Gansaonré Rabi Joël, Moore Lynne, Kobiané Jean-François, Sié Aly, Haddad Slim
Faculté de Médecine, Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada.
VITAM-Centre de Recherche en Santé Durable de l'Université Laval, Québec, QC, Canada.
PLoS One. 2024 Dec 11;19(12):e0314051. doi: 10.1371/journal.pone.0314051. eCollection 2024.
Impaired growth in childhood can lead to poor cognitive development and low school performance. However, literature on the effects of stunting on school trajectory is very limited. The primary objective of this research was to estimate the age at which children start school according to levels of height-for-age z-score (stunting). A second objective was to estimate the gain in terms of age at school entry associated with an improvement in height-for-age z-score. A third objective was to explore the relationship between stunting, grade repetition, and school dropout.
We used longitudinal data from the Ouagadougou (Burkina Faso) Health and Demographic Surveillance System. Data from a 2010 health survey of children under 5 years of age were merged with subsequent longitudinal schooling data. The study included 767 children globally who participated in the health and education surveys. Education data allowed us to apprehend academic trajectory measured by age at school entry, repetition, and dropout. The health survey gathered anthropometric information that was used to measure stunting. The adjusted age at school entry was estimated using a Poisson model. The gain represents the difference in adjusted age at school entry for different values of height-for-age. The relationship between stunting and grade repetition and dropout was studied using a discrete-time survival model.
Results showed that children entered school on average at 5.7 years old, and the incidence of grade repetition and dropout was 17.7 and 6.6 per 100 persons-years, respectively. The adjusted age at school entry of severely stunted children was 6.2 years [95% confidence intervals (CI): 6.1; 6.3] compared to 5.1 years [95% CI: 5.0; 5.3] for children who had normal growth. The difference (gain) in adjusted age at school entry between severely and non-stunted children was thus 1.06 [95% CI: 0.87; 1.25] years. If a child's growth changed from severe stunting to normal growth, their risk of repeating a grade decreased by 5.0 [95% CI: 0.0; 9.0] per 100 persons-years. We did not observe a relationship between height-for-age and dropout.
The results show that schooling is affected in several ways for children who are stunted. The age at school entry of stunted children is more likely to be delayed. Also, being stunted is associated with higher incidence of grade repetition. However, the relationship between stunting and dropout was inconclusive.
儿童期生长发育受损会导致认知发展不良和学业成绩低下。然而，关于发育迟缓对学业轨迹影响的文献非常有限。本研究的主要目的是根据年龄别身高Z评分（发育迟缓）水平估计儿童开始上学的年龄。第二个目的是估计与年龄别身高Z评分改善相关的入学年龄增加情况。第三个目的是探讨发育迟缓、留级和辍学之间的关系。
我们使用了瓦加杜古（布基纳法索）健康与人口监测系统的纵向数据。2010年对5岁以下儿童的健康调查数据与随后的纵向学校教育数据进行了合并。该研究包括全球范围内767名参与健康和教育调查的儿童。教育数据使我们能够了解以入学年龄、留级和辍学衡量的学业轨迹。健康调查收集了用于测量发育迟缓的人体测量信息。使用泊松模型估计调整后的入学年龄。增加量代表不同年龄别身高值的调整后入学年龄差异。使用离散时间生存模型研究发育迟缓与留级和辍学之间的关系。
结果显示，儿童平均5.7岁入学，留级和辍学发生率分别为每100人年17.7例和6.6例。重度发育迟缓儿童的调整后入学年龄为6.2岁[95%置信区间（CI）：6.1；6.3]，而生长正常儿童为5.1岁[95%CI：5.0；5.3]。因此，重度发育迟缓和非发育迟缓儿童调整后入学年龄的差异（增加量）为1.06岁[95%CI：0.87；1.25]。如果儿童的生长从重度发育迟缓转变为正常生长，他们的留级风险每100人年降低5.0[95%CI：0.0；9.0]。我们未观察到年龄别身高与辍学之间的关系。
结果表明，发育迟缓儿童的上学情况在多个方面受到影响。发育迟缓儿童的入学年龄更有可能延迟。此外，发育迟缓与留级发生率较高有关。然而，发育迟缓与辍学之间的关系尚无定论。
