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  • Title: Growth and behavior development in rural infants in relation to malnutrition and environment.
    Author: Upadhyay SK, Saran A, Agarwal DK, Singh MP, Agarwal KN.
    Journal: Indian Pediatr; 1992 May; 29(5):595-606. PubMed ID: 1500108.
    Abstract:
    A group of 224 children from a rural cohort of 625 children registered from 1981 to 1983 in 10 villages of KV Block, Varanasi was assessed for morbidity, physical growth, and behavior development (Gesell's developmental schedule). By first birthday children of normal nutrition grade were reduced to one fourth and numbers in Grade II and III malnutrition doubled. This deterioration in nutritional status was probably due to high morbidity, i.e., gastrointestinal, respiratory infections, etc. The skull circumference was 43 cm at the age of one year, being lower by 3 cm than the average size. Children having Grades II and III malnutrition showed poor development in all the areas of behavior, i.e., motor, adaptive, language and personal social. Besides malnutrition, environmental factors like mother's involvement in teaching, encouraging the child, talking to him or being within the visual range; the parental education, their caste and the child's birth order contributed significantly to the development of the child during infancy. The goal of this study was to better understand the risk of developing malnutrition, the age of onset and its severity, and common morbidities and causes of mortality. The aim was also to determine whether malnutrition or other behavioral factors affected behavior development. A cohort of 625 children born between November 1981 and March 1983 from 10 rural villages in KV Block, Varanasi, India, was registered and followed for 1 year. Data from 224 children, who provided continuous data for at least 4 age points out of 5, was analyzed. Information was obtained on morbidity, physical growth, and behavior based on Gesell's development schedule. Children were grouped based on degrees of malnutrition (weight-for-age schedule of the Indian Academy of Pediatrics) at 4, 16, 28, and 52 weeks. Some Caldwell Home Inventory items and other environmental and socioeconomic measures were obtained by questionnaire. The village population mirrored the characteristics of the 120,000 rural population in the surrounding 112 villages covering 147 sq. miles. The male/female ratio was 10009:39. Infant mortality rates were 133/1000 live births; neonatal mortality rates were 64/1000 live births. 26% have low birth weight (2500 g). 13% of preschool children suffer from severe malnutrition and 50% from mild malnutrition. 79.4% of mothers and 21.2% of fathers were illiterate. 56% had an income of less than Rs.100/year/capita. The findings showed that the height and weight of study children declined from the 20th centile at 3 months to the 3rd centile after 6 months. By 1 year, those children with normal nutrition were reduced by 25% and the numbers of children with Grade II and III malnutrition doubled. Underfeeding as well as high morbidity may be responsible for the deterioration. The skull circumference was 3 cm smaller than the average of 43 cm at 1 year of age. All areas of behavioral development were poorer among children with Grade II and III malnutrition. Environment influenced development later in infancy, particularly mother's teaching, encouraging, or talking and parental education, caste, and birth order.
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