Diarrhoea and growth faltering in rural Zimbabwe.

OBJECTIVE

To assess the evidence that diarrhoea is an important cause of growth faltering in young children in developing countries.

DESIGN

Prospective, longitudinal cohort study.

SETTING

Worker's compounds on commercial farms in Shamva, rural Zimbabwe.

SUBJECTS

204 children < 12 months old were enrolled, 73 from birth. The median age at enrolment was 4 months. Eleven children died and 39 were lost to follow-up.

INTERVENTIONS

Prospective weekly diarrhoea surveillance by farm health workers and monthly anthropometry.

RESULTS

Growth faltering was severe, but there was little difference in average rates of growth between children with frequent diarrhoea and infrequent diarrhoea. The results of an interval-based data analysis were consistent with there being only a transient effect of diarrhoea on weight gain. Estimation of weight faltering following episodes of diarrhoea and the rate of return to the trend in the 9-14 month age range, indicated that weight loss associated with each episode was small (approximately 2%) and return to the child's trend was 90% complete within a month. At older ages than this, weight loss appeared to be less, and estimates were not statistically significant.

CONCLUSIONS

These observations lend weight to the hypothesis that recurrent episodes of diarrhoea are not a potent cause of growth faltering in early childhood except in a small minority of largely catastrophic cases. Inadequate food intake is a more plausible explanation.