Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Population, Practice and Policy Programme UCL Great Ormond Street Institute of Child Health, London, United Kingdom.
PLoS One. 2018 Nov 5;13(11):e0200380. doi: 10.1371/journal.pone.0200380. eCollection 2018.
Stunting or linear growth retardation in childhood is associated with delayed cognitive development due to related causes (malnutrition, illness, poor stimulation), which leads to poor school outcomes at later ages, although evidence of the association between the timing and persistence of stunting and school outcomes within the sub-Saharan African context is limited.
Anthropometric data around birth (0-4 months), early (11-16 months) and late childhood (ages 4-8 years) along with school outcomes up until the age of 11 were analysed for a cohort of 1,044 respondents, born between 2002-2004 in Karonga district, northern Malawi. The schooling outcomes were age at school enrolment, grade repetition in Standard 1 and age-for-grade by age 11. Height-for-Age Z-scores (HAZ) and growth trajectories were examined as predictors, based on stunting (<-2SD HAZ) and on trajectories between early and late childhood (never stunted, improvers, decliners or persistently stunted). Multinomial and logistic regression were used to estimate the association between stunting/trajectories and schooling, adjusted for socioeconomic confounders.
The effects of stunting on schooling were evident in early childhood but were more pronounced in late childhood. Children who were stunted in early childhood (9.3%) were less likely to be underage at enrolment, more likely to repeat Standard 1 and were 2-3 times more likely to be overage for their grade by the age of 11, compared to their non-stunted peers. Those persistently stunted between early and late childhood (7.3%) faced the worst consequences on schooling, being three times as likely to enrol late and 3-5 times more likely to be overage for their grade by the age of 11, compared to those never stunted. Compared to improvers, those persistently stunted were three times as likely to be overage by two or more years by the age of 11, with no effect on enrolment or repetition.
Our findings confirm the importance of early childhood stunting on schooling outcomes and suggest some mitigation by improvements in growth by the age of starting school. The nutritional and learning needs of those persistently stunted may need to be prioritised in future interventions.
儿童时期的发育迟缓或线性生长迟缓与相关原因（营养不良、疾病、不良刺激）导致的认知发育延迟有关，这会导致以后在学校的学习成绩较差，尽管在撒哈拉以南非洲地区，发育迟缓的发生时间和持续时间与学校学习成绩之间的关系证据有限。
对马拉维北部卡隆加区 2002-2004 年间出生的 1044 名受访者的出生（0-4 个月）、早期（11-16 个月）和晚期儿童（4-8 岁）的人体测量数据以及 11 岁之前的学校学习成绩进行了分析。学校学习成绩为入学年龄、一年级留级和 11 岁时的年龄年级。身高年龄 Z 分数（HAZ）和生长轨迹被视为预测指标，基于发育迟缓（<-2SD HAZ）和早期到晚期儿童之间的轨迹（从未发育迟缓、改善者、下降者或持续发育迟缓者）。使用多项和逻辑回归来估计发育迟缓/轨迹与学校教育之间的关联，调整了社会经济混杂因素。
发育迟缓对学校教育的影响在儿童早期就已经显现，但在儿童晚期更为明显。在儿童早期发育迟缓的儿童（9.3%）入学年龄较小的可能性较低，更有可能留级，到 11 岁时年龄年级偏高的可能性是其非发育迟缓同龄人的 2-3 倍。在早期和晚期儿童之间持续发育迟缓的儿童（7.3%）在学校教育方面面临最严重的后果，入学年龄较晚的可能性是其非发育迟缓同龄人的三倍，到 11 岁时年龄年级偏高的可能性是其非发育迟缓同龄人的 3-5 倍。与改善者相比，那些持续发育迟缓的儿童到 11 岁时年龄年级偏高两年或两年以上的可能性是其两倍，入学或留级的可能性没有变化。
我们的研究结果证实了儿童早期发育迟缓对学校学习成绩的重要性，并表明在开始上学时通过改善生长可以减轻一些影响。那些持续发育迟缓的人的营养和学习需求可能需要在未来的干预措施中得到优先考虑。
