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  • Title: Morbidity and growth performance of infants in Madura, Indonesia.
    Author: Kolsteren PW, Kusin JA, Kardjati S.
    Journal: Ann Trop Paediatr; 1997 Sep; 17(3):201-8. PubMed ID: 9425374.
    Abstract:
    Between January 1987 and July 1988, all children born in two villages on the island of Madura, Indonesia were visited weekly by a field worker trained to interview mothers on disease symptoms. The maximum recall period was 1 week. All infants were measured (weight and height) at monthly intervals. Information on growth and morbidity is analysed for infants from birth until the age of 11 months. Morbidity, defined as acute respiratory tract infection (ARI), diarrhoea, fever and other diseases, is analysed over 4-week periods and related to growth performance. In total, there are 1373 4-week reporting periods with morbidity information from birth to the age of 12 months. Of all the diseases recorded (1021), 47% were ARI, 13% diarrhoea, 14% fever and 26% other diseases. The average (SD) duration of diarrhoea was 7 (11) days, ARI 14 (9) days, fever 6 (4) days and 16 (10) days for other diseases. The most striking results in this analysis are: (i) the lack of a relationship between morbidity and growth (either linear or weight) during the 1st 6 months of life; (ii) the existence of a relationship between illness and weight increment for which only ARI showed significant influence for infants of 6 months and more; (iii) the lack of a relationship between morbidity and linear growth performance at all ages; and (iv) the fact that no cumulative effect of disease on growth performance was found to explain the observations. To collect data on infant morbidity and growth, all children born in an 18-month period in 1987-88 in two villages on the island of Madura, Indonesia, were visited weekly by a field worker. Infants were weighed and measured monthly. In total, 1373 4-week reporting periods covering birth through 12 months were available for analysis. Disease was present in 51% of these periods, and 22% of infants had more than one illness episode in a 4-week period. Of the 1021 disease episodes recorded, the most prevalent were acute respiratory infection (47%), fever (14%), and diarrhea (13%). The average durations of these three diseases were 14 +or- 9 days, 6 +or- 4 days, and 7 +or- 11 days, respectively. Extrapolation of these findings suggests the average infant in Mandura will have 4 episodes of acute respiratory infection, 1-2 episodes of diarrhea and fever, and 2-3 episodes of other diseases in the first year of life. There was no association between morbidity and growth in the first 6 months of life. However, between 6 and 11 months of age, acute respiratory infection (but not diarrhea) was significantly associated with incremental weight loss. Height was not affected by morbidity at any age. There was no cumulative effect of disease on growth performance. These findings suggest that if infants are breast fed, well cared for, and provided access to curative care in the first year of life, as the infants in Mandura were, intercurrent illness has no midterm adverse effect on growth.
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