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IJE Advance Access published online on April 22, 2004
International Journal of Epidemiology, doi:10.1093/ije/dyh174
© 2004 by International Epidemiological Association
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Accepted February 19, 2004

Original paper

No improvement in weight-for-age of young children in southern Senegal, 1969-1992, despite a drastic reduction in mortality. Evidence from a growth monitoring programme

Sybil Pinchinat 1, Catherine Enel 2, Gilles Pison 2, Géraldine Duthé 2, Emmanuel Lagarde 3, François Simondon 1, Kirsten B. Simondon 1*

1 UR024, Institut de Recherche pour le Développement (IRD), 911, avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
2 Institut National d'Études Démographiques (INED), 133 boulevard Davout, 75980 Paris Cedex 20, France
3 U88, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital National de Saint-Maurice, 14 rue du Val d'Osne, 94410 Saint-Maurice, France

* To whom correspondence should be addressed. E-mail: kirsten.simondon{at}mpl.ird.fr.


  Abstract

Background Undernutrition is associated with an increased risk of death among young children in developing countries. Infant and child nutritional status and mortality were monitored in a rural area of Casamance, Senegal.

Methods Analysis of weight measurements taken at 3-24 months of age during routine growth monitoring in the community's private dispensary 1969-1992 (3912 children, 4642 child-years) and of mortality rates of children estimated from maternal recall for 1960-1985 and yearly census 1985-1995.

Results Between 1960-1964 and 1990-1994, under-5 and child (1-4 years) mortality rates decreased from 312 to 127 and from 201 to 68 per 1000, respectively. About 90% of resident children attended growth monitoring in 1985-1992. Mean weight-forage was at a minimum at 15 months of age (-1.60 z-scores [SD: 0.95]); the prevalence of underweight was 33.2% (95% CI: 31.5, 34.9). The latter increased significantly over time, both when comparing all years of follow-up (P for trend <0.01) and over three pre-defined time periods (28.6, 34.6, and 35.0% in 1969-1974, 1975-1984, and 1985-1992, respectively, P for trend <0.05). Mean weight-for-age decreased over time in infancy and in the second year of life.

Conclusion No improvement in nutritional status was found among young children 1969-1992 despite a drastic decrease in mortality. Focused public health interventions such as vaccinations and malaria prevention probably did not enhance weight-for-age. Paradoxically, growth monitoring may have been more helpful in improving health than growth.

Keywords Growth, nutrition disorders, trends, infant, Africa, mortality


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