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
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....
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| Published in | PloS one Vol. 15; no. 12; p. e0244486 |
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| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
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United States
Public Library of Science
31.12.2020
Public Library of Science (PLoS) |
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| Abstract | 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. |
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| AbstractList | Introduction 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. Methodology 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. Results 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). Conclusion 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. 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. Introduction 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. Methodology 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. Results 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). Conclusion 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. INTRODUCTIONLittle 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. METHODOLOGYWe 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. RESULTSCompared 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). CONCLUSIONSAM 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. 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. |
| Audience | Academic |
| Author | Mwene-Batu, Pacifique Molima, Christian Donnen, Philippe Chabwine, Joelle Kashama, Nicolas Bisimwa, Ghislain Dramaix, Michèle Macq, Jean Baguma, Marius Bapolisi, Achille Chimanuka, Christine |
| AuthorAffiliation | 3 Nutrition Department, Centre de Recherche en Sciences Naturelles de Lwiro (CRSN-Lwiro), DR Congo 5 Neurosciences Group, Biomedical Research Institute (BIOMED), UHasselt, Diepenbeek, Belgium 1 Ecole Régionale de Santé Publique, Université Catholique de Bukavu (UCB), Bukavu, DR Congo 4 Hôpital Provincial General de Référence de Bukavu (HPGRB), Faculty of Medicine, Université Catholique de Bukavu (U.C.B.), Bukavu, DR Congo 7 Division of Neurorehabilitation, Rehabilitation Clinic, Fribourg Hospital, Fribourg, Switzerland Centre Hospitalier Regional Universitaire de Tours, FRANCE 6 Laboratory of Cognitive and Neurological Science, Department of Neuroscience and Movement Science, Medicine Section, University of Fribourg, Fribourg, Switzerland 8 Institute of Health and Society, Université catholique de Louvain (UCLouvain), Brussels, Belgium 2 Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium |
| AuthorAffiliation_xml | – name: 6 Laboratory of Cognitive and Neurological Science, Department of Neuroscience and Movement Science, Medicine Section, University of Fribourg, Fribourg, Switzerland – name: 4 Hôpital Provincial General de Référence de Bukavu (HPGRB), Faculty of Medicine, Université Catholique de Bukavu (U.C.B.), Bukavu, DR Congo – name: 7 Division of Neurorehabilitation, Rehabilitation Clinic, Fribourg Hospital, Fribourg, Switzerland – name: 5 Neurosciences Group, Biomedical Research Institute (BIOMED), UHasselt, Diepenbeek, Belgium – name: Centre Hospitalier Regional Universitaire de Tours, FRANCE – name: 1 Ecole Régionale de Santé Publique, Université Catholique de Bukavu (UCB), Bukavu, DR Congo – name: 3 Nutrition Department, Centre de Recherche en Sciences Naturelles de Lwiro (CRSN-Lwiro), DR Congo – name: 8 Institute of Health and Society, Université catholique de Louvain (UCLouvain), Brussels, Belgium – name: 2 Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium |
| Author_xml | – sequence: 1 givenname: Pacifique orcidid: 0000-0003-0413-2732 surname: Mwene-Batu fullname: Mwene-Batu, Pacifique organization: Hôpital Provincial General de Référence de Bukavu (HPGRB), Faculty of Medicine, Université Catholique de Bukavu (U.C.B.), Bukavu, DR Congo – sequence: 2 givenname: Ghislain surname: Bisimwa fullname: Bisimwa, Ghislain organization: Nutrition Department, Centre de Recherche en Sciences Naturelles de Lwiro (CRSN-Lwiro), DR Congo – sequence: 3 givenname: Marius orcidid: 0000-0002-4934-4846 surname: Baguma fullname: Baguma, Marius organization: Neurosciences Group, Biomedical Research Institute (BIOMED), UHasselt, Diepenbeek, Belgium – sequence: 4 givenname: Joelle surname: Chabwine fullname: Chabwine, Joelle organization: Division of Neurorehabilitation, Rehabilitation Clinic, Fribourg Hospital, Fribourg, Switzerland – sequence: 5 givenname: Achille surname: Bapolisi fullname: Bapolisi, Achille organization: Hôpital Provincial General de Référence de Bukavu (HPGRB), Faculty of Medicine, Université Catholique de Bukavu (U.C.B.), Bukavu, DR Congo – sequence: 6 givenname: Christine surname: Chimanuka fullname: Chimanuka, Christine organization: Ecole Régionale de Santé Publique, Université Catholique de Bukavu (UCB), Bukavu, DR Congo – sequence: 7 givenname: Christian surname: Molima fullname: Molima, Christian organization: Ecole Régionale de Santé Publique, Université Catholique de Bukavu (UCB), Bukavu, DR Congo – sequence: 8 givenname: Michèle surname: Dramaix fullname: Dramaix, Michèle organization: Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium – sequence: 9 givenname: Nicolas surname: Kashama fullname: Kashama, Nicolas organization: Nutrition Department, Centre de Recherche en Sciences Naturelles de Lwiro (CRSN-Lwiro), DR Congo – sequence: 10 givenname: Jean surname: Macq fullname: Macq, Jean organization: Institute of Health and Society, Université catholique de Louvain (UCLouvain), Brussels, Belgium – sequence: 11 givenname: Philippe surname: Donnen fullname: Donnen, Philippe organization: Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33382748$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | COPYRIGHT 2020 Public Library of Science 2020 Mwene-Batu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2020 Mwene-Batu et al 2020 Mwene-Batu et al |
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| DOI | 10.1371/journal.pone.0244486 |
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| DocumentTitleAlternate | Long-term effects of severe acute malnutrition on adult cognitive, academic and behavioural development |
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| Editor | Denis, Frédéric |
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| References | JC Wells (pone.0244486.ref020) 2019; 6736 M Werfalli (pone.0244486.ref042) 2018; 11 J Korhonen (pone.0244486.ref031) 2014; 31 S Song (pone.0244486.ref010) 2009; 68 VM Moceri (pone.0244486.ref050) 2000; 54 VO Owino (pone.0244486.ref025) 2011; 93 SK Ampaabeng (pone.0244486.ref006) 2013; 32 DP Schmitt (pone.0244486.ref038) 2005; 89 R Martínez (pone.0244486.ref018) 2007 M Dramaix (pone.0244486.ref024) 1993; 307 M Keita (pone.0244486.ref054) 2014 J Martín-albo (pone.0244486.ref041) 2007; 10 BJ Akombi (pone.0244486.ref015) 2017; 14 R Martin (pone.0244486.ref048) 2009; 373 T Bellaj (pone.0244486.ref037) 2008; 86 Princeton University (pone.0244486.ref039) 1965 R Martorell (pone.0244486.ref017) 2018 R.H. Franke (pone.0244486.ref019) 1975; 23 C Derouesné (pone.0244486.ref033) 1999; 28 CR Sudfeld (pone.0244486.ref051) 2015; 135 G Babacan-Yıldız (pone.0244486.ref036) 2015 pone.0244486.ref021 FX Gomez-Olive (pone.0244486.ref044) 2017; 2 CG Victora (pone.0244486.ref005) 2008; 371 KA LD Cagney (pone.0244486.ref055) 2002; 57B N Lelijveld (pone.0244486.ref013) 2016; 4 A McCarthy (pone.0244486.ref060) 2007; 86 G Bisimwa (pone.0244486.ref026) 2012; 95 T Fritsch (pone.0244486.ref056) 2007; 47 P Mwene-batu (pone.0244486.ref029); 15 M Schneider (pone.0244486.ref045) 2015; 50 MA Mendez (pone.0244486.ref052) 1999; 129 ZA Bhutta (pone.0244486.ref003) 2008; 371 Z Song (pone.0244486.ref012) 2013; 97 JJ Thompson (pone.0244486.ref049) 2014; 9 G Asiki (pone.0244486.ref014) 2019; 12 P Fondu (pone.0244486.ref027) 1978; 31 pone.0244486.ref030 WHO (pone.0244486.ref001) 2016 T Gaudonville (pone.0244486.ref032) 2017 RE Black (pone.0244486.ref004) 2013; 382 J Hoddinott (pone.0244486.ref016) 2013; 98 Action Contre la Faim (pone.0244486.ref023) 2011 pone.0244486.ref035 G Fink (pone.0244486.ref009) 2014; 100 UNICEF (pone.0244486.ref022) 2017 YE Somassè (pone.0244486.ref053) 2016; 12 G Gascoin (pone.0244486.ref059) 2013; 42 Z Zhang (pone.0244486.ref008) 2010; 71 RE Black (pone.0244486.ref007) 2013; 382 CM McDonald (pone.0244486.ref002) 2013; 97 K Habtamu (pone.0244486.ref046) 2017; 15 M Folstein (pone.0244486.ref034) 1975; 12 EB Malembaka (pone.0244486.ref043) 2019; 19 R Andel (pone.0244486.ref057) 2007; 19 CJ Newman (pone.0244486.ref047) 2011; 365 D Spence (pone.0244486.ref058) 2007; 92 B Paluku (pone.0244486.ref028) 2002 C Huang (pone.0244486.ref011) 2014 M Makhubela (pone.0244486.ref040) 2017 |
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| Snippet | 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... Introduction Little is known about the outcomes of subjects with a history of severe acute malnutrition (SAM). We therefore sought to explore the long-term... Introduction Little is known about the outcomes of subjects with a history of severe acute malnutrition (SAM). We therefore sought to explore the long-term... INTRODUCTIONLittle is known about the outcomes of subjects with a history of severe acute malnutrition (SAM). We therefore sought to explore the long-term... IntroductionLittle is known about the outcomes of subjects with a history of severe acute malnutrition (SAM). We therefore sought to explore the long-term... |
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| SubjectTerms | 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 |
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| Title | 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 |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/33382748 https://www.proquest.com/docview/2474469415/abstract/ https://search.proquest.com/docview/2474500042 https://pubmed.ncbi.nlm.nih.gov/PMC7774943 https://doaj.org/article/a2c1852951f34ccfa2a9c2fc339e983e http://dx.doi.org/10.1371/journal.pone.0244486 |
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