DIARRHEA AND GROWTH FALTERING IN RURAL ZIMBABWE

Objective: To assess the evidence that diarrhoea is an important cause of growth faltering in young children in developing countries. Design : Prospective, longitudinal cohort study. Setting: Worker's compounds on commercial farms in Shamva, rural Zimbabwe. Subjects: 204 children < 12 months old were enrolled, 73 from birth. The median age at enrolm ent was 4 months. Eleven children died and 39 were lost to follow-up. Interventions: Prospective weekly diarrhoea surveillance by farm healt h workers and monthly anthropometry. Results: Growth faltering was sev ere, but there was little difference in average rates of growth betwee n children with frequent diarrhoea and infrequent diarrhoea. The resul ts of an interval-based data analysis were consistent with there being only a transient effect of diarrhoea on weight gain. Estimation of we ight faltering following episodes of diarrhoea and the rate of return to the trend in the 9-14 month age range, indicated that weight loss a ssociated with each episode was small (approximately 2%) and return to the child's trend was 90% complete within a month. At older ages than this, weight loss appeared to be less, and estimates were not statist ically significant. Conclusions: These observations lend weight to the hypothesis that recurrent episodes of diarrhoea are not a potent caus e of growth faltering in early childhood except in a small minority of largely catastrophic cases. Inadequate food intake is a more plausibl e explanation.