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Biomedical subjects

S Grantham-McGregor

Publications and source records attributed to S Grantham-McGregor.

At least 19 recordsLinked to original sources
PubMed2005

The effect of early stimulation on maternal depression: a cluster randomised controlled trial.

AIM: To determine the effect of early childhood stimulation with undernourished children and their mothers on maternal depression. METHODS: Mothers of 139 undernourished children (weight for age < or =-1.5 z-scores) aged 9-30 months were recruited from 18 government health centres in the parishes of Kingston, St Andrew, and St Catherine, Jamaica. They received weekly home visits by community health aides for one year. Mothers were shown play activities to do with their child using home made materials, and parenting issues were discussed. Frequency of maternal depressive symptoms was assessed by questionnaire. Child development was also measured. RESULTS: Mothers in the intervention group reported a significant reduction in the frequency of depressive symptoms (b = -0.98; 95% CI -1.53 to -0.41). The change was equivalent to 0.43 SD. The number of home visits achieved ranged from 5 to 48. Mothers receiving > or =40 visits and mothers receiving 25-39 visits benefited significantly from the intervention (b = -1.84, 95% CI -2.97 to -0.72, and b = -1.06, 95% CI -2.02 to -0.11, respectively) while mothers receiving <25 visits did not benefit. At follow up, maternal depression was significantly negatively correlated with children's developmental quotient for boys only. CONCLUSIONS: A home visiting intervention with mothers of undernourished children, with a primary aim of improving child development, had significant benefits for maternal depression. Higher levels of maternal depression were associated with poorer developmental levels for boys only.

Adult↗
PubMed2003

Mothers of undernourished Jamaican children have poorer psychosocial functioning and this is associated with stimulation provided in the home.

OBJECTIVES: To compare mothers of undernourished children with mothers of adequately nourished children on maternal depression, parenting self-esteem, social support and exposure to stressors and to determine if these variables are independently related to undernutrition and stimulation provided in the home after controlling for socio-economic status. DESIGN: A case control study. SETTING: Children and their mothers were recruited from 18 government health centres in the Kingston, St Andrew and St Catherine parishes of Jamaica. SUBJECTS: One hundred and thirty-nine mothers of undernourished children (WAZ< or =-1.5z scores) aged 9 - 30 months and 71 mothers of adequately nourished children (WAZ > -1z scores) matched for sex and age group were enrolled into the study. RESULTS: Mothers of undernourished children came from poorer homes but had similar social support to mothers of adequately nourished children. They were more depressed, had lower levels of parenting self-esteem (both P<0.01), reported higher levels of economic stress (P<0.001) and provided a less stimulating home environment (P<0.05). However, after controlling for social background variables there was no independent relationship between either psychosocial function or home stimulation and nutritional status. Undernutrition was found to be mainly explained by economic factors. The mothers' self-esteem was independently associated with the level of stimulation provided to the child. CONCLUSIONS: When caring for undernourished children attention should be paid to the psychosocial status of the mother as well as the physical condition of the child. SPONSORSHIP: Thrasher Research Fund; Campus Research and Publication Fund, UWI, Jamaica.

Case-Control Studies↗
PubMed2002

Psychological well-being of orphans in Dar El Salaam, Tanzania.

UNLABELLED: Forty-one orphans whose fathers and/or mothers had died from AIDS, and were living in the poor suburbs of Dar Es Salaam, Tanzania, were compared with 41 matched non-orphans from the same neighbourhoods. The subjects were given an arithmetic test and a semi-structured questionnaire concerning any internalizing problems, their attendance at school and their experiences of punishment, reward and hunger. The scale of internalizing problems comprised 21 items adapted from the Rand Mental Health and Beck Depression Inventories concerning mood, pessimism, somatic symptoms, sense of failure, anxiety, positive affect and emotional ties. Most orphans lived with aunts and uncles. Compared with non-orphans, they were significantly less likely to be in school but those who did attend school had similar arithmetic scores. Significantly more orphans went to bed hungry. Orphans had markedly increased internalizing problems compared with non-orphans (p < 0.0001) and 34% reported they had contemplated suicide in the past year. Multiple regression analysis indicated that the independent predictors of internalizing problem scores were sex (females higher than males), going to bed hungry, no reward for good behaviour, not currently attending school, as well as being an orphan. CONCLUSION: The orphans not only had unmet basic needs, but also had markedly increased internalizing problems, thus their long-term mental health would be in jeopardy. There is an urgent need to expand and improve current intervention programmes not only to meet the basic needs but also to include psychosocial support, counselling services for the orphans, and training for their carers and teachers.

Adolescent↗
PubMed2002

Early childhood stunting and later behaviour and school achievement.

BACKGROUND: Stunting in early childhood is common in developing countries and is associated with poorer cognition and school achievement in later childhood. The effect of stunting on children's behaviours is not as well established and is examined here. METHOD: Children who were stunted at age 9 to 24 months and had taken part in a 2-year intervention programme of psychosocial stimulation with or without nutritional supplementation were reexamined at age 11-12 years and compared with non-stunted children from the same neighbourhoods. Their school and home behaviours were assessed using the Rutter Teacher and Parent Scales and school achievement was measured using the Wide Range Achievement Test (WRAT) and the Suffolk Reading Scales. RESULTS: No significant intervention effects were found among the stunted groups. Thus data from the four intervention groups were aggregated for subsequent analyses, comparing all 116 stunted children with 80 non-stunted children. Controlling for social background variables, the stunted group had more conduct difficulties (p < .05) as rated by their parents. They also had significantly lower scores in arithmetic, spelling, word reading and reading comprehension than the non-stunted children (all p < .001). Conduct difficulties and hyperactivity were related to poorer school achievement. Controlling for the children's IQ, the stunted children's arithmetic scores remained significantly lower than those of the non-stunted children, but reading and spelling scores were not different. CONCLUSIONS: Previously stunted children had more conduct difficulties at home, regardless of their social background, than non-stunted children. Their educational attainment was also poorer than non-stunted children and these results are suggestive of a specific arithmetic difficulty. Children with behaviour problems performed less well at school.

Achievement↗
PubMed2001

A review of studies on the effect of iron deficiency on cognitive development in children.

Studies on the effect of iron deficiency on children's cognition and behavior are selectively reviewed, looking for evidence of a causal relationship. Most correlational studies have found associations between iron-deficiency anemia and poor cognitive and motor development and behavioral problems. Longitudinal studies consistently indicate that children anemic in infancy continue to have poorer cognition, school achievement, and more behavior problems into middle childhood. However, the possible confounding effects of poor socioeconomic backgrounds prevent causal inferences from being made. In anemic children <2 y old, short-term trials of iron treatment have generally failed to benefit development. Most longer trials lacked randomized placebo groups and failed to produce benefits. Only one small randomized controlled trial (RCT) has shown clear benefits. It therefore remains uncertain whether the poor development of iron-deficient infants is due to poor social backgrounds or irreversible damage or is remediable with iron treatment. Similarly, the few preventive trials have had design problems or produced no or questionable benefits only. For children >2 y old, the evidence from RCT is reasonably convincing but not conclusive. RCT of iron treatment are warranted especially in younger children.

Achievement↗
PubMed2001

The effects of birth weight and postnatal linear growth retardation on blood pressure at age 11-12 years.

STUDY OBJECTIVE: To determine the effects of birth weight and linear growth retardation (stunting) in early childhood on blood pressure at age 11-12 years. DESIGN: Prospective cohort study. SETTING: Kingston, Jamaica. PARTICIPANTS: 112 stunted children (height for age < -2 SD of the NCHS references) and 189 non-stunted children (height for age > -1 SD), identified at age 9-24 months by a survey of poor neighbourhoods in Kingston. MAIN RESULTS: Current weight was the strongest predictor of systolic blood pressure (beta= 4.90 mm Hg/SD weight 95%CI 3.97, 5.83). Birth weight predicted systolic blood pressure (beta = -1.28 mm Hg/SD change in birth weight, 95% CI -2.17, -0.38) after adjustment for current weight. There was a significant negative interaction between stunting in early childhood and current weight indicating a larger effect of increased current weight in children who experienced linear growth retardation in early childhood. There was no interaction between birth weight and current weight. The increase in blood pressure from age 7 to age 11-12 was greater in children with higher weight at age 11-12 and less in children with higher birth weight and weight at age 7. CONCLUSIONS: Birth weight predicted systolic blood pressure in Jamaican children aged 11-12. Postnatal growth retardation may potentiate the relation between current weight and blood pressure. Greater weight gain between ages 7 and 11 was associated with a greater increase in systolic blood pressure. The relation between growth and later blood pressure is complex and has prenatal and postnatal components.

Anthropometry↗
PubMed1999

Health research in the commonwealth Caribbean.

Health research and the dissemination of its findings are important to healthcare development. It is therefore useful to monitor the productivity of scientists and to examine the difficulties which affect their ability to conduct and publish research findings. This study aimed to examine these factors in six Caribbean countries. Health researchers publishing two or more papers in referred professional journals between 1987 and 1990 were interviewed to determine area of research, number of publications and research constraints. In those four years, 427 first authored articles were published by those interviewed. University of the West Indies (UWI) researchers in the three campus territories published most of the articles, with little research being done in noncampus territories. Of seven priority areas defined by Caribbean Health Ministers, most researchers were interested in chronic diseases, maternal and child health, followed by nutrition and the acquired immunodeficiency syndrome (AIDS). There was not much research on human resource development and strengthening of health care systems. Major constraints to research were lack of resources including funding, time, staff and equipment. Despite this, only 54% had applied for funding. There were few posts for research at the UWI. Notwithstanding these constraints, researchers were conducting several projects simultaneously and were involved with more projects than would be expected from the number of publications. Many expressed the need for experienced advice and assistance in writing protocols and analyzing data. At the UWI it might be helpful to appoint a senior person or group in each department with specific responsibility for promoting research.

Caribbean Region↗
PubMed1998

Family and personal characteristics of aggressive Nigerian boys: differences from and similarities with Western findings.

PURPOSE: To identify the family and child determinants of aggressive behaviour in Nigerian elementary school boys and to compare the findings with previous ones from Western studies. METHODS: Forty-seven aggressive boys from four elementary schools in Lagos, Nigeria were compared with 47 matched pro-social boys. Teacher rating and peer nomination were combined to select subjects. The subjects and their parents were given structured questionnaires to obtain information on possible risk factors for aggression. RESULTS: Compared with pro-social boys, it was found that significantly more aggressive boys came from polygamous families and crowded homes, had more siblings, received less parental affection, were more physically punished, less supervised at home, witnessed more domestic conflicts, did poorly at school, had poorer verbal intelligence and attributed malice more readily than pro-social boys. Logistic regression indicated that the independent family predictors of aggression were crowding, little paternal affection, and corporal punishment. The independent child predictors were biased attribution and poor school achievement. Corporal punishment at school was also an independent predictor of aggression. CONCLUSIONS: The family and child determinants of aggressive behaviour in Nigeria are similar to those found in Western studies except for the small contribution of family instability and overwhelming influence of corporal punishment in our sample. Models of intervention developed in the West may therefore be cautiously applied to Nigerian children.

Aggression↗
PubMed1996

Trichuris trichiura infection and cognitive function in Jamaican school children.

Trichuris trichiura is extremely prevalent worldwide and there is concern that this geohelminth may affect the cognitive function of children in developing countries. A random-controlled, double-blind, treatment trial was conducted in Jamaican children with light to moderate infections. This was part of a research programme involving several studies in Jamaica. Ninety-seven subjects, each with a minimum of 1200 T. trichiura eggs/g faeces, were randomly assigned to placebo (N = 48) or treatment (N = 49) groups. Each pair of infected children was matched with an uninfected classmate (N = 48). All children were given seven cognitive function tests: French-learning; digit spans (forwards and backwards), Corsi block span; fluency; picture search; and silly sentences. Albendazole was given to the treatment group and the other groups received a placebo. Three months later, these treatments were repeated, and the cognitive function battery was given again. On pre-test, the infected groups performed significantly poorer only in the silly-sentence test (analysis of variance F-value = 8.17; two degrees of freedom; P < 0.001). There was no significant improvement with treatment in any of the tests. Taking into account these findings and those of the other Jamaican studies, it is therefore probable that light to moderate Trichuris infections have little effect on cognitive functioning in school children who have adequate nutritional status.

Albendazole↗
PubMed1995

A review of studies of the effect of severe malnutrition on mental development.

This is a review of studies on the relationship between mental development and severe malnutrition. School-age children who suffered from early childhood malnutrition have generally been found to have poorer IQ levels, cognitive function, school achievement and greater behavioral problems than matched controls and, to a lesser extent, siblings. The disadvantages last at least until adolescence. There is no consistent evidence of a specific cognitive deficit. The evidence of a causal relationship is strong but not unequivocal because of difficulties in interpreting retrospective case control studies. Marked improvements in development can occur after adoption or intervention. Therefore, the outcome depends to a large extent on the quality of the subsequent environment. It is likely that extremely deprived environments would exacerbate the effects. There is limited evidence that other nutritional deficiencies may interact with previous malnutrition in affecting cognition. The mechanism linking malnutrition to poor development is still not established.

Child↗
PubMed1994

School performance, nutritional status and trichuriasis in Jamaican schoolchildren.

Severe infections by the geohelminth Trichuris trichiura detrimentally affect young children's growth and development. There is concern that mild to moderate infections may affect older children's school performance and nutritional status. We therefore examined the relationship between varying intensities of infection and school achievement, attendance and nutritional status in 616 schoolchildren. A total of 409 children with Trichuris infection of intensities greater than 1200 eggs per gram of stool (epg) were first identified, then for every 2 infected children in a class, an uninfected child was selected. After controlling for socioeconomic status, gender, age, school and the presence of Ascaris infections, the uninfected children had higher reading and arithmetic scores than children with infections of more than 4000 epg and were taller than those with intensities greater than 2000 epg. However, there were no significant differences in spelling, school attendance and body mass index. Although a treatment trial is needed to determine causation, these results indicate that moderate levels of infection are associated with poor school achievement and growth.

Case-Control Studies↗
PubMed1994

The long-term follow-up of severely malnourished children who participated in an intervention program.

18 severely malnourished children (IM) who participated in a 3-year home-visiting program were compared with 2 other comparison groups comprising 17 severely malnourished (NIM) and 19 adequately nourished children (controls). On enrollment, all the groups were in the same hospital, and both malnourished groups had lower developmental levels than the controls. The IM group received intervention for 3 years after hospitalization, consisting of weekly or 2 weekly home visits with toy demonstrations. At 7, 8, 9, and 14 years after leaving the hospital, the 3 groups were compared on tests of school achievement and IQ. The NIM group showed no sign of reducing their deficits, and at the 14-year follow-up they had markedly lower scores on the WISC verbal and performance scales, the Wide Range Achievement Test (WRAT), and the Peabody Picture Vocabulary Test (PPVT), than the controls. Throughout the follow-up the IM group's scores were intermediate between the NIM and the controls in every test. At the 14-year follow-up, their scores were significantly higher than those of the NIM group in the WISC verbal scale, and the difference approached significance in the WRAT. We conclude that psychosocial intervention should be an integral part of treatment for severely malnourished children.

Adolescent↗
PubMed1991

Behaviour of severely malnourished children in a Jamaican hospital.

The behaviour of 18 children with severe malnutrition between the ages of six and 24 months was observed. They were compared with 21 age-matched adequately nourished children in hospital with other diseases, and were given regular developmental assessments with the Griffiths test. On admission to hospital the malnourished children were less active and more apathetic than the controls when alone in their cots, while the controls were more distressed. When given toys, initially the malnourished children explored them less, using fewer play actions and touching fewer toys. These differences were not present on recovery. Initial behaviour did not predict later developmental levels.

Brain Damage, Chronic↗
PubMed1990

Bioelectrical impedance, anthropometry and body composition in stunted and non-stunted children.

Bioelectrical impedance (BIA) and anthropometric measurements were taken of 129 stunted and 32 non-stunted children aged 9-24 months in Kingston, Jamaica. The reliability of BIA in such young children was examined and the relationships between impedance and anthropometry were determined. The stunted children had significantly lower body mass index (BMI) and smaller triceps skinfolds than the non-stunted children, suggesting differences in body composition between the groups. Resistance was significantly higher in the stunted children than the non-stunted children and nutritional group (stunted or non-stunted) contributed significantly to the variance in resistance after controlling for length, weight, mid-upper arm circumference, triceps and subscapular skinfolds, age and sex. This suggests that there were differences in body composition and/or body shape between the groups beyond that measured by the anthropometric indices used. Total body water (TBW) was estimated using an equation for Jamaican children of comparable age. As a percentage of body weight the TBW estimates were the same for the two groups, a finding which is inconsistent with the anthropometric data.

Anthropometry↗