Long-term effects of severe acute malnutrition during childhood on adult cognitive, academic and behavioural development in African fragile countries: The Lwiro cohort study in Democratic Republic of the Congo

• Published in: PloS one Vol. 15; no. 12; p. e0244486
• Main Authors: Mwene-Batu, Pacifique, Bisimwa, Ghislain, Baguma, Marius, Chabwine, Joelle, Bapolisi, Achille, Chimanuka, Christine, Molima, Christian, Dramaix, Michèle, Kashama, Nicolas, Macq, Jean, Donnen, Philippe
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 31.12.2020; Public Library of Science (PLoS)
• Subjects: Activities of Daily Living; Adolescent; Adult; Adults; Age; Biology and Life Sciences; Birth weight; Case-Control Studies; Chi-square test; Child Development - physiology; Child Health; Child, Preschool; Children; Children & youth; Chronic illnesses; Cognition; Cognition & reasoning; Cognition - physiology; Cognitive ability; Cohort analysis; Computer and Information Sciences; Democratic Republic of the Congo; Disabilities; Disability; Disability Evaluation; Economic development; Economic growth; Education; Educational aspects; Educational Status; Female; Follow-Up Studies; Health aspects; Human capital; Humans; Infant; Long-term effects; Male; Malnutrition; Medicine; Medicine and Health Sciences; Mental Status and Dementia Tests - statistics & numerical data; Mortality; Nutrition; Nutritional status; Pediatric research; People and Places; Psychological aspects; Psychological factors; Public health; Schedules; Self Concept; Self esteem; Severe Acute Malnutrition - complications; Severe Acute Malnutrition - mortality; Severe Acute Malnutrition - physiopathology; Severe Acute Malnutrition - rehabilitation; Social Sciences; Statistical tests; Survival; Survivors - psychology; Survivors - statistics & numerical data; Young Adult; Democratic Republic of the Congo; Congo (Kinshasa); Belgium; Congo-Democratic Republic of Congo; Switzerland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0244486

Little is known about the outcomes of subjects with a history of severe acute malnutrition (SAM). We therefore sought to explore the long-term effects of SAM during childhood on human capital in adulthood in terms of education, cognition, self-esteem and health-related disabilities in daily living. We traced 524 adults (median age of 22) in the eastern Democratic Republic of the Congo, who were treated for SAM during childhood at Lwiro hospital between 1988 and 2007 (median age 41 months). We compared them with 407 community controls of comparable age and sex. Our outcomes of interest were education, cognitive function [assessed using the Mini Mental State Examination (MMSE) for literate participants, or its modified version created by Ertan et al. (MMSE-I) for uneducated participants], self-esteem (measured using the Rosenberg Self-Esteem Scale) and health-related social and functional disabilities measured using the World Health Organization Disability Assessment Schedule (WHODAS). For comparison, we used the Chi-squared test along with the Student's t-test for the proportions and means respectively. Compared with the community controls, malnutrition survivors had a lower probability of attaining a high level of education (p < 0.001), of reporting a high academic performance (p = 0.014) or of having high self-esteem (p = 0.003). In addition, malnutrition survivors had an overall mean score in the cognitive test that was lower compared with the community controls [25.6 compared with 27.8, p = 0.001 (MMSE) and 22.8 compared with 26.3, p < 0.001(MMSE-I)] and a lower proportion of subjects with a normal result in this test (78.0% compared with 90.1%, p < 0.001). Lastly, in terms of health-related disabilities, unlike the community controls, malnutrition survivors had less social disability (p = 0.034), but no difference was observed as regards activities of daily living (p = 0.322). SAM during childhood exposes survivors to low human capital as regards education, cognition and behaviour in adulthood. Policy-deciders seeking to promote economic growth and to address various psychological and medico-social disorders must take into consideration the fact that appropriate investment in child health as regards SAM is an essential means to achieve this.