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Biomedical subjects

Sally Grantham-McGregor

Publications and source records attributed to Sally Grantham-McGregor.

9 recordsLinked to original sources
PubMed2007

Developmental potential in the first 5 years for children in developing countries.

Many children younger than 5 years in developing countries are exposed to multiple risks, including poverty, malnutrition, poor health, and unstimulating home environments, which detrimentally affect their cognitive, motor, and social-emotional development. There are few national statistics on the development of young children in developing countries. We therefore identified two factors with available worldwide data--the prevalence of early childhood stunting and the number of people living in absolute poverty--to use as indicators of poor development. We show that both indicators are closely associated with poor cognitive and educational performance in children and use them to estimate that over 200 million children under 5 years are not fulfilling their developmental potential. Most of these children live in south Asia and sub-Saharan Africa. These disadvantaged children are likely to do poorly in school and subsequently have low incomes, high fertility, and provide poor care for their children, thus contributing to the intergenerational transmission of poverty.

Adolescent↗
PubMed2005

Review of the evidence linking protein and energy to mental development.

OBJECTIVE: To examine the evidence as to whether the relationship between undernutrition and poor child development is causal. DESIGN: Selected studies from developing countries were discussed. Observational studies were first considered then experimental studies of preventative and remedial supplementation. The type of functions affected, the presence of sensitive periods and the role of protein and energy versus that of micronutrients were reviewed. RESULTS: Childhood undernutrition is generally associated with concurrent and longer term deficits in cognition, behaviour and motor skills, although the relationship is likely to be confounded by socio-economic factors. Supplementation trials have had many design problems. However, those beginning at any age from pregnancy up to 24 months have consistently had concurrent benefits suggesting a causal relationship. Supplement begun in older children had little or no effect, albeit there are too few studies to conclude with confidence. The limited evidence suggests that benefits are more likely to be sustained if supplementation begins in late pregnancy or at birth and is continued until the child is at least 24 months old. Deficits in cognition tend to be global and there is insufficient evidence of specific deficits. There is some evidence that the first 2 years of life are most sensitive to the effects of undernutrition. Most studies have failed to separate the effects of energy and protein from those of micronutrients. One study showed that energy and/or protein affects children's development. Psychosocial stimulation has had consistent benefits on undernourished children's development. CONCLUSIONS: Public health nutrition programmes should include a component in which children who are at risk are targeted during the first 2 years of life with combined interventions involving nutrition, health care and early stimulation.

Age Factors↗
PubMed2005

Can the provision of breakfast benefit school performance?

Studies of an association between school performance (enrollment, attendance, achievement, classroom behavior, and school drop-out) and nutritional status are discussed and the evidence of an effect of school meals evaluated. Many studies have shown associations between hunger, poor dietary intakes, stunting, underweight, and poor school performance after controlling for socioeconomic conditions. However, it remains possible that unmeasured socioeconomic variables could explain the relationship. Rigorous short-term studies of missing breakfast have generally found detrimental effects on children's cognition whereas studies of providing breakfast have shown benefits particularly in malnourished children. Classroom conditions may modify the effects of breakfast on behavior. There are extremely few longer term studies of the effects of giving school meals. Nearly all involved breakfast and very few had randomized controlled designs. Studies comparing participants with non-participants or comparing matched schools have found benefits (but bias due to self-selection) of receiving breakfast; inadequate matching of schools also remains possible. One longer term randomized controlled trial found benefits associated with attendance and arithmetic performance. In conclusion, most studies of giving breakfast have found benefits to school performance but many had serious design problems, were short-term, and were not conducted in the poorest countries. In order to advise policy makers correctly, there is an urgent need to run long-term randomized controlled trials of giving school meals in poor countries and to determine the effects of age and nutrition status of the children, the quality of the school, and the timing of the meal. The special needs of orphans should also be considered.

Absenteeism↗
PubMed2004

Feasibility of integrating early stimulation into primary care for undernourished Jamaican children: cluster randomised controlled trial.

OBJECTIVES: To assess the feasibility of integrating early psychosocial stimulation into primary care for undernourished children and to determine the effect on children's development and mothers' knowledge and practices of childrearing. DESIGN: Cluster randomised controlled trial. SETTING: 18 clinics in three Jamaican parishes. PARTICIPANTS: 139 undernourished children aged 9 to 30 months and their mothers enrolled in intervention or control clinics. INTERVENTIONS: Weekly home visits by community health aides for one year in addition to usual duties. Parenting issues were discussed with the mothers and play activities were demonstrated with the children using homemade materials. MAIN OUTCOME MEASURES: Children's scores on the Griffiths mental development scales and mothers' knowledge and practices of childrearing measured by questionnaires. RESULTS: Children from the intervention group showed significant improvements in development: developmental quotient, 7.8 points (95% confidence interval 4.5 to 11.1); hearing and speech, 10.7 (5.9 to 15.4 points); hand and eye coordination, 6.8 (3.4 to 10.1 points); and performance subscale, 11.0 (5.6 to 16.4 points). No improvements were shown on the locomotor subscale. The mothers from the intervention group showed improved knowledge and practices of childrearing. Change in children's body mass index and height independently affected change in development. CONCLUSION: Integrating parenting skills and early psychosocial stimulation for undernourished children into primary care was feasible and effective in improving the children's development and mothers' knowledge and practices of childrearing.

Child Development↗
PubMed2003

A randomized controlled trial of a home-visiting intervention on cognition and behavior in term low birth weight infants.

OBJECTIVES: To determine whether early psychosocial intervention with low birth weight term (LBW-T) infants improved cognition and behavior and to compare LBW-T with normal birth weight (NBW) infants. STUDY DESIGN: A randomized controlled trial was carried out in Kingston, Jamaica, with 140 LBW-T infants (weight<2500 g). The intervention comprised weekly home visits by paraprofessionals for the first 8 weeks of life aimed at improving maternal-child interaction. LBW-T and 94 matched NBW (weight 2500 to 4000 g) infants were recruited from the main maternity hospital. Main outcome measures were problem solving (2 means-end tests: cover and support) and 4 behavior ratings at 7 months. Analyses used were the t test for intervention effects and multiple regression to compare LBW and NBW infants. RESULTS: LBW-T intervened infants had higher scores than LBW-T control infants on the cover test (P<.05) and were more cooperative (P<.01) and happy (P<.05). LBW-T control infants had poorer scores on both the cover (P<.001) and support tests (P<.01), vocalized less (P<.02), and were less cooperative (P<.001), happy (P<.02), and active (P<.02) than NBW infants. LBW-T intervened infants had lower scores than NBW infants only on the support test (P<.05). CONCLUSIONS: Early low-cost intervention can improve cognition and behavior of LBW-T infants in developing countries.

Anthropometry↗