Human growth, nutrition, and health status in sub‐Saharan Africa

Abstract

The 45 countries of sub‐Saharan Africa are the greatest aggregation of developing countries in the world with the greatest population growth rates, the highest levels of infant and child mortality, and the poorest economies. The Physical Quality of Life Index of 33 sub‐Saharan countries varies between 20.5 and 66.0 compared to levels greater than 80 for developed countries. Within this context the acceptance and widespread use of routine monitoring of the growth and nutritional status of children, to indicate their health and well‐being, is arguably one of the most important applied research goals of human biologists. This paper reviews growth and nutritional status at three phases of life; birth, 0 to 5 years, and childhood and adolescence. Percentages of low birth weight are universally high with the majority of countries exhibiting low birthweight levels between 10% and 20%. The range of recorded mean birthweights, from the smallest to the largest, falls below the medians for developed countries and yet mean birthweight has been steadily increasing over the last decade. About 40% of children under the age of 5 years are within the mild to moderate range of malnutrition as defined by growth retardation and some biochemical changes but lack clinical signs and symptoms (McLaren, 1984). The pattern of growth in height and weight through childhood and adolescence is characterised by a gradual fall away from the 50th centile of American norms, so that by early adolescence about 50% of representative samples of rural children are below the 5th centile. Adolescence is extended in time and reduced in vigour, such that peak velocities appear low but postpeak velocities stay higher than equivalent velocities for children in developed countries. The net effect of this pattern is that adult heights are between the 5th and 50th centiles. Absolute levels of subcutaneous fat are lower than those of American blacks throughout childhood and adolescence but the predominantly centralised patterning of fat appears to be similar for both American and African blacks and consistently less peripheral than in white children. At all phases of the growth process the adverse socioeconomic environment of sub‐Saharan Africa and the consequent low levels of health interact to confound the genetic potential of African children. Copyright © 1991 Wiley‐Liss, Inc., A Wiley Company