Association between stunting and neuro-psychological outcomes among children in Burkina Faso, West Africa

Anselme Simeon Sanou; Abdoulaye Hama Diallo; Penny Holding; Victoria Nankabirwa; Ingunn Marie S Engebretsen; Grace Ndeezi; James K Tumwine; Nicolas Meda; Thorkild Tylleskär; Esperance Kashala-Abotnes

doi:10.1186/s13034-018-0236-1

Association between stunting and neuro-psychological outcomes among children in Burkina Faso, West Africa

Child Adolesc Psychiatry Ment Health. 2018 Jun 7:12:30. doi: 10.1186/s13034-018-0236-1. eCollection 2018.

Authors

Affiliations

¹ 1Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
² Department of Public Health, Centre MURAZ Research Institute, Ministry of Health, Bobo-Dioulasso, Burkina Faso.
³ 3Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso.
⁴ Identitea, Nairobi, Kenya.
⁵ 5Department of Epidemiology & Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.
⁶ 6Centre for Intervention Science in Maternal and Child Health (CISMAC), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
⁷ 7Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda.

Abstract

Background: In Burkina Faso, stunting affects children and is a public health problem. We studied the association between stunting and child's neuro-psychological outcomes at 6-8 years of age in rural Burkina Faso using the Kaufman Assessment Battery for Children, 2nd edition (KABC-II), the Children's Category Test 1 (CCT-1) and the Test of Variable of Attention (TOVA).

Methods: We re-enrolled children of a previously community-based Exclusive breastfeeding trial in Burkina Faso. We assessed a total of 532 children aged 6-8 years using KABC-II for memory (Atlantis and Number Recall subtests), spatial abilities (Conceptual Thinking, Face Recognition and Triangle subtests), reasoning (Block Counting subtest), general cognition and CCT-1 for cognitive flexibility. A total 513 children were assessed using the TOVA to measure attention and inhibition. We calculated the Cohen's d to examine the effect size and conducted a linear regression to examine the association.

Results: The proportion of stunting was 15.6% (83/532). Stunted children performed significantly poorer for memory (Atlantis and Number Recall), spatial abilities (Conceptual Thinking, Face Recognition and Triangle), general cognition and attention with a small effect size compared to non-stunted children. Children who were exposed scored significantly higher errors for cognitive flexibility and inhibition with a small effect size compared to unexposed children. At standardized and unstandardized multivariable regression analysis, stunted children performed significantly poorer for Atlantis (p = 0.001), Number Recall (p = 0.02), Conceptual Thinking (p = 0.01), Triangle (p = 0.001), general cognition (p ≤ 0.0001) and attention (p = 0.04) compared to non-stunted children. Children who were exposed scored significantly higher errors for cognitive flexibility (p = 0.02) and for inhibition (p = 0.02) compared to unexposed children. We adjusted all the results for age, schooling, sex, playing, father education, mother employment and promotion of previous exclusive breastfeeding.

Conclusion: Stunting is associated with poorer neuro-psychological outcomes among children in rural Burkina Faso. Initiatives related to prevention need to be established and advice on nutrition need to be provided.

Keywords: Africa; Burkina Faso; CCT-1; Children; KABC-II; Neuro-psychological test; Nutrition; Stunting; TOVA.