News — Women who experience malnutrition have children who often fail to attain normal growth. A recent Yale-led study focused on how environmental factors before birth affect how children develop after birth. Understanding the role of environmental factors in malnutrition could improve precision public health programs to aid both mothers and children.
The results of the study were published in .
“As a pediatric neurosurgeon, malnutrition may seem out of my lane,” says , MD, PhD, Harvey and Kate Cushing Professor of Neurosurgery at Yale School of Medicine. “But malnutrition is a huge problem in low- and middle-income countries around the world, and is especially prominent in sub-Saharan Africa and southern Asia.”
Schiff points to prevalence of hydrocephalus (an abnormal buildup of fluid around the brain) in his neurosurgical practice in the country. has identified malnutrition as a critical factor in the surgical outcomes of such children. Schiff and his colleagues had subsequently found that rainfall was a critical factor in , often leading to hydrocephalus in the infants that survived their infections. This work was supported by that found growth stunting—the most common physical manifestation of childhood malnutrition—had its highest incidence at birth.
Schiff led a team of colleagues to explore how environmental, demographic, and economic development factors, as well as land topography might affect the growth of young children—from newborns to 5-year-olds—in Uganda.
The researchers evaluated height and weight data from more than 5,200 children, information compiled by the Ugandan Demographic and Health Survey between June 2015 and December 2016. The data were compared to environmental factors, including satellite-derived measurements of rainfall, a drought index (a balance of rainfall to evaporation), an aridity index, temperature, and vegetation indices.
The study focused on stunting—the long-term growth response in children to sustained poor diet and repeated illness—and wasting—a short-term outcome resulting from inadequate calorie intake or illness. Children who experience wasting can recover but often experience increased risk of stunting and poor neurocognitive development, as well as increased mortality. While deaths associated with stunting and wasting are on the decline globally, more than 250,000 and 1,100,000 children continue to die from each condition, respectively, around the world every year.
The team found that 30% of the Ugandan children in the study showed signs of stunting. The incidence of wasting was 4%. These conditions were more common in villages in the northeastern and southwestern regions of the country, where more than 40% of young children experienced stunting and more than 6% experienced wasting.
Additionally, the researchers found that multiple measures of water availability prior to birth were significantly associated with subsequent measures of malnutrition in the children. Three months prior to birth, higher drought to water balance index was associated with poor growth outcomes in young children. Higher raw rainfall 11 months before birth was associated with more successful growth outcomes. Aridity over the year prior to birth was especially associated with wasting. The team also examined poverty as a factor to explain poor growth outcomes, but they did not find any associations in the growth data.
“Drought affects crop production, leading to food shortages and poor nutrition, especially for pregnant women, and it also limits access to clean water, increasing the risk of infections,” says , MD, PhD, assistant professor in the Department of Public Health Sciences at Penn State University and first author on the study. “These combined stresses during pregnancy can result in babies being born already malnourished and struggling to catch up as they grow.”
About 150 million children worldwide are currently stunted. Schiff estimates that over 2 million Ugandan children younger than 5 years old had stunting in 2020. The associations with drought and rainfall open new opportunities to develop public health interventions that improve women’s nutrition before and during pregnancy and their children’s outcomes early in life.
“Although this study focused on Uganda, the lessons are relevant across many countries dealing with climate-related food insecurity,” said Ssentongo. “This research gives us a powerful tool to act early so we can prioritize interventions in the most vulnerable regions.”
The research reported in this news article was supported by the National Institutes of Health (NIH Director’s Transformative award 1R01AI145057) and Yale University. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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