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Growth and determinants at two years of age in a South African birth cohort
Aim: Early childhood is a critical period for optimal growth but there are limited data from low- and middle-income countries (LMICs) on the determinants of growth during this time. This study aimed to investigate growth and its determinants in children at 2 years of age in a South African birth coh...
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| Format: | Thesis |
| Language: | English English |
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Department of Paediatrics and Child Health
2025
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| _version_ | 1867613544921432064 |
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| access_status_str | Open Access |
| author | Itzikowitz, Raphaela |
| author2 | Zar, Heather |
| author_browse | Itzikowitz, Raphaela Zar, Heather |
| author_facet | Zar, Heather Itzikowitz, Raphaela |
| author_sort | Itzikowitz, Raphaela |
| collection | Thesis |
| description | Aim: Early childhood is a critical period for optimal growth but there are limited data from low- and middle-income countries (LMICs) on the determinants of growth during this time. This study aimed to investigate growth and its determinants in children at 2 years of age in a South African birth cohort in a resource-limited region. Methods: Mother-child pairs enrolled in a South African birth cohort, the Drakenstein Child Health Study (DCHS), were followed from birth to two years. Comprehensive socio-demographic and psychosocial data collected during the antenatal period and nutritional information, intercurrent illness and immunisation data collected longitudinally in the first 2 years was used. Anthropometric data, measured at 2 years, were analysed as z-scores adjusted for child age, sex, and prematurity, and used to classify undernutrition (wasting, underweight for age and or stunting), overweight for age or obesity. Logistic regression was done to identify predictors of undernutrition, overweight or obesity at 2 years. Results: Anthropometric data from 897 children (51% male; 22% HIV-exposed, uninfected) were included. 69 (8%) were underweight, 20 (2%) were wasted and stunting occurred in 167 (19%) children; 116 children were overweight (13%), and 42 were (5%) obese. Overall, 351 (39%) had some form of growth impairment. Higher birth weight, or length, higher maternal height or better maternal education were associated with lower odds of undernutrition or stunting at 2 years. Male sex, antenatal maternal smoking or prematurity were associated with increased odd of undernutrition or stunting. Higher birth weight was associated with increased odds of being overweight for age. Better maternal education was associated with increased odds of obesity, but antenatal smoke exposure reduced the risk. Conclusion: There is a substantial burden of malnutrition in South African children during early childhood encompassing both undernutrition and obesity. Stunting, indicative of chronic growth impairment, is most prevalent. Antenatal risk factors are important predictors of poor growth outcomes. Strengthened strategies to improve childhood nutrition and address modifiable factors in the antenatal and early childhood periods are needed. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/41653 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-06-10T12:37:50.764Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Department of Paediatrics and Child Health |
| publisherStr | Department of Paediatrics and Child Health |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/41653 Growth and determinants at two years of age in a South African birth cohort Itzikowitz, Raphaela Zar, Heather Anthropometry child growth Low-middle income countries stunting obesity Aim: Early childhood is a critical period for optimal growth but there are limited data from low- and middle-income countries (LMICs) on the determinants of growth during this time. This study aimed to investigate growth and its determinants in children at 2 years of age in a South African birth cohort in a resource-limited region. Methods: Mother-child pairs enrolled in a South African birth cohort, the Drakenstein Child Health Study (DCHS), were followed from birth to two years. Comprehensive socio-demographic and psychosocial data collected during the antenatal period and nutritional information, intercurrent illness and immunisation data collected longitudinally in the first 2 years was used. Anthropometric data, measured at 2 years, were analysed as z-scores adjusted for child age, sex, and prematurity, and used to classify undernutrition (wasting, underweight for age and or stunting), overweight for age or obesity. Logistic regression was done to identify predictors of undernutrition, overweight or obesity at 2 years. Results: Anthropometric data from 897 children (51% male; 22% HIV-exposed, uninfected) were included. 69 (8%) were underweight, 20 (2%) were wasted and stunting occurred in 167 (19%) children; 116 children were overweight (13%), and 42 were (5%) obese. Overall, 351 (39%) had some form of growth impairment. Higher birth weight, or length, higher maternal height or better maternal education were associated with lower odds of undernutrition or stunting at 2 years. Male sex, antenatal maternal smoking or prematurity were associated with increased odd of undernutrition or stunting. Higher birth weight was associated with increased odds of being overweight for age. Better maternal education was associated with increased odds of obesity, but antenatal smoke exposure reduced the risk. Conclusion: There is a substantial burden of malnutrition in South African children during early childhood encompassing both undernutrition and obesity. Stunting, indicative of chronic growth impairment, is most prevalent. Antenatal risk factors are important predictors of poor growth outcomes. Strengthened strategies to improve childhood nutrition and address modifiable factors in the antenatal and early childhood periods are needed. 2025-09-01T06:59:59Z 2025-09-01T06:59:59Z 2025 2025-09-01T06:55:47Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/41653 en eng application/pdf Department of Paediatrics and Child Health Faculty of Health Sciences University of Cape Town |
| spellingShingle | Anthropometry child growth Low-middle income countries stunting obesity Itzikowitz, Raphaela Growth and determinants at two years of age in a South African birth cohort |
| thesis_degree_str | Master's |
| title | Growth and determinants at two years of age in a South African birth cohort |
| title_full | Growth and determinants at two years of age in a South African birth cohort |
| title_fullStr | Growth and determinants at two years of age in a South African birth cohort |
| title_full_unstemmed | Growth and determinants at two years of age in a South African birth cohort |
| title_short | Growth and determinants at two years of age in a South African birth cohort |
| title_sort | growth and determinants at two years of age in a south african birth cohort |
| topic | Anthropometry child growth Low-middle income countries stunting obesity |
| url | http://hdl.handle.net/11427/41653 |
| work_keys_str_mv | AT itzikowitzraphaela growthanddeterminantsattwoyearsofageinasouthafricanbirthcohort |