Catch-up growth in Malawian babies, a longitudinal study of normal and low birthweight babies born in a malarious endemic area.

INTRODUCTION Infant growth has not been studied in developing countries in relation to maternal factors related to malaria in pregnancy and maternal illiteracy. OBJECTIVE To describe growth patterns in infants with low and normal birthweight and determine maternal risk factors for infant undernutrition. METHODS Babies born in a rural district of southern Malawi were recruited. An infant cohort was selected on the basis of low or normal birthweight. Weight and length were recorded at birth and at 4-weekly intervals until at 52 weeks after birth. Maternal characteristics at first antenatal attendance and delivery were obtained. Odds ratios in univariate analysis were adjusted for birthweight. Factors included in the multivariate regression included maternal illiteracy, season of birth, maternal iron deficiency and number of infant illness episodes. RESULTS Low birthweight infants were shorter and lighter throughout infancy than either normal birthweight or international reference values. At 12 months, placental or peripheral malaria at delivery (adjusted odds 1.8; 1.0, 3.1), number of infant illness episodes (AOR = 2.1; 1.2, 3.6) and maternal illiteracy (AOR = 2.7; 1.5, 4.9) were independently associated with low weight for age. Maternal short stature (AOR = 1.8; 1.1. 3.2), male sex (AOR = 2.4; 1.4, 4.1), number of infant illness episodes (AOR = 2.6; 1.5, 4.4), and birth in the rainy season (2.1; 1.2, 3.7) were independently associated with stunting. Placental or peripheral malaria at delivery (AOR = 2.2; 1.1, 4.4) and number of illness episodes (AOR = 2.2; 1.1, 4.5) were independently associated with thinness. CONCLUSION Malaria during pregnancy and maternal illiteracy are important maternal characteristics associated with infant undernutrition. Innovative health/literacy strategies are required to address malaria control in pregnancy in order to reduce the magnitude of its effects on infant undernutrition.