
- Moses M. Ngari,
- Narshion Ngao,
- Peace Aber,
- Philliness Prisca Harawa,
- Priya Sukhtankar,
- Robert H.J. Bandsma,
- Roseline Maïmouna Bamouni,
- Sassy Molyneux,
- Shalton Mwaringa,
- Shamsun Nahar Shaima,
- Syed Asad Ali,
- Syeda Momena Afsana,
- Sayera Banu,
- Tahmeed Ahmed,
- Wieger P. Voskuijl,
- Zaubina Kazi
Affiliations
- Celine Bourdon
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada
- Abdoulaye Hama Diallo
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso; Department of Public Health, Centre Muraz Research Institute, Bobo-Dioulasso, Burkina Faso
- Abu Sadat Mohammad Sayeem Bin Shahid
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Md Alfazal Khan
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Ali Faisal Saleem
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Benson O. Singa
- Kenya Medical Research Institute, Nairobi, Kenya
- Blaise Siézanga Gnoumou
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Caroline Tigoi
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Catherine Achieng Otieno
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Chrisantus Odhiambo Oduol
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Christina L. Lancioni
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
- Christine Manyasi
- Department of Paediatrics, Mbagathi Hospital, Nairobi, Kenya
- Christine J. McGrath
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
- Christopher Maronga
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Christopher Lwanga
- Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda
- Daniella Brals
- Department of Global Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Dilruba Ahmed
- Clinical Microbiology and Immunology Laboratory, Office of Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dinesh Mondal
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Donna M. Denno
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
- Dorothy I. Mangale
- Department of Global Health, University of Washington, Seattle, WA, USA
- Emmanuel Chimwezi
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Emmie Mbale
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Ezekiel Mupere
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
- Gazi Md Salauddin Mamun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- Issaka Ouédraogo
- Department of Pediatrics, Banfora Referral Regional Hospital, Banfora, Burkina Faso
- James A. Berkley
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Corresponding author. Clinical Research Department, KEMRI–Wellcome Trust Research Programme, PO Box 230, Kilifi 80108, Kenya.
- James M. Njunge
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Jenala Njirammadzi
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- John Mukisa
- Department of Immunology and Department of Molecular Biology Makerere University College of Health Sciences, Kampala, Uganda
- Johnstone Thitiri
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Judd L. Walson
- Departments of International Health and Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Corresponding author. Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe St., Baltimore, Maryland 212105, USA.
- Julie Jemutai
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Kirkby D. Tickell
- Department of Global Health, University of Washington, Seattle, WA, USA
- Lubaba Shahrin
- Hospitals, Office of Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Macpherson Mallewa
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Md Iqbal Hossain
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Mohammod Jobayer Chisti
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Molline Timbwa
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Moses Mburu
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Moses M. Ngari
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Narshion Ngao
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Peace Aber
- Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda
- Philliness Prisca Harawa
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Priya Sukhtankar
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Robert H.J. Bandsma
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Roseline Maïmouna Bamouni
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Sassy Molyneux
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Health Systems and Research Ethics Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Shalton Mwaringa
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Shamsun Nahar Shaima
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Syed Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Syeda Momena Afsana
- Clinical Biochemistry Laboratory, Office of Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Sayera Banu
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- Tahmeed Ahmed
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Office of Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Wieger P. Voskuijl
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi; Amsterdam UMC, Location University of Amsterdam, Amsterdam Institute for Global Child Health, Emma Children’s Hospital, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, Location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9, Amsterdam, the Netherlands
- Zaubina Kazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Journal volume & issue
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Vol. 70
p. 102530
Abstract
Summary: Background: Growth faltering is well-recognized during acute childhood illness and growth acceleration during convalescence, with or without nutritional therapy, may occur. However, there are limited recent data on growth after hospitalization in low- and middle-income countries. Methods: We evaluated growth following hospitalization among children aged 2–23 months in sub-Saharan Africa and South Asia. Between November 2016 and January 2019, children were recruited at hospital admission and classified as: not-wasted (NW), moderately-wasted (MW), severely-wasted (SW), or having nutritional oedema (NO). We describe earlier (discharge to 45-days) and later (45- to 180-days) changes in length-for-age [LAZ], weight-for-age [WAZ], mid-upper arm circumference [MUACZ], weight-for-length [WLZ] z-scores, and clinical, nutritional, and socioeconomic correlates. Findings: We included 2472 children who survived to 180-days post-discharge: NW, 960 (39%); MW, 572 (23%); SW, 682 (28%); and NO, 258 (10%). During 180-days, LAZ decreased in NW (−0.27 [−0.36, −0.19]) and MW (−0.23 [−0.34, −0.11]). However, all groups increased WAZ (NW, 0.21 [95% CI: 0.11, 0.32]; MW, 0.57 [0.44, 0.71]; SW, 1.0 [0.88, 1.1] and NO, 1.3 [1.1, 1.5]) with greatest gains in the first 45-days. Of children underweight (<−2 WAZ) at discharge, 66% remained underweight at 180-days. Lower WAZ post-discharge was associated with age-inappropriate nutrition, adverse caregiver characteristics, small size at birth, severe or moderate anaemia, and chronic conditions, while lower LAZ was additionally associated with household-level exposures but not with chronic medical conditions. Interpretation: Underweight and poor linear growth mostly persisted after an acute illness. Beyond short-term nutritional supplementation, improving linear growth post-discharge may require broader individual and family support. Funding: Bill & Melinda Gates Foundation OPP1131320; National Institute for Health Research NIHR201813.
