1.3 The Growth of School-Age Children
The physical growth of schoolchildren aged six to nine years of age is the result of both environmental and genetic factors and the interaction between these factors.42 In poor populations the main factors affecting the physical growth of school-age children are environmental factors experienced before puberty.43 These include poor food consumption patterns, illness, lack of sanitation, and poor health and hygiene practices.
The potential for catch-up growth among stunted children is thought to be limited after age two, particularly when children remain in poor environments.44 A recent study in the Philippines has shown that some catch-up between the ages of two and eight and a half years is feasible for children who were not born with low birthweight or severely stunted in infancy.45 However, stunting at age two years, regardless of whether catch-up was achieved or not, is significantly associated with later deficits in cognitive ability, further emphasizing the need to prevent early stunting.46 This is further discussed in section 4.1.
TABLE 1.6: Prevalence of stunting among first-grade schoolchildren in Latin America and the Caribbean
Sources: 49, 50, 52-60.
School feeding, both breakfast and lunch programmes, has been shown to improve school performance in both developing and industrialized countries.47 Simply alleviating hunger helps children to perform better. Children who are hungry have more difficulty concentrating and performing complex tasks, even if they are otherwise well nourished. Studies in Jamaica have shown that children who were wasted, stunted, or previously undernourished benefited most from the programmes.48
Data on the growth of school-age children that are generated in a consistent manner across countries and over time are difficult to find. The best data sets derive from height censuses beginning in 1979 on children entering primary school (first grade) in 11 countries of Latin America and the Caribbean.49, 50 Height census data of schoolchildren have been used for planning, evaluation, and advocacy in Central America for some time.51 This information has allowed governments and other organizations and institutions to detect growth retardation, to screen high-risk groups, and to target social interventions for nutrition security and human development.f
f The data presented in this section are from 49, 50, 52-60.
Stunting is common in schoolchildren in Latin America and the Caribbean (Table 1.6). In four of the countries in this review, more than one-third of children in school are stunted. In Guatemala and Peru prevalences are 50.6% and 48% respectively. Guatemala, Honduras, and Peru show a prevalence of stunting 20 times higher than expected in well-nourished populations. Children living in the northern areas of Central America have particularly high prevalences. These prevalences are similar to those found in other regions by the Partnership for Child Development in a five-countryg analysis of stunting in schoolchildren.61
g The five countries are Ghana, India, Indonesia, Tanzania, and Viet Nam.
Primary school begins at age seven throughout Central America. In all countries except Belize, stunting is more prevalent among children who enter school at an older age. In Costa Rica stunting is up to five times higher in nine-year-olds than in six-year-olds. In Honduras, Mexico, and Panama older school entrants have three times more stunting than six-year-olds. Stunting is particularly widespread in Guatemalan nine-year-olds (67.2%).
Trends in stunting of schoolchildren are illustrated in Figures 1.3 and 1.4 for Costa Rica and Honduras. In Costa Rica, stunting dropped from 20.4% to 7.5% over the period 1979 to 1997, indicating a sustained improvement in the quality of life, including better basic health care and other services. This period saw the implementation of a strong food and nutrition security policy, which was effective in targetting the most socially and economically disadvantaged. In Honduras, on the other hand, the overall increase in stunting was probably related to the economic and sociopolitical crises this country faced during this period.
A higher proportion of boys than girls are stunted in all countries (Figure 1.5). This difference may be due to behavioural patterns associated with gender in Latin America and the Caribbean. In most of the countries, boys aged six to nine in general spend more time outside the home than girls do. Proximity to the household may allow girls better physical access to available food.
Sources: 49, 50, 52-60.
Table 1.7 shows prevalences of stunting broken into rural and urban categories for five countries. In all five countries schoolchildren living in rural areas are more stunted than children living in cities, by a wide margin. In Belize, stunting is more than three times more prevalent in rural areas than in urban areas. In Peru, stunting is almost twice as common in rural areas as in cities; This almost certainly reflects differential access to livelihoods and services.
A paucity of data from other regions of the developing world has prevented an analysis of undernutrition in school-age children elsewhere. There are enormous educational and economic gains to be achieved from improving the nutrition and health of school-age children. There are also highly cost-effective means to achieve these aims, including mass application of antihelminthics, delivery of micronutrients (particularly iron and iodine), and treatment of injuries and routine health problems.
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