Type of Paper: Original Article; Prospective Medical Evaluations and Parent-Report
Purpose: To describe the health and environmental conditions of children adopted from India into Sweden prior to and soon after arrival
- Pre-adoption health information was reported by parents.
- Post-adoption medical evaluations included :
- Physical growth: standard anthropometry [height, weight, head circumference (OFC)]. Z scores were calculated using National Center for Health Statistics as a reference
- Other nutritional measures: anemia, parasite infection
- Motor development
Participants: 114 children adopted from India into Sweden between the ages 3 and 72 months at arrival (average age was 15. 2 months). 77% of the children were adopted from orphanages, 22% from foster homes, and 1% from hospitals.
Methods: Families were recruited through five adoption organizations. Parents completed a questionnaire on their child’s social and health conditions in India. Physicians completed standard medical evaluations soon after arrival. The majority (86%) were completed within 2 weeks of arrival.
- Pre-adoption health information was available for 32% of the children. The following diagnoses were reported:
- Protein-energy malnutrition: 28%
- Anemia: 14%
- Diarrhea: 25%
- Low birth weight (<2500g): 81%
- Other: There was a single case each of intestinal parasites and vitamin A deficiency.
- Post-arrival medical evaluations:
- Physical growth:
- Average z scores were below the mean (i.e., z score of 0). Average z scores were:
- Height for age (HAZ): -2. 23 (range: -6. 20 to 0. 90)
- Weight for age (WAZ): -2. 25 (range: -5. 21 to -0. 14)
- Weight for height (WHZ): -0. 94 (range: -2. 82 to 0. 91)
- Head circumference for age (OFCZ): -1. 98 (range: -4. 62 to 0. 84)
- The following number of children were below -2 z scores for growth (-2 z scores is equivalent to approximately the 5th percentile), fitting the WHO criteria for malnutrition:
- HAZ (stunted only): 47%
- WHZ (wasted only): 1. 8%
- Both stunted and wasted (HAZ & WHZ): 6. 4%
- The youngest (0-5 months) and the oldest children (≥18 months) had lower HAZ and WAZ than the other age groups.
- Birth weight was positively correlated with both HAZ and WAZ. Those with smaller birth weights had lower height and weight at arrival.
- Other nutrition-related diagnoses:
- Diarrhea: 4. 4%
- Anemia (hemoglobin < 100g/L): 15%; Anemia was more common in children with WAZ < -3 z scores.
- Parasitic or bacterial infections in stools: 44%
- Motor delays were associated with malnutrition:
- Motor delays were more common in those who were stunted (stunted: 47%; nonstunted: 8%).
- Motor delays were more common in those with anemia (anemic: 23%; non-anemic: 4%).
Conclusions & Clinical Implications: There was a high incidence of stunting, wasting, and a combination of both stunting and wasting in children adopted from India at the time of arrival. There was also a high rate of low birth weight (81%). Children born early may be at a greater risk for malnutrition and need special nutritional considerations. This study found that birth weight was associated with both height and weight at the time of arrival. Anemia and parasitic infections were also common. Although not discussed in this paper, intestinal parasites could interfere with proper nutrient absorption and may increase the risk for both macronutrient (e. g. , physical growth) and micronutrient (vitamins and minerals) malnutrition. Motor delays at arrival were associated with stunting and anemia.
Limitations of the Nutritional Results: Pre-adoption information was only available for a few of the children in this study. Pre-adoption information was also reported by parents and the accuracy of the pre-adoption information available to the parents is unknown. Also, the only marker used to identify anemia was hemoglobin, and it was not reported whether the anemia was due to iron deficiency or another etiology. This study was also undertaken 20 years ago and may not represent the current health of similar children.
Reference: Proos LA, Hofvander Y, Wennqvist K, Tuvemo T. A longitudinal study on anthropometric and clinical development of Indian children adopted in Sweden. Upsala Journal of Medical Sciences. 1992; 97 (1): 79-92. http://www.ncbi.nlm.nih.gov/pubmed/1523738