Young Zanzibari Children with Iron Deficiency, Iron Deficiency Anemia, Stunting, or Malaria Have Lower Motor Activity Scores and Spend Less Time in Locomotion

Authors: OLNEY, DEANNA - WHNRC, UCD, INTL. NUTR.; POLLITT, ERNESTO - UCD, INTL. NUTR.; KARIGER, PATRICIA - CORNELL UNIV. ITHACA, NY; KHALFAN, SABRA - PUBLIC HEALTH, TANZANIA; ALI, NADRA - PUBLIC HEALTH, TANZANIA; TIELSCH, JAMES - JOHN HOPKINS UNIV.; SAZAWAL, SUNIL - JOHN HOPKINS UNIV.; BLACK, ROBERT - JOHN HOPKINS UNIV.; MAST, DARRELL - JOHN HOPKINS UNIV.; Allen, Lindsay - A; STOLTZFUS, REBECCA - CORNELL UNIV. ITHACA, NY

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/1/2007
Publication Date: 12/1/2007
Citation: Olney, D.K., Pollitt, E., Kariger, P.K., Khalfan, S.S., Ali, N.S., Tielsch, J.M., Sazawal, S., Black, R., Mast, D., Allen, L.H., Stoltzfus, R.J. 2007. Young Zanzibari Children with Iron Deficiency, Iron Deficiency Anemia, Stunting, or Malaria Have Lower Motor Activity Scores and Spend Less Time in Locomotion. Journal of Nutrition. 137:2756-2762, 2007.

Interpretive Summary: Motor activity is important for children’s development. It improves cognitive and social-emotional development through a child’s exploration of his or her physical and social environment. A study conducted in Pemba, Zanzibar, Tanzania revealed that children 9-18 months old (n=771) who are stunted, have iron deficiency, iron deficiency anemia or malaria are less active than children who are not suffering from these health and nutrition related problems. However, the relative importance of these factors depends on the developmental level of the child. For example, in children who are only able to crawl or sit on their own, malaria has the biggest effect on how active a child is, whereas in children who are able to walk on their own, iron deficiency, anemia and linear growth are more strongly correlated with activity levels than is malaria infection. Anemia, stunting, and malaria affect millions of children worldwide and amelioration of these problems has the potential to improve both the health of the affected children and their motor, cognitive, and social-emotional development.

Technical Abstract: Motor activity improves cognitive and social-emotional development through a child’s exploration of his or her physical and social environment. This study assessed anemia, iron deficiency, hemoglobin (Hb), length-for-age Z-score (LAZ), and malaria infection as predictors of motor activity in 771 children aged 5–19 mo. Trained observers conducted 2- to 4-h observations of children’s motor activity in and around their homes. Binary logistic regression assessed the predictors of any locomotion. Children who did not locomote during the observation (nonmovers) were excluded from further analyses. Linear regression evaluated the predictors of total motor activity (TMA) and time spent in locomotion for all children who locomoted during the observation combined (movers) and then separately for crawlers and walkers. Iron deficiency (77.0%), anemia (58.9%), malaria infection (33.9%), and stunting (34.6%) were prevalent. Iron deficiency with and without anemia, Hb, LAZ, and malaria infection significantly predicted TMA and locomotion in all movers. Malaria infection significantly predicted less TMA and locomotion in crawlers. In walkers, iron deficiency anemia predicted less activity and locomotion, whereas higher Hb and LAZ significantly predicted more activity and locomotion, even after controlling for attained milestone. Improvements in iron status and growth and prevention or effective treatment of malaria may improve children’s motor, cognitive, and social-emotional development either directly or through improvements in motor activity. However, the relative importance of these factors is dependent on motor development, with malaria being important for the younger, less developmentally advanced children and Hb and LAZ becoming important as children begin to attain walking skills.