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Editor,—The paper by Poskitt and colleagues from The Gambia1 indicates that there has been a disappointing lack of improvement in the nutritional status and mortality of young African children during the 25 years’ existence of the famous field station. Previous research from Keneba suggested a relation between diarrhoeal diseases and growth faltering, but despite considerable reductions in diarrhoea incidence and duration of attacks over the past 15 years, nutritional status has not improved, implying that these children were malnourished primarily because of a lack of food rather than because of high rates of diarrhoea.
This challenge to the orthodox “diarrhoea–malnutrition vicious cycle” theory, first voiced by Briend in an analysis of morbidity and growth data from Bangladesh,2 is also supported by our findings in rural Zimbabwe.3 4 Children from commercial farm labour compounds were enrolled in a prospective study of diarrhoea morbidity and growth. Growth faltering in the 2nd year of life was severe but there was little difference in the average rates of growth between children with frequent and infrequent diarrhoea. The results of an interval based data analysis similar to that employed by Briend, were consistent with there being only a transient effect of diarrhoea on weight gain. Estimation of weight faltering following episodes of diarrhoea and the rate of return to the trend in the 9–14 month age group indicated that weight loss associated with each episode was small (around 2% of body weight), and return to the child’s trend was 90% complete within a month.
Our observations lend weight to the hypothesis that recurrent episodes of diarrhoea are not a potent cause of growth faltering in early childhood except in a small number of largely catastrophic cases. Inadequate food intake is a more plausible explanation.