| dc.description.abstract | Health, growth and development during mid-childhood (from 5 to 14 years) are poorly characterised, and this period has been termed the ‘missing middle’. This thesis describes the piloting and application of the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox to measure growth, cognitive and physical function amongst the SHINE cohort in rural Zimbabwe. The SHINE cluster-randomised trial tested the effects of a household WASH intervention and/or infant and young child feeding (IYCF) on child stunting and anaemia at age 18 months in rural Zimbabwe. SHINE showed that IYCF modestly increased linear growth and reduced stunting by age 18 months, while WASH had no effects. The SAHARAN toolbox was used to measure 1000 HIV-unexposed children (250 in each intervention arm), and 275 HIV-exposed children within the SHINE cohort to evaluate long-term outcomes. Children were re-enrolled at age seven years to evaluate growth, body composition, cognitive and physical function. Four main findings are presented from the SAHARAN toolbox measurements of this cohort. Firstly, child sex, growth and contemporary environmental conditions are associated with school-age physical and cognitive function at seven years. Secondly, early-life growth and baseline environmental conditions suggest the impact of early-life trajectories on multiple aspects of school-age growth, physical and cognitive function. Thirdly, the long-term impact of HIV-exposure in pregnancy is explored, which indicate reduced cognitive function, cardiovascular fitness and head circumference by age 7 years. Finally, associations with the SHINE trial early life interventions are explored, demonstrating that the SHINE early-life nutrition intervention has minimal impact by 7 years of age, except marginally stronger handgrip strength. The public health implications advocate that child interventions need to be earlier (including antenatal), broader (incorporating nurturing care), deeper (providing transformational WASH) and longer (supporting throughout childhood), as well as targeting particularly vulnerable groups such as children born HIV-free. | en_US |
