The long-term effects of early kwashiorkor compared with marasmus. IV. Performance on the national high school entrance examination.

This is one of a series of studies on the long-term effects of early childhood malnutrition in Barbadian school children. This is the first report of the relationship between early malnutrition and later performance on a national examination administered to all 11-y-old children in Barbados to assign high school seats. We compared scores achieved on the 11-plus examination by 103 boys and girls with histories of marasmus or kwashiorkor with those obtained by 63 healthy comparison children and also with scores obtained by the total island population of children during the same years. We report that children with histories of either type of malnutrition confined to infancy had significantly lower scores on the national high school examination than healthy comparison children. Reduced 11-plus scores were closely associated with teacher reports of attention deficits in the classroom documented when the children were as young as 5 to 8 y of age and also with IQ and academic performance. Early malnutrition had independent effects on performance on the 11-plus examination even when home environmental conditions were controlled for. These findings have important implications for future opportunities available to children with histories of infantile malnutrition.

The long-term effects of early kwashiorkor compared with marasmus. IV. Performance on the national high school entrance examination

This one of a series of studies on the long-term effects of early childhood malnutrition in Barbadian school children. This is the first report of the relationship between early malnutrition and later performance on a national examination administered to all 11-y-old children in Barbados to assign high school seats. We compared scores achieved on 11-plus examination by 103 boys and girls with histories of marasmus or kwashiorkor with those obtained by 63 healthy comparison children and also with scores obtained by the total island population of children during the same years. We report that children with histories of either type of malnutrition confined to infancy had significantly lower scores on the national high school examination than health comparison children. Reduced 11-plus scores were closely associated with teacher reports of attention deficits in the classroom documented when the children were as young as 5 to 8 y of age and also with IQ and academic performance. Early malnutrition had independent effects on performance on the 11-plus examination even when home environmental conditions were controlled for. These findings have important implications for future opportunities available to children with histories of infantile malnutrition. (AU)

Long-term effects of early kwashiorkor compared with marasmus. II. Intellectual performance.

Intellectual performance including IQ (Wechsler Intelligence Scale for Children-Revised) and conservation was measured at ages 11-18 years in a follow-up study of Barbadian girls and boys who had histories of kwashiorkor (n = 53) or marasmus (n = 55) in their first year of life. They were compared with healthy neighborhood children matched by sex and age who had normal patterns of growth in early childhood (n = 58). On both IQ and conservation tests, children with previous kwashiorkor or marasmus had similar scores, which were significantly lower than scores of healthy comparison children. These findings were examined in relationship to current environmental conditions, which were similar in children with histories of kwashiorkor or marasmus and somewhat less advantaged than those of the comparison children. The effect of early malnutrition and related conditions at the time of episode still emerged as significant even when the current environmental factors were controlled for.

[Psychosomatic aspects of protein-calorie malnutrition in early childhood in a tropical environment. Facts and hypotheses]. / Les aspects psychosomatiques des malnutritions protéino-caloriques de la première enfance en milieu tropical. Faits et hypothèses.

After a brief look at the clinical descriptions of marasmus and kwashiorkor, and a summary of the physiopathological concepts of these protein calorie malnutritions (PCM), the author looks at arguments which suggest there is a change in the mother-child relationship at the onset of PCM, excluding, however, those malnutritions which appear in conditions of famine or catastrophe. These arguments are drawn principally from studies done in Africa, and are based on clinical, sociological, and ethnopsychiatric data. The contributing factor of maternal depression and that of relational characteristics of the child are considered, and an analysis is made of how these factors might converge at the onset of PCM. The author attempts to demonstrate the important role of a psychomotor retardation in the tableau of psychological troubles which present themselves during the course of Kwashiorkor. The role and importance of weaning, of the separation and the psychomotor retardation in the genesis of the "situation of malnutrition" are discussed. Finally, a parallel is established between PCM and early psychosomatic syndromes observed in the west, principally the anorexias and insomnias during the first year of life. The point in common between these situations and PCM is perhaps the onset of conditions having an upsetting and distorting effect on the mother-child relationship. The family and the entourage use certain collective representations in Africa ("Nit-KuBon", "Tjid-a-Paxer") to try and explain the onset of PCM. The description of these traditional representations is utilized as a materialization, by the mother and the social group, of an alteration of the mother-child relationship, and can be compared to representations which play the same role in the west.

The effects of different types of neonatal feminization and environmental stimulation on changes in sex-associated activity/spatial learning skills.

This research programme commenced in West Africa, where it was found that individuals with kwashiorkor gynaecomastia were feminized. This was also reinforced by the interacting dominant maternal socialization practices (Dawson, 1966). This was confirmed with feminized responses for adult male rats, on the Tolman-Maze (Dawson, 1972), while as well confirmed neonatally, for both feminized male and female rats (Dawson, Cheung and Lau, 1973, 1975). The present experiment tests the interacting effects of various levels of environmental stimulation, high, normal and low (Levitsky and Barnes, 1972), using feminized male rats. Thus castration, oestrogen and castration, and oestrogen feminized males, were contrasted with male and female controls. The results confirmed the physiological growth curves and other anatomical differences. As well, the activity data confirmed the hypothesis, for the combined samples (where high Ns mean more reliability) and also the environmental stimulation (F ratio: d.f. 18 and 57, 11.37, p less than 0.001; low Ns here mean lower reliability). However, for the symmetrical maze, the results for the combined samples, were not as convincing as in Dawson et al. (1973, 1975), although the environmental stimulation produced significant results in many cases, including a significant interaction for the analysis of variance (F ratio: d.f. 18 and 57, 3.12 p less than 0.001).

A prospective 15-year follow-up study of kwashiorkor patients. Part II. Social circumstances, educational attainment and social adjustment.

Of 221 infants serially admitted to hospital with kwashiorkor and continuously observed thereafter, 116 were available for study after 15 years. Eighty-nine siblings formed the comparison group. This report is a final assessment of their social circumstances, attainment in education and adjustment to society. Economic circumstances had improved considerably, housing adequacy had deteriorated and family instability had become relatively less marked. Achievement in education resembled that of the population from which the sample was drawn, and there was no difference between that of ex-patients and siblings. The majority of school-leavers were in gainful occupation but the nature of the work was unskilled or semiskilled. Delinquency was equally common in ex-patients and siblings. More than a quarter of the boys showed serious or potentially serious antisocial behaviour.

Dietary and metabolic effects on rhesus social behavior: protein and protein-calorie malnutrition.

Forty-seven monkeys were fed 1 of 8 diets between the ages of 1 and 7 months containing full-, half-, or quarter-strength protein or protein and calories using either casein or soy protein. While on the diet, malnourished infants were inactive both socially and nonsocially. When returned to a normal diet, previously malnourished subjects were more agonistic towards familiar peers but more friendly and less agonistic when later paired with unfamiliar monkeys. The data suggest that short periods of early severe malnutrition may protect the individual against adverse social conditions (e.g., isolation) and delay the development of normal social skills.

A social score for kwashiorkor: explaining the look in the child's eyes.

Following the observation that many children with kwashiorkor had a deprived look in their eyes, the guardians of 107 children with kwashiorkor and 111 controls were interviewed about their home life, in a survey made at New Mulago Hospital, Kampala, between 1969 and 1972. A child's age, sex and tribe were found to have an influence on the nutritional state, therefore 50 of each group were matched for these variables. Ten significant associations were found which distinguished kwashiorkor patients from the control group. Children with kwashiorkor were more likely to be attended by someone other than the mother; to have changed attendants when ill; to have a pregnant mother; and to have separated parents. Further to these, singletons of split partnerships were at special risk; breast-feeding had stopped; weaning was begun for bad reasons; a child was more often living away from the parents and had been sent away coincident with weaning. The fathers tended to be poor. It is suggested that these 10 factors could be used as a social scoring system in assessing the risk of incipient kwashiorkor.

A new look at the assessment of mental development in young children recovering from severe malnutrition.

Previous studies of malnourished children in hospital have shown that their developmental quotients (DQS) improve as their nutritional status improves, but they have not taken into account the possible effects of being in hospital and of test practice. The present study assessed development of malnourished and adequately nourished children in hospital and found that mean DQS of each group rose to a similar extent during recovery from illness. It is concluded that DQS on admission to hospital were lowered by the children's discomfort and unhappiness at being in hospital, and/or by illness, and that rises in DQ shown by children recovering from malnutrition are not necessarily attributable to improving nutritional status.

A new look at the asssessment of mental development in young children recovering from severe malnutrition

Previous studies of malnourished children is hospital have shown that their developmental quotients (DQs) improve as their nutritional status improves, but they have not taken into account the possible effects of being in hospital and of test practice. The present study assessed development of malnourished and adequately nourished children in hospital and found that mean DQs of each group rose to a similar extent during recovery from illness. It is concluded that DQs on admission to hospital were lowered by the children's discomfort and unhappiness at being in hospital, and/or by illness, and that rises in DQ shown by children recovering from malnutrition are not necessarily attributable to improving nutritional status. (AU)