Growth Trajectories among Toddlers in Rural Cambodia; Increased Risk for Severe Stunting in Poorer Communities - Abstract
Objectives: Previous studies of a Cambodian birth cohort showed significant differences in birth weight, ponderal index and head circumference between newborns from two rural communities. The differences were associated with maternal anthropometrics and socioeconomic background, and the smallest babies were born to the mothers from the poorest communities. To see if the differences persisted postnatally, we followed the birth cohort for 18 months to investigate the children’s physical growth and cognitive development. Setting: A follow-up of a birth cohort from two rural Cambodian communities; Chroy Sdao commune (inland area) and Eak Phnom district (floating villages). The participants from the floating villages had significantly lower socioeconomic status than women from the inland area. Participants: 152 children were included and examined at the age of approximately 18 months.Main outcome measures: We measured the children’ weight, height, and head circumference. Language, social and motoric skills were assessed using Ages and Stages Questionnaire adapted to a Cambodian setting. Results: The significant differences in weight found at birth between the two areas had increased during the first 18 months of life. Birth length was similar, however, at the time of follow-up, the growth trajectory for children from Eak Phnom district was less favorable, leaving 53.3 % of them categorized as stunted compared to 20.7 % in children from Chroy Sdao (p < 0.001). The proportion for underweight children were 30 % versus 10 % (p < 0.001). The children from Eak Phnom district scored significantly lower in the cognitive development test. Conclusion: Our findings show that growth trajectories in children from Eak Phnom continue to divert negatively compared to children with better living conditions. The same children also score lower in cognitive development tests. The differences are large, and there is an urgent need for interventions by local health authorities and policymakers.