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Title:   Author  item
                                            OLNEY, DEANNA - University Of Californiaitem
                                            KARIGER, PATRICIA - Cornell Universityitem
                                            STOLTZFUS, REBECCA - Cornell Universityitem
                                            KHALFAN, SABRA - Cornell Universityitem
                                            ALI, NADRA - Cornell Universityitem
                                            TIELSCH, JAMES - Johns Hopkins School Of Public Healthitem
                                            SAZAWAL, SUNIL - Johns Hopkins School Of Public Healthitem
                                            BLACK, ROBERT - Johns Hopkins School Of Public Healthitem
                                            POLLITT, ERNESTO - University Of Californiaitem
                                            Allen, Lindsay

                                                         - *A*
  Submitted to: Journal of Nutrition
                                    Publication Type: Peer Reviewed Journal
                                    Publication Acceptance Date: 1/29/2009
                                    Publication  Date: 2/18/2009
                                    Citation: Olney, D.K., Kariger, P.K., Stoltzfus, R.J., Khalfan, S.S., Ali, N.S., Tielsch, J.M., Sazawal, S., Black, R., Pollitt, E., Allen, L.H. 2009. Development of nutritionally at-risk young children is predicted by malaria, anemia, and stunting in Pemba, Zanzibar. Journal of Nutrition. 139:763-772.Interpretive Summary: This article used a structural equation modeling approach to investigate the relationships between health and child development outcomes in a large sample of malnourished children in an area where malaria is endemic, which allowed us to test the overall fit of the model to the data as well as to examine specific pathways of effects. This analysis has illustrated that stunting, anemia, and malaria infection negatively affected motor activity as well as motor and language development. Given these results, it is possible that early intervention with iron, zinc, or prevention of malaria to improve anemia and/or growth may prevent or improve some of the deficits in developmental outcomes for these variables. Furthermore, the combinations of both direct and indirect effects explaining the relationships between the variables in the model illustrate the multiple pathways through which overall child development can be affected, and possible points for intervention.
                                Technical Abstract: Nutritionally at-risk children suffer delays in physical growth and motor and language development. Infectious diseases such as malaria pose an additional risk. We examined the cross-sectional relationships among malaria infection, hemoglobin (Hb) concentration, length-for-age Z-scores (LAZ), motor activity, behavior, and motor and language development in 841 Zanzibari children 5–19 mo old. We used structural equation modeling to test the fit of the data to a theoretical model and to examine the relationships among the variables in 3 age groups (5–9, 10–14, and 15–19 mo). The model fit the data for all age groups. In the youngest and oldest groups, children with higher malaria parasite densities had significantly lower Hb and LAZ. Higher LAZ significantly predicted higher total motor activity, and motor and language development scores in all age groups. In the oldest group, children who had higher Hb had higher motor development and activity scores. Malaria was directly and indirectly related to motor activity in the 10- to 14-mo-old group [standardized total effects, 20.14; direct, 20.10 (P = 0.015); and indirect, 20.038]. The significant fit of the models to the data and the statistical significance of many of the specific pathways highlight the complexities of the relationships between health and nutrition and child development outcomes in this population. In addition, the results suggest that multiple interventions are likely necessary to improve child development outcomes in this population of nutritionally at-risk children and that the potential effectiveness of interventions may differ according to age (i.e. prevention and treatment of anemia, stunting, and malaria).


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