Pinchinat S, Enel C, Pison G, Duthe G, Lagarde E, Simondon F, Simondon KB. No improvement in weight-for-age of young children in southern Senegal, 1969-1992, despite a drastic reduction in mortality. Evidence from a growth monitoring programme. Int J Epidemiol. 33(6):1202-1208.
UR024, Institut de Recherche pour le Developpement (IRD), 911, avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France.
BACKGROUND: Undernutrition is associated with an increased risk of death
among young children in developing countries. Infant and child nutritional
status and mortality were monitored in a rural area of Casamance, Senegal.
METHODS: Analysis of weight measurements taken at 3-24 months of age
during routine growth monitoring in the community's private dispensary
1969-1992 (3912 children, 4642 child-years) and of mortality rates of
children estimated from maternal recall for 1960-1985 and yearly census
1985-1995. RESULTS: Between 1960-1964 and 1990-1994, under-5 and child
(1-4 years) mortality rates decreased from 312 to 127 and from 201 to
68 per 1000, respectively. About 90% of resident children attended growth
monitoring in 1985-1992. Mean weight-forage was at a minimum at 15 months
of age (-1.60 z-scores [SD: 0.95]); the prevalence of underweight was
33.2% (95% CI: 31.5, 34.9). The latter increased significantly over time,
both when comparing all years of follow-up (P for trend <0.01) and
over three pre-defined time periods (28.6, 34.6, and 35.0% in 1969-1974,
1975-1984, and 1985-1992, respectively, P for trend <0.05). Mean weight-for-age
decreased over time in infancy and in the second year of life. CONCLUSION:
No improvement in nutritional status was found among young children 1969-1992
despite a drastic decrease in mortality. Focused public health interventions
such as vaccinations and malaria prevention probably did not enhance
weight-for-age. Paradoxically, growth monitoring may have been more helpful
in improving health than growth.