Abstract
Aim: To determine the timing of growth faltering among under 3 year old children.
Methods: Prospective population based cohort study in Lungwena, rural Malawi, southeast Africa. A total of 767 live born babies were regularly visited from birth until 3 years of age. Weight, height, and mid upper arm circumference were measured at monthly intervals until 18 months and at three month intervals thereafter. Growth charts were constructed using the LMS method and comparisons made to two international databases: the traditional United States National Center for Health Statistics/World Health Organisation (NCHS/WHO) reference and the recently developed 2000 Centers for Disease Control (CDC) growth reference.
Results: Compared to the 2000 CDC reference population, newborns in Lungwena were on average 2.5 cm shorter and 510 g lighter. On a population level, height faltering was present at birth and continued throughout the first three years. Weight faltering, on the other hand, occurred mainly between 3 and 12 months of age. At 36 months, the mean weight and height of the study children were 2.3 kg and 10.5 cm lower than those of the reference population, respectively. The results remained essentially similar when the comparisons were made to the NCHS/WHO reference.
Conclusions: The fact that weight and height faltering do not follow identical time patterns suggests that they may have different origin and determinants. Further studies on the aetiology of height faltering and different approaches to preventive interventions are needed.
Full Text
The Full Text of this article is available as a PDF (133.2 KB).
Figure 1.

Attained weight (A) and height (B) centiles (3rd, 50th, and 97th) for Lungwena children compared to the 2000 CDC reference; both sexes combined.
Figure 2.

Attained weight (A) and height (B) centiles (3rd, 50th, and 97th) for Lungwena children compared to the NCHS/WHO reference; both sexes combined.
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bailey R. C., Kamenga M. C., Nsuami M. J., Nieburg P., St Louis M. E. Growth of children according to maternal and child HIV, immunological and disease characteristics: a prospective cohort study in Kinshasa, Democratic Republic of Congo. Int J Epidemiol. 1999 Jun;28(3):532–540. doi: 10.1093/ije/28.3.532. [DOI] [PubMed] [Google Scholar]
- Beaton G. H., Ghassemi H. Supplementary feeding programs for young children in developing countries. Am J Clin Nutr. 1982 Apr;35(4 Suppl):863–916. doi: 10.1093/ajcn/35.4.864. [DOI] [PubMed] [Google Scholar]
- Cole T. J. The LMS method for constructing normalized growth standards. Eur J Clin Nutr. 1990 Jan;44(1):45–60. [PubMed] [Google Scholar]
- Garza C., Frongillo E., Dewey K. G. Implications of growth patterns of breast-fed infants for growth references. Acta Paediatr Suppl. 1994 Sep;402:4–10. doi: 10.1111/j.1651-2227.1994.tb13352.x. [DOI] [PubMed] [Google Scholar]
- Kulmala T., Vaahtera M., Ndekha M., Cullinan T., Salin M. L., Koivisto A. M., Ashorn P. Socio-economic support for good health in rural Malawi. East Afr Med J. 2000 Mar;77(3):168–171. doi: 10.4314/eamj.v77i3.46616. [DOI] [PubMed] [Google Scholar]
- Kulmala T., Vaahtera M., Ndekha M., Koivisto A. M., Cullinan T., Salin M. L., Ashorn P. Gestational health and predictors of newborn weight amongst pregnant women in rural Malawi. Afr J Reprod Health. 2001 Dec;5(3):99–108. [PubMed] [Google Scholar]
- Kulmala T., Vaahtera M., Ndekha M., Koivisto A. M., Cullinan T., Salin M. L., Ashorn P. The importance of preterm births for peri- and neonatal mortality in rural Malawi. Paediatr Perinat Epidemiol. 2000 Jul;14(3):219–226. doi: 10.1046/j.1365-3016.2000.00270.x. [DOI] [PubMed] [Google Scholar]
- Martorell R., Khan L. K., Schroeder D. G. Reversibility of stunting: epidemiological findings in children from developing countries. Eur J Clin Nutr. 1994 Feb;48 (Suppl 1):S45–S57. [PubMed] [Google Scholar]
- Neumann C. G., Harrison G. G. Onset and evolution of stunting in infants and children. Examples from the Human Nutrition Collaborative Research Support Program. Kenya and Egypt studies. Eur J Clin Nutr. 1994 Feb;48 (Suppl 1):S90–102. [PubMed] [Google Scholar]
- Rivera J., Ruel M. T. Growth retardation starts in the first three months of life among rural Guatemalan children. Eur J Clin Nutr. 1997 Feb;51(2):92–96. doi: 10.1038/sj.ejcn.1600371. [DOI] [PubMed] [Google Scholar]
- Taha T. E., Dallabetta G. A., Canner J. K., Chiphangwi J. D., Liomba G., Hoover D. R., Miotti P. G. The effect of human immunodeficiency virus infection on birthweight, and infant and child mortality in urban Malawi. Int J Epidemiol. 1995 Oct;24(5):1022–1029. doi: 10.1093/ije/24.5.1022. [DOI] [PubMed] [Google Scholar]
- Waterlow J. C., Buzina R., Keller W., Lane J. M., Nichaman M. Z., Tanner J. M. The presentation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years. Bull World Health Organ. 1977;55(4):489–498. [PMC free article] [PubMed] [Google Scholar]
- Whitehead R. G., Paul A. A. Growth charts and the assessment of infant feeding practices in the western world and in developing countries. Early Hum Dev. 1984 Apr;9(3):187–207. doi: 10.1016/0378-3782(84)90031-8. [DOI] [PubMed] [Google Scholar]
