|OLNEY, DEANNA - International Food Policy Researc Institute (IFPRI)|
|KARIGER, PATRICIA - University Of California|
|STOLZFUS, REBECCA - University Of California|
|Allen, Lindsay - A|
Submitted to: Early Human Development
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/25/2013
Publication Date: 5/28/2013
Citation: Olney, D.K., Kariger, P.K., Stolzfus, R.J., Allen, L.H. 2013. Developmental effects of micronutrient supplementation and malaria in Zanzibari children. Early Human Development. 89:667-674. DOI: 10.1016/j_earlhumdev.2013.04.013.
Interpretive Summary: This study has demonstrated that the incidence of malaria, and supplementation with iron+folic acid with or without zinc, affects developmental outcomes in nutritionally at-risk Zanzibari children. It also revealed that repeated, uncomplicated attacks of malaria have significant negative effects on developmental outcomes, with a more global impact on the development of younger children. Furthermore, using the example of the relationship between HAZ and motor development, this study has demonstrated that the development of nutritionally at-risk children is fundamentally different from that of well-nourished children. When considering interventions to improve the health, nutrition and development of young 446 children, it is essential to consider the characteristics of the population and how these factors may affect the impact of an intervention. From this study, it is clear that prevention of malaria and iron deficiency anemia, and improvements in growth, will improve the development of young Zanzibari children.
Technical Abstract: Background: Children’s development is affected by the interplay of internal and external factors and changes in one factor can precipitate changes in multiple developmental domains. Objective: To test a theoretical model of children’s development we used structural equation modeling to fit the model to longitudinal data from a one-year micronutrient supplementation trial conducted with Zanzibari children aged 5-9 mo (n=106) and 10-14 mo (n=141) at baseline. Design: This was a substudy of a randomized, placebo-controlled, 2 x 2 factorial trial of the effects of daily supplementation with iron (12.5 mg) + folic acid (50 µg) (FeFA) with or without zinc (10 mg) (Zn) on child mortality. Longitudinal data on children’s hemoglobin, growth, malaria infection, motor development, motor activity, and language development and caregiver behavior were used in these analyses. We tested the fit of the theoretical model separately for the two age groups and examined the direct and indirect relationships among the variables in the model. Results: The theoretical models were a good fit to the data for both age groups and revealed that FeFA with or without Zn had positive effects on motor development. FeFA alone had negative effects on language development in both age groups and Zn alone had negative effects on language development in children aged 10-14 mo. The incidence of malaria had negative effects on the majority of health and development outcomes in children aged 5-9 mo, and on motor development and hemoglobin in children aged 10-14 mo. Conclusions: These findings illustrate how nutrition and health factors can affect different domains of development and how these changes can precipitate changes in other domains. More work is needed to better understand the multiple impacts of internal and external factors on children’s development and how changes in developmental domains interact with each other over time to determine children’s overall developmental trajectory.