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Objective: To provide HIV-positive mothers who opted for exclusive breastfeeding or formula feeding from birth to 6 months postpartum as a means of prevention of mother-to-child transmission (PMTCT) of HIV with a sustainable infant food support programme (FSP) from 6 to 12 months postpartum. We describe the implementation and assessment of this pilot initiative. Design: The FSP included a 6-month provision of locally produced infant fortified mix (IFM; 418 kJ/100 g of gruel) for non-breastfed infants coupled with infant-feeding and psychosocial counselling and support. Acceptability and feasibility were assessed in a subsample of sixty-eight mother-infant pairs. Setting: The FSP was developed in collaboration with local partners to support. participants in a PMTCT prevention study. Formula WAS provided for free from 0 to 6 months postpartum. Cessation by 6 months was recommended for breast feeding mothers. Results: The FSP was positively received and greatly encouraged breastfeeding mothers to cease by 6 months. As recommended, most infants were given milk as an additional replacement food, mainly formula subsidised by safety networks. Among daily IFM consumers, feeding practices were satisfactory overall; however, the IFM was shared within the family by more than one-third of the mothers. Cessation of IFM consumption was observed among twenty-two infants, seventeen of whom were fed milk and five neither of these. Conclusions: Without any food support most mothers would have been unable to provide appropriate replacement feeding. The food security of non-breastfed infants urgently needs to be addressed in HIV PMTCT programmes. Our findings on a simple cost-effective pioneer intervention provide an important foundation for this process.

Background Evidence suggests that intrauterine growth restriction followed by rapid post-natal growth is associated with high blood pressure. We assessed the effect of early size and post-natal growth on blood pressure in a population from West Africa, where fetal growth retardation and childhood malnutrition are common. Methods A total of 1288 Senegalese subjects were followed from infancy to young adulthood (mean age 17.9 years). Adult systolic blood pressure (SBP) was regressed on infant and adult anthropometric characteristics. Results In unadjusted analyses, infant size was positively associated with adult SBP (1.1 +/- 03; P = 0.001 for weight; 0.7 +/- 0.3; P = 0.04 for length). With adjustment for current size, the regression coefficients for infant size were reversed (-0.2 +/- 0.3; P = 0.51 for weight; -0.3 +/- 0.3; P = 0.35 for length). SBP increased by 4.1 and 2.9 mmHg for 1 standard deviation (SD) increase in current weight or height, respectively. No interaction between infant size and current size was found in the overall models (P = 0.11 for weight, P = 0.95 for height), but this term interacted with sex for weight effect. A negative interaction was found in males (-0.9 +/- 0.4; P = 0.02) but not in females (0.3 +/- 0.4; P = 0.46). The association of current weight with SBP was stronger in lighter weight male infants. Conclusions These findings support the hypothesis that subjects who were small in early life and experienced enhanced post-natal growth have higher levels of SBP, even in low-income settings.

Negative consequences of malaria might account for seasonality in nutritional status in children in the Sahel. We report the impact of a randomized, double-blind, placebo-controlled trial of seasonal intermittent preventive anti-malarial treatment on growth and nutritional status in 1,063 Senegalese preschool children. A combination of artesunate and sulfadoxine-pyrimethamine was given monthly from September to November. In the intervention arm, mean weight gain was significantly greater (122.9 ± 340 versus 42.9 ± 344 [SD] g/mo, P < 0.0001) and losses in triceps and subscapular skinfold measurements were less (−0.39 ± 1.01 versus −0.66 ± 1.01 mm/mo, and −0.15 ± 0.64 versus −0.36 ± 0.62 mm/mo, respectively, P < 0.0001 for both). There was no difference in height increments. The prevalence of wasting increased significantly in the control arm (4.6% before versus 9.5% after, P < 0.0001), but remained constant in intervention children: 5.6% versus 7.0% (P = 0.62). The prevention of malaria would improve child nutritional status in areas with seasonal transmission.

BackgroundOptimal feeding of infants and young children in developing countries includes daily feeding of animal-source foods.ObjectiveTo evaluate constraints on the availability of animal-source foods at the community level, access to animal-source foods at the household level, and intake of animal-source foods at the individual level among children under 3 years of age in case studies in five developing countries: Mexico, Peru, Haiti, Senegal, and Ethiopia.MethodsData were obtained from published and unpublished research and from program experiences of health and agriculture specialists.ResultsIn Ethiopia, 27% to 51% of case-study chil- dren had consumed an animal-source food on the previous day; from 56% to 87% of children in the other case-study sites had consumed an animal-source food on the previous day. Data on intake of animal-source foods in grams were only available for the Latin American case-study sites, where daily milk intake was high in Mexico and Peru (195 and 180 g/day, respectively) and the intakes of meat, fish, and poultry (MFP) (29.0 and 13.6 g/day) and of egg (18.4 and 4.9 g/day) were low. The conceptual model guiding this work identified more constraining factors at the community and household levels than at the individual level. The most common constraints on feeding animal-source foods to young children were poverty, animal health, and land degradation at the community level; cost of animal-source foods and limited livestock holdings at the household level; and caregivers' perceptions of giving animal-source foods to children at the individual level.ConclusionsFor program planning, it is useful to simultaneously consider factors that affect community availability of, household access to, and children's intake of animal-source foods. Efforts to overcome individual- level constraints on intake of animal-source foods should be coupled with activities to address community and household constraints.

Available data on the long-term consequences of preschool stunting are scarce and conflicting. The objective of this study was to assess the amount of catch-up growth from preschool stunting and the effect of migration (change in environment) during adolescence. A cohort study from preschool age (1‐5 y) to adulthood (18‐23 y) was conducted among 2874 subjects born in a rural area of Senegal. The subjects were divided into 3 groups of preschool stunting: none, mild, and marked, with height-for-age Z-scores of .21, 2 2t o21, and ,22, respectively. At follow-up, the history of migration was recalled. Mean height was 161.3 cm for girls and 174.0 cm for boys ($20 y). Stunted subjects remained smaller than the others: the age-adjusted height deficit between the 2 extreme categories was 6.6 and 9.0 cm in girls and boys, respectively. However, their height increment from early childhood to adulthood differed (69.3, 70.5, and 72.0 cm, P ¼ 0.0001, and 78.9, 80.0, and 80.3 cm, P , 0.01, for nonstunted, mildly stunted, and markedly stunted girls and boys, respectively). The duration of labor migration to the city was associated with height increment in girls only in a nonlinear relation (adjusted means: 67.2, 69.3, 67.4, and 67.7 cm for 4 groups of increasing duration, P , 0.01). In conclusion, Senegalese children caught up in height prior to adulthood, with the adult means ;2 cm below the WHO/NCHS reference. However, this global catch up did not reduce height differences between formerly stunted and nonstunted children to any greater extent and it was not enhanced by labor migration. J. Nutr. 136: 2412‐2420, 2006.

Ruel and Menon recently published a young child feeding index based on characteristics taken from 24-h and 7-d recalls. A strong positive association was found in 7 Latin American Demographic and Health Surveys for 12- to 36-mo-old children (1). The aim of this study was to test for associations of this index with height-for-age and linear growth in African children. Children (n = 500), aged 12-42 mo, living in a rural area of Senegal were visited in their homes in April-May, and 24-h and 7-d food recalls were conducted with their mothers. Height was measured, and measurements taken 7 mo earlier were used to compute linear growth rates. General linear models were used to adjust for potential confounders (child age and sex, maternal height, BMI, and socioeconomic status). The feeding index was not associated with either height-for-age (adjusted means: -1.01, -1.06, and -1.20 Z-scores for the 1st, 2nd, and 3rd tercile, respectively) or with linear growth (6.2, 6.0, and 6.3 cm/7 mo for the 3 terciles, respectively). Continuing breast-feeding was negatively associated with height-for-age (P < 0.05) and positively associated with linear growth (P < 0.01). Frequent consumption of fruit was positively associated with both (P = 0.059 and P = 0.027, respectively, in adjusted models), whereas food consumption from an animal source was not. In conclusion, the composite feeding index was independent of height and linear growth in these rural African children, due in part to reverse causality between breast-feeding duration and stunting.

Although use of acellular pertussis vaccine was associated with a higher rate of vaccine failure than that of whole-cell vaccine in the Senegal Pertussis Trial conducted in 1990-1994 on 4189 children, risk factors for vaccine failure regarding exposure and susceptibility to pertussis have not been studied so far. Pertussis occurred in 346 vaccinated children. Three factors were found to be associated with vaccine failure, independently of the vaccine type, namely the degree of exposure, birth rank, and time since weaning. In the whole-cell vaccine group, the risk of failure increased with birth rank [RR = 2.95 (1.51-5.75)] and was higher in non stunted children [RR = 1.43 (1.05-1.94)]. In the acellular vaccine group, the risk of failure increased with age at exposure to B. pertussis [RR = 2.24 (1.21-4.12) after 18 months of age] and the degree of exposure [RR = 2.14 (1.17-3.93) when the child shared the hut of an index case]. These results highlight the influence of environmental factors on the success of pertussis vaccination. However, they do not explain the shorter duration of protection provided by the acellular vaccine compared to the whole-cell vaccine which persist after controlling and thus might be related to the nature of the vaccine.

Nutritional status was monitored in a random sample of inhabitants of three villages in Northern Senegal where irrigated rice cultivation started in July 1989. In early 1990, weight and height were measured in children and adults. From 1990–1995, 290 preschool children, 175 mothers of the children and 99 men aged 20–60 years were followed longitudinally. The prevalence of wasting in children fell from 11.4% (95% confidence interval: 7.4–15.4%) in 1990 to 3.8% (1.5–6.0) in 1995, while the prevalence of stunting initially declined and then increased. Prevalence of chronic energy deficiency (BMI 25 kg/m2) increased significantly over time in both sexes. Individual annual weight gains of adults were significantly greater than zero from 1990 to 1991 (mean: 1.8 kg/yr) and from 1991 to 1992 (mean:...

This study compares the growth and maturity status of Sereer girls (Senegal) temporarily migrating to an urban setting during the dry season to work as maids in the capital city, Dakar, with girls remaining in rural communities. A total of 343 girls, aged 12.5-14.5 were surveyed : 222 lived year-round in several villages (sedentes) and 121 girls worked in Dakar for 8 months of the year (migrants). All girls were born and reared under the same conditions and in the same rural communities in Senegal. Growth and nutritional status were assessed with anthropometry, and the body mass index (BMI) was calculated. Sexual maturation was assessed by stage of breast development and occurrence of menarche. A questionnaire on housing conditions, food consumption patterns, nature of work, health status, and reasons for leaving the villages was administered to 57 urban girls. Overall, the girls were small relative to NCHS/WHO reference values : 30-40% were lower than -2 z-scores of age-specific medians. They also had less subcutaneous fat. Only nine girls had attained menarche and 30% were prepubertal in breast development. The migrants had a significantly higher body mass and BMI and thicker skinfolds than sedentes, but there was no difference in stature. The migrants were also more sexually mature than the sedentes. Comparison of anthropometric status 2 years before migration, in 1995, showed no differences between migrant and sedentes girls. Within migrant girls, those with two or more stays in Dakar were taller and heavier than newcomers. These results suggest that seasonal movement to the city results in improved nutritional status, as reflected larger body mass and increased fatness. These factors appear to be associated with better living conditions in the city. (Résumé d'auteur)

Sulfadoxine-pyrimethamine with amodiaquine (SP-AQ) is a highly efficacious regimen for intermittent preventive treatment to prevent malaria in children (IPTc), but the amodiaquine component is not always well tolerated. We determined the association between amodiaquine dosage by body weight and mild adverse events (AEs) and investigated whether alternative age-based regimens could improve dosing accuracy and tolerability, using data from two trials of IPTc in Senegal, one in which AQ dose was determined by age and the other in which it was determined by weight category. Both dosage strategies resulted in some children receiving AQ doses above the recommended therapeutic range. The odds of vomiting increased with increasing amodiaquine dosage. In one study, incidence of fever also increased with increasing dosage. Anthropometric data from 1,956 children were used to predict the dosing accuracy of existing and optimal alternative regimens. Logistic regression models describing the probability of AEs by dosage were used to predict the potential reductions in mild AEs for each regimen. Simple amendments to current AQ dosing schedules based on the child's age could substantially increase dosing accuracy and thus improve the tolerability of IPTc using SP-amodiaquine in situations where weighing the child is impractical.

Although infections contribute to growth faltering in preschool children, malaria prevention seems to have limited impact on height status. In 2002-2003, a malaria intermittent preventive treatment (IPT) trial was conducted in Senegal, including randomly selected preschool children from 11 villages, A rapid decrease in stunting prevalence (from 28.3 to 16.3%; P < 0.0001) was reported in both intervention and placebo groups. During this 15-mo period, both groups of children benefited from active detection and prompt treatment of malaria attacks. In this study, we investigated whether management of malaria morbidity could explain the improvement of height status. An anthropometric survey, conducted in September 2004 in the area, included 929 2- to 5-y-old children, Some 539 children, previously included in the 2002-2003 IPT trial, benefited from active malaria morbidity management and formed the malaria trial group. The remaining 390 children constituted the control group. Mean height-for-age and stunting prevalence in September 2004 were compared between groups adjusting for age and mother's activity. Mean height-for-age Z-scores did not differ between trial (-1.17 +/- 0.93) and control children (-1.24 +/- 1.00; P = 0.25). Only 36- to 47-mo-old malaria trial children had a lower prevalence of stunting than controls of similar age (19.4 vs. 28.7%; P = 0.044). Compared with the usually slow progression of height status related to better living conditions, it seems very likely that the rapid improvement observed among IPT study children resulted from the trial. These findings suggest that improved health services provided by the trial may also have benefited children not included living in study villages. J. Nutr. 140: 625-629, 2010.

In Burkina Faso, prolonged breastfeeding with introduction of ritual fluids from birth is a deep-seated norm. We explored HIV-infected mothers' views and experiences of the acceptability and feasibility of the World Health Organization's recommended infant-feeding options within a mother-to-child-transmission prevention trial. A qualitative study was conducted on 17 formula-feeding and 19 breastfeeding mothers, from a larger cohort of 51 eligible HIV-infected women, consenting to participate in separate focus group discussions in early post-partum. Mothers opted for breastfeeding essentially out of fear of family rejection. Most of them were afraid of denigration for disrespecting tradition if they formula-fed or being suspected of HIV infection. Achieving exclusive breastfeeding remained a difficult challenge as they engaged in a continuous struggle with close elders to avoid fluid feeding. Additional stress and fatigue were fed by their perception of a high transmission risk through breast milk. Exclusive formula-feeding seemed easier to implement, especially as formula was provided free of charge. Formula-feeding mothers more frequently had a supportive partner, a strong personality and lived in better socio-economic conditions than breastfeeding mothers (76% had education and electricity supply vs. 42%, respectively). Exclusive breastfeeding for the first 6 months remains the most appropriate option for many HIV-infected mothers in sub-Saharan Africa. Its acceptability and feasibility urgently need to be improved by promoting it as the best feeding option for all infants. Other crucial interventions are the promotion of voluntary counselling and testing for couples, and greater partner involvement in infant-feeding counselling.

Background In sub-Saharan Africa, preschool children represent the population most vulnerable to malaria and malnutrition. It is widely recognized that malnutrition compromises the immune function, resulting in higher risk of infection. However, very few studies have investigated the relationship between malaria, malnutrition and specific immunity. In the present study, the anti-Plasmodium falciparum IgG antibody (Ab) response was evaluated in children according to the type of malnutrition. Methods Anthropometric assessment and blood sample collection were carried out during a cross-sectional survey including rural Senegalese preschool children. This cross-sectional survey was conducted in July 2003 at the onset of the rainy season. Malnutrition was defined as stunting (height-for-age P. falciparum whole extracts (schizont antigens) was assessed by ELISA in sera of the included children. Results Both the prevalence of anti-malarial immune responders and specific IgG Ab levels were significantly lower in malnourished children than in controls. Depending on the type of malnutrition, wasted children and stunted children presented a lower specific IgG Ab response than their respective controls, but this difference was significant only in stunted children (P = 0.026). This down-regulation of the specific Ab response seemed to be explained by severely stunted children (HAZ ≤ -2.5) compared to their controls (P = 0.03), while no significant difference was observed in mildly stunted children (-2.5 < HAZ P. falciparum Ab response appeared to be independent of the intensity of infection. Conclusion Child malnutrition, and particularly stunting, may down-regulate the anti-P. falciparum Ab response, both in terms of prevalence of immune responders and specific IgG Ab levels. This study provides further evidence for the influence of malnutrition on the specific anti-malarial immune response and points to the importance of taking into account child malnutrition in malaria epidemiological studies and vaccine trials.

Objective: To assess adverse effects of long-term highly active antiretroviral therapy (HAART), that is, lipodystrophy and metabolic disorders, in a cohort of African patients. Methods: One hundred eighty HIV-1-infected patients treated with HAART for 4-9 years in Dakar and 180 age-matched and sex-matched controls were enrolled. Regional subcutaneous fat changes were assessed by physicians, and fasting blood samples were drawn. Centralization of body fat was estimated using skinfold ratio, waist circumference, and waist to hip ratio (WHR). Results: Mean duration of HAART was 5.4 years. Main drugs received were zidovudine, stavudine, and protease inhibitors. The prevalence of moderate-severe lipodystrophy was 31.1% (95% confidence interval: 24.3 to 37.9), with 13.3%, 14.5%, and 3.3% for lipoatrophy, lipohypertrophy, and mixed forms, respectively. Mild-severe lipodystrophy affected 65.0% (58.0; 72.0) of patients. Stavudine was the only independent risk factor (any vs. none: odds ratio = 2.8; 1.4 to 5.5). Patients had lower body mass index and skinfolds but greater centralization of body fat (WHR, P < 0.0001 and skinfold ratio, P < 0.001), fasting glucose (P < 0.0001), homeostasis model assessment insulin resistance, and triglyceride levels (P < 0.01 for both) than controls. Moderately-severely lipodystrophic patients had higher triglyceride and low-density lipoprotein cholesterol than other patients (P < 0.001 and P < 0.05, respectively). Conclusions: Moderate-severe lipodystrophy affected one third of West African patients on long-term HAART and was associated with a less favorable metabolic profile.

Background The long terminal half life of piperaquine makes it suitable for intermittent preventive treatment for malaria but no studies of its use for prevention have been done in Africa. We did a cluster randomized trial to determine whether piperaquine in combination with either dihydroartemisin (DHA) or sulfadoxine-pyrimethamine (SP) is as effective, and better tolerated, than SP plus amodiaquine (AQ), when used for intermittent preventive treatment in children delivered by community health workers in a rural area of Senegal. Methods Treatments were delivered to children 3–59 months of age in their homes once per month during the transmission season by community health workers. 33 health workers, each covering about 60 children, were randomized to deliver either SP+AQ, DHA+PQ or SP+PQ. Primary endpoints were the incidence of attacks of clinical malaria, and the incidence of adverse events. Results 1893 children were enrolled. Coverage of monthly rounds and compliance with daily doses was similar in all groups; 90% of children received at least 2 monthly doses. Piperaquine combinations were better tolerated than SP+AQ with a significantly lower risk of common, mild adverse events. 103 episodes of clinical malaria were recorded during the course of the trial. 68 children had malaria with parasitaemia >3000/µL, 29/671 (4.3%) in the SP+AQ group, compared with 22/604 (3.6%) in the DHA+PQ group (risk difference 0.47%, 95%CI −2.3%,+3.3%), and 17/618 (2.8%) in the SP+PQ group (risk difference 1.2%, 95%CI −1.3%,+3.6%). Prevalences of parasitaemia and the proportion of children carrying Pfdhfr and Pfdhps mutations associated with resistance to SP were very low in all groups at the end of the transmission season. Conclusions Seasonal IPT with SP+PQ in children is highly effective and well tolerated; the combination of two long-acting drugs is likely to impede the emergence of resistant parasites. Trial Registration ClinicalTrials.gov NCT00529620

In sub-Saharan Africa, malaria and malnutrition are major causes of morbidity and mortality in children less than five years of age. To explore the impact of malnutrition on subsequent susceptibility to malaria, a cohort of 874 rural preschool children in Senegal was followed-up during one malaria transmission season from July through December. Data on nutritional status and Plasmodium falciparum parasitemia were collected at baseline. Malaria morbidity was monitored through weekly home visits. Wasted children (weight-for-height z-score < -2) were at lower risk of having at least one subsequent clinical malaria attack (odds ratio = 0.33; 95% confidence interval = 0.13-0.81, P = 0.02), whereas stunting (height-for-age z-score < -2) or being underweight (weight-for-age z-score < -2) was not associated with clinical malaria. Although non-biological explanations such as overprotection of wasted children by their mothers should be considered, immunomodulation according to nutritional status could explain the lower risk of malaria attack among wasted children.

The importance of breast-feeding for infant and child health and survival in less developed countries has been the subject of a number of studies over the last 25 years. However the epidemic of AIDS in low-income countries together with the discovery of an important risk of mother-to-child transmission of HIV-1 through breast-milk has prompted renewed interest in this subject. Indeed in order to weigh the mortality risks associated with different infant feeding practices against the risk of mother-to-child transmission of the virus it is essential to have precise estimates of relative risk of death of non-breastfed infants within narrow age intervals. Available decision guides mostly use relative mortality risks published by a WHO working group based on 6 retrospective or prospective studies among which 3 contributed to risk estimations during infancy. The mortality risk was not analysed by mode of breast-feeding (i.e. exclusive predominant or partial) because such data were not available for all studies included. In addition exclusive breast-feeding is rare in many settings and sample sizes are therefore insufficient to assess mortality risks associated with this mode of feeding. This is unfortunate since a cohort study in South Africa suggested that exclusive breast-feeding up to 3 months postpartum may be associated with a lower risk of postnatal HIV-1 transmission to the child than when other fluids or foods are added. As for all observational epidemiological studies those dealing with the association between child mortality and breast-feeding may be subject to a number of methodological problems. The objective of this workshop was to illustrate some of these using examples from the literature and mostly consider confounding reverse causality and bias by indication. (excerpt)

Objective: To describe levels, monthly variations and trends in weight and arm circumference of non-pregnant lactating women living in the Sahel, characterized by one short yearly rainy season (July-October). Methods: A mixed unbalanced cross-sectional longitudinal observational study conducted at 3, 5, 7 and 10 months postpartum among 3869 women living in the Sine area in central Senegal who had brought their infants into dispensaries for immunization from January 1990 to February 1997, and 1-5 consecutive children per woman ( 26 106 visits). Results: Mean weight was 55.7 kg (s.d.: 7.1), but it varied by 2.5-3.9 kg each year, from high means during the dry season ( March-May) to low means at the end of the rainy season (September-November). The prevalence of underweight, overweight and obesity ( body mass index (BMI)

Undernutrition in young children in developing countries is associated with an increased risk of death. But in several studies, a decrease in mortality was not associated with any decrease in the prevalence of undernutrition.A rural population of Casamance (Senegal) has been under yearly demographic surveillance by The French National Institute of Demographic Studies (INED) since 1985. Between 1960-1964 and 1990-1994, under-5 and child (1-4 years) mortality rates dropped from 312 to 127 and from 201 to 68 per 1,000, respectively. Since 1961, French Catholic nuns who are also professional nurses have been in charge of a private village dispensary located in a rural area of Casamance. This dispensary delivers permanent, high quality service and is widely attended. GROWTH MONITORING PROGRAMME: A growth-monitoring programme, supported by Cathwell, was initiated in 1969 for 0-5-year-old children (0-3 from 1985). Children were weighed wearing light clothes to the nearest 10g. Weights were recorded in a register that also contained information concerning identity (name, sex, date of birth) and address. All weights were plotted on growth charts kept by the mothers. During the sessions, the nurses provided nutrition education messages (i.e., preparation of high-energy and nutrient-dense infant gruels using local foods), advice on illness management (oral rehydration during diarrhoea) and hygiene (well and water-jar disinfection, construction of pit-latrines), importance of vaccination. From 1975, they also distributed free chloroquine during the malaria transmission season (May-November) for prevention and early presumptive treatment. Most likely thanks to this programme, infant and child mortality reached a low level at the end of the 1980s. In 1990, plasmodium resistance to chloroquine appeared, increasing malaria mortality.All weight measurements taken in 1969-1994 were entered into a database. This paper presents an analysis of weight measurements taken at 3-23 months of age from 1969-1992. A total of 4,636 infants were weighed at least once, but only 3,912 infants (1,983 boys and 1,929 girls) were available for the analysis, 724 being excluded due to missing data.The average coverage of the programme during the month of February was 88% for infants aged 3-23 months. Mean weight was examined at three target ages: 5, 11 and 15 months. Not only did the nutritional status not improve between 1969 and 1989, it even deteriorated in some years for all three age-cohorts. The nutritional status of infants in this community did not differ significantly from that of 12-23 month-old Senegalese children in the 1992-1993 Demographic and Health Survey (DHS). Seasonal differences in mean weight and the prevalence of underweight became significant in the rainy season since 1975. Underweight for the 15-month-old children increased over time during the rainy season. These findings were unexpected, since malaria morbidity is thought to be at least partially responsible for seasonal variations in the nutritional status of young children, and despite the fact that the nurses began a malaria control programme in 1975.The rapid transition towards lower childhood mortality observed in this rural area of Casamance (Senegal), was not concomitant with any improvement in infants' nutritional status from 1969 through 1992. Focused public health interventions such as vaccinations and malaria prevention probably did not improve the nutritional status. Paradoxically, growth monitoring may have been more helpful in improving health than growth. Targeted specific nutritional interventions are needed to significantly improve growth of children in this community.

Summary Background In the Sahel and sub-Sahelian regions of Africa, malaria transmission is highly seasonal. During a short period of high malaria transmission, mortality and morbidity are high in children under age 5 years. We assessed the efficacy of seasonal intermittent preventive treatment—a full dose of antimalarial treatment given at defined times without previous testing for malaria infection. Methods We did a randomised, placebo-controlled, double-blind trial of the effect of intermittent preventive treatment on morbidity from malaria in three health-care centres in Niakhar, a rural area of Senegal. 1136 children aged 2–59 months received either one dose of artesunate plus one dose of sulfadoxine-pyrimethamine or two placebos on three occasions during the malaria transmission season. The primary outcome was a first or single episode of clinical malaria detected through active or passive case detection. Primary analysis was by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00132561. Findings During 13 weeks of follow-up, the intervention led to an 86% (95% CI 80–90) reduction in the occurrence of clinical episodes of malaria. With passive case detection, protective efficacy against malaria was 86% (77–92), and when detected actively was 86% (78–91). The incidence of malaria in children on active drugs was 308 episodes per 1000 person-years at risk, whereas in those on placebo it was 2250 episodes per 1000 person-years at risk. 13 children were not included in the intention-to-treat analysis, which was restricted to children who received a first dose of antimalarial or placebo. There was an increase in vomiting in children who received the active drugs, but generally the intervention was well tolerated. Interpretation Intermittent preventive treatment could be highly effective for prevention of malaria in children under 5 years of age living in areas of seasonal malaria infection.

Extensive data from animal and human studies indicate that iron deficiency impairs thyroid metabolism. The aim of this study was to determine thyroid hormone status in iron-deficient adolescent girls. By stepwise random sampling from among all public high schools for girls in Lar and its vicinity in southern Iran, 103 out of 431 iron deficient subjects were selected. Urine and serum samples were collected and assayed for urinary iodine and serum ferritin, iron, total iron binding capacity (TIBC), thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroid hormones (fT4 and fT3), triiodothyronine resin uptake (T3RU), reverse triiodothyronine (rT3), selenium and albumin concentrations. Hematological indices for iron status confirmed that all subjects were iron-deficient. There was a significant correlation between T4 and ferritin (r = 0.52, P0.001) and between TSH and ferritin (r = -0.3, P0.05). Subjects with low serum ferritin had a higher ratio of T3/T4 (r = -0.42, P0.01). Using stepwise regression analysis, only ferritin contributed significantly to the rT3 concentration (r = -0.35, P0.01). The results indicate that the degree of iron deficiency may affect thyroid hormone status in iron-deficient adolescent girls.

Sir—Caulfield, Bentley and Ahmed recently reviewed the evidence for an association between prolonged breastfeeding and malnutrition in developing countries. 1 They stated that most prior studies had demonstrated a negative association (increased malnutrition or lower mean nutritional status, both in terms of heightfor-age and weight-for-height, among prolonged breastfed children), although an absence of a relationship, or even positive relationships have been described. We agree with the authors that confounding alone cannot explain the negative association between breastfeeding status and nutritional status, and also that ‘reverse causality’ is more likely to explain it. The authors state that according to their knowledge, ‘there is little more than anecdotal support from the scientific literature’ to support the hypothesis of reverse causality. However, at least three papers based on longitudinal studies provide results that suggest that malnourished children are weaned later than other children. In rural Guatemala, children weaned before the age of 36 months were taller than the children weaned later, and since the height differences existed from infancy, they were not a result of earlier weaning. 2 In rural Bangladesh, mean weight-for-age of children aged 12‐36 months, who were to be weaned during the following month was slightly, but significantly higher than the mean of children who were to remain breastfed, after adjustment for age (70.4% versus 69.6% of the NCHS median, P , 0.05). 3 In a periurban area of Guinea-Bissau in West Africa, children with a very low weight-for-age ( ,‐2.5 z-scores) at 10‐17 months were weaned significantly later than other children (24.1 versus 22.3 months, P , 0.05). This difference remained significant after adjustment for ethnic group and mother’s age and education. 4

Objectives. We studied reasons for cessation of breastfeeding before the age of 15 months, replacement feeding modes, and child mortality in West Africa. Methods. Data were gathered for 12208 children born between 1987 and 1997 in a rural area of Senegal. Interviews were conducted with caregivers of early-weaned children, and child mortality risks were assessed. Results. Fewer than 1% of children had been weaned early. The main reasons for early weaning were maternal death and new pregnancy (in 41% and 27% of cases, respectively). Twenty percent of children had been relactated by a wet nurse, and 16% had received formula. Many early-weaned children died before the age of 2 years (26%), particularly those weaned early as a result of the mother’s death (hazard ratio = 5.1; 95% confidence interval [CI] = 1.74, 15.0). Girls had a lower hazard ratio than boys (0.16; 95% CI=0.05, 0.41). Conclusions. Our results showed that early cessation of breastfeeding was rare but that associated mortality was high, especially when the mother had died.

This study aimed to assess the timing of sexual maturation (breast development and menarche occurrence) among sub-Saharan African adolescent girls from rural areas. In the framework of a longitudinal study of growth at puberty, the stages of pubertal development (Tanner classification) and menarche occurrence were recorded at intervals between 1995 and 2000 in a sample of 406 Senegalese adolescent girls from a rural area. Nutritional status was estimated during infancy, childhood, and adolescence within this sample, and body composition was estimated only during adolescence. At the beginning of the study (1995), the adolescent girls were 11.4 years old (SD = 0.6). At the end of the study, they were 16.5 years old (SD = 0.6). Median and quartile ages at entry into each maturity stage and its confidence limits were estimated by a lognormal parametric survival model. These adolescent girls were shorter and thinner than girls of the same age from developed countries. Median age at the onset of breast development was 12.6 years (95% CI = 12.5-12.8). Median age at the end of sexual maturation and median age at menarche were estimated respectively at 15.8 years (95% CI = 15.7-15.9) and 15.9 years (95% CI = 15.7-15.9). These adolescent girls were less mature than other adolescent girls of the same age from other developing countries. Their puberty was extremely delayed compared to that of adolescent girls of the same age from industrialized countries. Puberty in these Senegalese adolescent girls is delayed by about 3 years. This may be due to malnutrition, significant energy expenditure, and poor diet and living conditions, and possibly to genetic control.

OBJECTIVES Several studies have shown an association between vaccination and child mortality in developing countries. The present paper examines this issue using data from a Senegalese rural area which has been monitored from 1983 to the present. METHODS We analysed two birth cohorts, comprising 7796 and 3573 persons who had received either BCG and DTP (diphtheria-tetanus-pertussis) simultaneously or neither of these vaccines, and who had been followed from birth to 2 years of age. The association between vaccinations and mortality was assessed by Cox proportional hazards model. RESULTS Mortality ratios for recipients of the BCG/DTP combination were 0.59 (95% CI: 0.46-0.74) for the first cohort and 0.70 (0.50-0.97) for the second cohort. Mortality ratios for measles vaccine recipients were 0.98 (0.75-1.27) for the first cohort and 0.87 (0.57-1.30) for the second cohort. CONCLUSIONS The BCG/DTP combination was associated with a reduction in mortality whereas measles vaccination was not associated with mortality.

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.

Objective:To describe the living conditions of Senegalese adolescent girls according to their migration status, and to define the main socio-economic and biological determinants of their nutritional and growth status.Design:Health and living conditions, sexual maturation, and nutritional and growth status of adolescent girls were determined within the framework of a longitudinal study on growth.Settings:The capital city of Senegal (Dakar) and a rural community (Niakhar), 120 km south-east of Dakar.Subjects:Three hundred and thirty-one girls, 14.5–16.6 years of age, were recruited from the same villages. Thirty-six per cent of the sample remained in the villages to attend school and/or to help with household subsistence tasks (non-migrants). The remaining (64%) migrated to cities to work as maids (migrants) and lived in two different socio-economic environments: at the home of a guardian during the night and in the house of the employer during the daytime.Results:Family rural environment and guardian and employer urban environments were socio-economically different (P < 0.001). Living conditions in urban areas were better than in rural areas and the employer's environment was socio-economically more favourable. Migrants had more advanced sexual maturation and higher body mass index (BMI), fat mass index (FMI) and mid-upper arm circumference than non-migrants. However, migrants were smaller than non-migrants. BMI, FMI and weight-for-age were related to socio-economic levels and duration of migration. Schooling was positively related to height and negatively related to BMI.Conclusions:Migrants enjoyed better living conditions than non-migrants. This could be partly due to the better socio-economic environment of the employer. It was associated with earlier puberty and better nutritional status, but not with a better growth.

Objective: To evaluate body composition changes using bioelectrical impedance analysis and skinfold thickness measurements in infants from tropical areas who become stunted between 4–18 months of age. Design and measurements: Follow-up study. Extracellular water to total body water ratio index (length2/resistance at low to high frequency), peripheral fat (tricipital and subscapular skinfold thickness), and length-for-age index were studied at 4 and 18 months of age. Setting: Low-income areas in four tropical regions (Congo, Senegal, Bolivia and New Caledonia). Subjects: Infants were included in the analysis provided they were neither stunted nor wasted at 4 months. Two groups of infants were compared, those that were stunted at 18 months (n=61) or not (n=170). Results: The extracellular water to total body water ratio index and the sum of skinfold thickness measurements were similar in the two groups at 4 months, and only the extracellular water to total body water ratio index was significantly different at 18 months. When no stunting appeared between 4 and 18 months, the change in the extracellular water to total body water ratio index was not linked with variations in length-for-age, and presented the expected pattern of variation in body water compartments. When stunting occurred, variation in length-for-age was related to significant changes in the extracellular water to total body water ratio index, the biggest increase in the proportion of extracellular water being found in the most stunted infants. Variations in the sum of the two skinfold thickness measurements presented the expected pattern for the 4–18 months growth and did not differ between the two groups. Conclusions: Multifrequency resistances suggested that stunting was associated with a lack of the expansion of the intracellular compartment that is expected during normal growth of cell mass, together with preserved fat mass. Sponsorship: Supported by grant 92L0623 from the French Ministry of Research, and by Institut de Recherche pour le Developpement (IRD).

Background: In Africa lactational amenorrhea is the major reason for birth spacing. Objective: We studied whether the early introduction of complementary food to infants is associated with an increased risk of menstruation resumption in rural African women. Design: Senegalese women (n = 855) were included at 2–3 mo postpartum and followed up at 4–5 and 6–7 mo in dispensaries. A subsample of 502 women were followed up at 9–10 mo and twice yearly at home thereafter. Risk factors for menstruation resumption were assessed with logistic regression with control for maternal parity occupation education postpartum body mass index child sex and weight-for-age and season. Results: The risk of menstruation resumption was 4.2% (95% CI: 2.8% 5.6%) at 6–7 mo and 6.5% (4.0% 8.9%) at 9–10 mo. Compared with the introduction of complementary food after 6–7 mo introduction at 2–3 4–5 or 6–7 mo was associated with a greater odds of menstruation resumption at 6–7 mo [odds ratios (ORs): 5.08 (1.01 25.5) 6.00 (1.29 27.4) and 4.45 (0.96 20.6; NS) respectively]. Introduction of food at 4–5 or 6–7 mo compared with that after 6–7 mo was associated with significantly greater odds of menstruation resumption at 6–7 mo (5.13; 1.16 22.6) but not at 9–10 mo (3.07; 0.65 14.4; NS) or year 2. Conclusion: Child age at introduction of complementary food was significantly associated with the odds of menstruation resumption at 6–7 mo postpartum. (authors)

Objective: To study the long-term impact of stunting during infancy on maturation, growth and fat distribution in adolescence. Design: A cohort of 406 Senegalese adolescent girls of rural origin underwent clinical and growth assessments every year from 1995 to 1999. Subjects: Mean coverage rate was 82% at each round. Adolescent girls were 11.4±0.5 y of age in 1995 and 15.5±0.5 y of age in 1999. Their growth status during infancy was known. About 20% of the girls had a height–age (H–age) below −2 Z-scores (chronic malnutrition or stunting) when they were 6–18 months of age. As adolescents, the girls were divided into two groups on the basis of H–age: those stunted and those non-stunted during infancy. Measurements: Sexual maturation was assessed by stage of breast development and menarche. Height, body mass, sitting height, bi-iliac and bi-acromial diameters, and six skinfolds were measured. Results: Differences in sexual maturation between previously stunted and non-stunted girls were not significant. Girls stunted at infancy caught up in body weight and subcutaneous fat mass during puberty, but they did not catch up on stature, sitting height or skeletal breadths (bi-acromial and bi-iliac diameters) until the final observation in 1999. Stunted girls did not have less subcutaneous fat (sum of six skinfolds) or a lower BMI. Regional variation in subcutaneous fat distribution (Z-score profile) indicated greater accretion at the biceps and subscapular sites in stunted compared to the non-stunted girls. Regional fat distribution was also assessed by principal component analysis (PCA) performed on the residuals of the six skinfolds measured during the final round (1999). PCA identified three components. Stunted and non-stunted girls were similar for the first (trunk–extremity contrast) and second (anterior–posterior contrast) components. However, there was a difference for the third component: stunted girls tended to accumulate more subcutaneous fat on the upper part of the body (trunk or arms) than non-stunted girls. Conclusion: Stunted Senegalese girls have a potential for catching up in growth during puberty. The greater accumulation of subcutaneous fat on the upper body in stunted girls may be a consequence of complex hormonal adjustments at the onset of puberty. Sponsorship: Institut de Recherche pour le Developpement (IRD anciennement ORSTOM) and the Nestle Foundation. European Journal of Clinical Nutrition (2001) 55, 50–58

BACKGROUND In many developing countries, breastfed children have a lower nutritional status than those weaned from 12 months of age. Reverse causality, that is, earlier weaning of healthy and well-nourished children, is a possible explanation. METHODS Maternal reasons for early and late weaning were investigated in a cohort of 485 rural Senegalese children using structured interviews during two rounds at the ages of 18--28 and 23--33 months, respectively. Length, weight and height were assessed, and dates of weaning were monitored. RESULTS The mean duration of breastfeeding was 24.1 months (quartiles 21.9 and 26.3). Two-thirds of mothers of breastfed children under 2 stated that they would wean at the age of 2, while for breastfed children aged 2 years, a 'tall and strong' child was the most prevalent criterion. The main reasons for weaning prior to 2 years (N = 244) were that the child ate well from the family plate (60%), that the child was 'tall and strong' (46%) and maternal pregnancy (35%). The main reasons for weaning later than the age of 2 were: a 'little, weak' child (33%), food shortage (25%), illness of the child (24%) and refusal of family food (14%, N = 120). Children breastfed above the age of 2 because they were 'small and weak' had lower mean height-for-age and a greater prevalence of stunting than children breastfed late for other reasons (P < 0.0001). CONCLUSION The habit of postponing weaning of stunted children very likely explains why breastfed children have lower height-for-age than weaned children in this setting.

La littérature traduit généralement une synergie entre la Malnutrition Protéïno-Energétique (MPE) et les infections. Pour certaines situations, cette synergie est discutée, comme par exemple les relations entre malnutrition et paludisme. Dans la cas de la rougeole, ses interactions avec la malnutrition posent un certain nombre d'interrogations quant aux rôles respectifs de la malnutrition ou de l'intensité de l'exposition dans la sévérité de la rougeole. L'objectif de ce travail, dans ce contexte, est d'évaluer l'impact de l'état nutritionnel sur la sévérité de la rougeole. Il a été conduit au Laboratoire d'Epidémiologie des Maladies Infectieuses et Parasitaires de l'Institut de Recherhce pour le Developpement de Montpellier à partir de données anthropométriques et vaccinales recueillies à Niakhar (zone rurale du Sénégal), sur 623 enfants de moins de 10 ans chez lesquels la rougeole a été signalée entre 1988 et 1993. L'état nutritionnel a été apprécié à partir de l'indice poids-taille, du tour de bras, de l'indice taille-âge et de certains marqueurs de malnutrition tels que la période de naissance et la durée d'allaitement. La gravité de la rougeole a été évaluée par un score de gravité calculé à partir des symptômes de rougeole pondérés par la sévérité avec laquelle les symptômes s'étaient exprimés et la vitesse de perte de poids durant l'épisode de rougeole. L'indice taille-âge et le score de gravité ont été retenus pour l'évaluation des relations entre l'état nutritionnel et la rougeole. Le fait d'être de sexe féminin s'est révélé être un facteur de risque du retard de croissance (RR égal à 2.11 et p inférieur à 0.05) mais n'a pas eu d'effet sur la sévérité de la rougeole. Des differences significatives ont été observées entre les groupes d'âge quant à la propension des enfants à être atteints de rougeole sévère et d'être retardés en taille (p inférieur à 0.01 dans les deux cas). (D'après résumé d'auteur)

Breastfeeding, when prolonged beyond infancy, is a risk factor for low nutritional status in most cross-sectional samples from less developed countries. Therefore, it has been suggested that prolonged breastfeeding impairs growth. To test whether, on the contrary, breastfeeding is prolonged because the child is already undernourished, nutritional status prior to weaning was compared according to age at weaning.Precise dates of birth and weaning were collected weekly through continuous demographic surveillance in a rural area of Senegal. Weight and length at 9-10 months were measured during vaccination sessions (coverage: 78%) from 1989 to 1996. Eight infants weaned before 9 months were excluded, and the duration of breastfeeding of the remaining 4515 children was compared according to nutritional status at 9-10 months by survival analysis.Length-for-age during infancy was associated with duration of breastfeeding: the median duration was 25.0 months for z-scores-2, 24.1 months for z-scores -2 to -1, 23.4 months for z-scores -1 to 0 and 22.7 months for z-scores0 (P for trend0.0001). Weight-for-length during infancy was also associated with duration of breastfeeding (P for trend0.0001), though the differences among groups were smaller. The relationships remained at the same significance levels after adjustment for season of birth, mother's age, parity, height, occupation and education.Duration of breastfeeding is not determined by characteristics of the mothers only. Women prolong breastfeeding for undernourished children and reduce the duration for well-nourished children, probably because they are aware of the mortality risk following weaning.Several cross-sectional studies conducted in developing countries have indicated that prolonged breast feeding has a detrimental effect on child growth. It is possible, however, that breast feeding is prolonged in an attempt to correct undernutrition. This possibility was assessed through reference to demographic surveillance data on 4515 infants conducted in rural Senegal in 1989-96. Weaning data were collected weekly and weight and length were measured during vaccination sessions at 9-10 months of age. The prevalences of stunting and wasting were 13.7% and 11.6%, respectively. The median duration of breast feeding was 25.0 months for length-for-age z-scores less than -2, 24.1 months for z-scores from -1 to 0, and 22.7 months for z-scores above 0 (p 0.0001). At 24 months, the probability of still being breast-fed was 70.7% for children with a length-for-age of less than -2 z-scores and 37.5% for those who had a length-for-age above 0 z-score. Weight-for-length was also significantly associated with breast-feeding duration, although the differences among groups were smaller. These associations retained significance after adjustment for season of birth, parity, and maternal age, height, occupation, and education. These findings suggest that mothers do tend to prolong breast feeding for undernourished children and reduce its duration for well-nourished infants. The lower nutritional status often reported among breast-fed infants is probably not due to any negative impact of prolonged breast feeding on growth, but rather to pre-existing differences.

This study describes the habitual physical activity of a group of women in Northern Senegal who are involved in a hydroagricultural development program and assesses its consequences for their nutritional status. A group of 30 women was followed on three occasions during a complete agricultural cycle. At each visit, activities were observed and timed over periods of 3 and 2 consecutive days. Anthropometric dimensions were taken at each visit, with a follow-up 1 year later. The women were divided into three groups according to reproductive status: pregnant (P), lactating (L), and nonpregnant, nonlactating (NPNL). The P group showed a gain in weight and body mass index only starting with the second trimester of pregnancy. During the postpartum stage, indices of arm muscle mass were lower than those measured prior to pregnancy. The L and NPNL groups did not show any changes in anthropometric indices during the cycle. Activity intensity levels among the women did not change from one visit to another. The levels could be classified as moderate to heavy intensity according to the FAO/WHO/UNU criteria. Overall the NPNL group was more active than the P group, with the latter increasing rest time and light activity at the onset of pregnancy. The time spent on subsistence activities outside of the household varied from one visit to the next according to the demand for agricultural labor. Estimated energy expenditure of the women was compatible with their physiological state; however, increased participation of P and L women in agricultural work, especially work related to rice cultivation, could have a negative impact on their nutritional status. © 1996 Wiley-Liss, Inc.

Summary In the Sahel, most malaria deaths occur among children 1–4 years old during a short transmission season. A trial of seasonal intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) and a single dose of artesunate (AS) showed an 86% reduction in the incidence of malaria in Senegal but this may not be the optimum regimen. We compared this regimen with three alternatives. Methods 2102 children aged 6–59 months received either one dose of SP plus one dose of AS (SP+1AS) (the previous regimen), one dose of SP plus 3 daily doses of AS (SP+3AS), one dose of SP plus three daily doses of amodiaquine (AQ) (SP+3AQ) or 3 daily doses of AQ and AS (3AQ+3AS). Treatments were given once a month on three occasions during the malaria transmission season. The primary end point was incidence of clinical malaria. Secondary end-points were incidence of adverse events, mean haemoglobin concentration and prevalence of parasites carrying markers of resistance to SP. Findings The incidence of malaria, and the prevalence of parasitaemia at the end of the transmission season, were lowest in the group that received SP+3AQ: 10% of children in the group that received SP+1AS had malaria, compared to 9% in the SP+3AS group (hazard ratio HR 0.90, 95%CI 0.60, 1.36); 11% in the 3AQ+3AS group, HR 1.1 (0.76–1.7); and 5% in the SP+3AQ group, HR 0.50 (0.30–0.81). Mutations associated with resistance to SP were present in almost all parasites detected at the end of the transmission season, but the prevalence of Plasmodium falciparum was very low in the SP+3AQ group. Conclusions Monthly treatment with SP+3AQ is a highly effective regimen for seasonal IPT. Choice of this regimen would minimise the spread of drug resistance and allow artemisinins to be reserved for the treatment of acute clinical malaria. Trial Registration Clinicaltrials.gov NCT00132548

Background : Prolonged breast-feeding is frequently associated with malnutrition in less-developed countries, even after adjustment for socioeconomic confounders. However, in rural Senegal, breast-feeding is prolonged when the child is stunted. Objective : We aimed to test whether the lower height-for-age of children weaned late is explained by their height before weaning or whether prolonged breast-feeding is associated with impaired growth. Design : A cohort of 443 Senegalese children recruited from dispensaries at 2 mo of age were visited in their homes at 6-mo intervals when they were approximately 1.5 to 3 y of age. Weight, length, arm circumference, and triceps skinfold thickness were measured. Six-month increments were analyzed in relation to breast-feeding (breast-fed compared with weaned children or breast-feeding duration), season, and maternal housing with use of multiple linear regression. Results : The mean duration of breast-feeding was 243.1 mo (quartiles 1 and 3 : 21.9 and 26.4). Height-for-age at the age of 3 y was negatively associated with age at weaning (P is less than 0.01), but this association disappeared after adjustment for height-for-age in infancy. Length increments were significantly greater in both the second and third years of life in children breast-fed for longer durations (P is less than 0.05) and tended to be greater in breast-fed than in weaned children in the second year of life (P = 0.05). In the third year of life, breast-fed children had greater length increments than did weaned children in the subgroup with poor housing (P for interaction is less than 0.05). Growth in weight did not differ significantly according to breast-feeding. Conclusion : Prolonged breast-feeding improved linear growth, and the negative relation between height-for-age and duration of breast-feeding was due to reverse causality. (D'après résumé d'auteur)