1. Long-term effects of severe acute malnutrition during childhood on adult cognitive, academic and behavioural development in African fragile countries: The Lwiro cohort study in Democratic Republic of the Congo
- Author
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Mwene-Batu, Pacifique, Bisimwa, Ghislain, Baguma, Marius, Chabwine, Joelle, Bapolisi, Achille, Chimanuka, Christine, Molima, Christian, Dramaix, Michèle, Kashama, Nicolas, Macq, Jean, Donnen, Philippe, Denis, Frédéric, and UCL - SSS/IRSS - Institut de recherche santé et société
- Subjects
Gerontology ,Male ,Activities of daily living ,030309 nutrition & dietetics ,Social Sciences ,Academic Skills ,Pediatrics ,Disability Evaluation ,Families ,0302 clinical medicine ,Child Development ,Cognition ,Medical Conditions ,Sociology ,Activities of Daily Living ,Medicine and Health Sciences ,Psychology ,Public and Occupational Health ,030212 general & internal medicine ,Survivors ,Young adult ,Children ,0303 health sciences ,Multidisciplinary ,medicine.diagnostic_test ,Child Health ,General Medicine ,Mental Status and Dementia Tests ,Cognitive test ,Social Networks ,Child, Preschool ,Democratic Republic of the Congo ,Medicine ,Educational Status ,Female ,General Agricultural and Biological Sciences ,Network Analysis ,Cohort study ,Research Article ,Adult ,Computer and Information Sciences ,Adolescent ,Science ,Disabilities ,Severe Acute Malnutrition ,Genetics and Molecular Biology ,03 medical and health sciences ,Young Adult ,medicine ,Humans ,Nutrition ,Mini–Mental State Examination ,business.industry ,Malnutrition ,Cognitive Psychology ,Infant ,Biology and Life Sciences ,medicine.disease ,Self Concept ,Health Care ,Age Groups ,Case-Control Studies ,General Biochemistry ,People and Places ,Quality of Life ,Cognitive Science ,Population Groupings ,business ,Follow-Up Studies ,Neuroscience - Abstract
Introduction Little is known about the outcomes of subjects with a history of severe acute malnutrition (SAM). We therefore sought to explore the long-term effects of SAM during childhood on human capital in adulthood in terms of education, cognition, self-esteem and health-related disabilities in daily living. Methodology We traced 524 adults (median age of 22) in the eastern Democratic Republic of the Congo, who were treated for SAM during childhood at Lwiro hospital between 1988 and 2007 (median age 41 months). We compared them with 407 community controls of comparable age and sex. Our outcomes of interest were education, cognitive function [assessed using the Mini Mental State Examination (MMSE) for literate participants, or its modified version created by Ertan et al. (MMSE-I) for uneducated participants], self-esteem (measured using the Rosenberg Self-Esteem Scale) and health-related social and functional disabilities measured using the World Health Organization Disability Assessment Schedule (WHODAS). For comparison, we used the Chi-squared test along with the Student’s t-test for the proportions and means respectively. Results Compared with the community controls, malnutrition survivors had a lower probability of attaining a high level of education (p < 0.001), of reporting a high academic performance (p = 0.014) or of having high self-esteem (p = 0.003). In addition, malnutrition survivors had an overall mean score in the cognitive test that was lower compared with the community controls [25.6 compared with 27.8, p = 0.001 (MMSE) and 22.8 compared with 26.3, p < 0.001(MMSE-I)] and a lower proportion of subjects with a normal result in this test (78.0% compared with 90.1%, p < 0.001). Lastly, in terms of health-related disabilities, unlike the community controls, malnutrition survivors had less social disability (p = 0.034), but no difference was observed as regards activities of daily living (p = 0.322). Conclusion SAM during childhood exposes survivors to low human capital as regards education, cognition and behaviour in adulthood. Policy-deciders seeking to promote economic growth and to address various psychological and medico-social disorders must take into consideration the fact that appropriate investment in child health as regards SAM is an essential means to achieve this.
- Published
- 2020