Rare prism

Who of the kids will die? Who will get a more-than-even chance to achieve full lives? “Seventy is the sum of our years, eighty if we are strong,” the Psalmist writes. More important, how do we ensure that, in the future, youngsters need no longer slump into premature graves?

Today’s headlines and evening news bulletins swirl around Erap Estrada getting fed up with Sen. Koko Pimentel’s reluctance to play ball with the opposition, with Manila Mayor Alfredo Lim’s word brawl with Vice Mayor Francisco Domagoso and with the Abu Sayyaf kidnapping of a Jordanian journalist.

In contrast, a conference in Cebu City held mid-June analyzed “Early Life Determinants of Health and Well-Being” but was barely noticed. Organized by the Consortium of Health Orientated Research in Transitioning Societies, the meeting examined child-health issues with a rare international prism: studies that tracked children across generations.

“Longitudinal analysis” is rare. Countries assembled, under the Consortium’s umbrella, are the Philippines, Brazil, India, South Africa and Guatemala. These five have ongoing birth cohort studies that cover close to 11,000 individuals. All had “at least 15 years or more of follow-up.”

Brazil failed to track 17 percent of infants, studied by Universidade Federal de Pelotas, into adulthood. In contrast, the Cebu Longitudinal Health and Nutrition Survey (CLHNS), at the University of San Carlos, lost contact with only 1 percent of 3,080 mothers and infants from 243 barangays, which it first examined in 1983.

“Cebu study findings shaped the first World Bank health financing strategy,” University of North Carolina’s Barry Popkin wrote. Cebu research was “instrumental” in the Unicef policy on breast milk substitutes and the Asian Development Bank’s programs on early child development. A Harvard University team used the CLHNS for analysis of two long-term vaccination programs.

Over the last 28 years, USC’s Office of Population Studies (OPS) conducted seven follow-up surveys. CLHNS data anchor 125 international and national research projects. They range from pre-birth malnutrition’s effect on blood pressure and early onset of menstruation to parental and peer pressure on young adult sexual behavior.

Yesterday’s Cebu infants are today’s adults. Some are parents and hold down jobs. There are school dropouts. A number have died and 136 moved out. One is an OFW worker in Iceland.

These life-changes are mirrored in the analysis. In CLHNS’ early years, focus was on infant feeding, birth spacing to nutritional status. In the 1990s, attention shifted to childhood stunting and entry-into-school development. As kids emerged into young adulthood, the spotlight turned to “early life factors that predict schooling and academic achievement.”

CLHNS mothers were monitored as to their long-term patterns of health, birth spacing to diet and work patterns, noted the International Journal of Epidemiology. CLHNS is “one of the few sources for long analysis of intimate partner violence… and consequences for women and young adults.”

In 2011, San Carlos completed its examination of new pregnancies and birth outcomes among those who were once 1983 infants. This “makes CLHNS a three-generation study.”

Linda Adair of North Carolina University and Judith Borja of San Carlos OPS, presented findings on breastfeeding in 17 urban barangays and 16 rural villages. Breastfeeding had declined. As an alternative, mothers fed their babies with milk formulas. Others used diluted condensed milk. Diarrhea was related to babies who were fed substitute milk, they found. Four in 10 of the babies who were not breastfed, and lived in poor conditions, proved vulnerable to diseases.

Cesar Victoria of Brazil cobbled the Consortium into its present structure. “The bottom line” for decisive intervention in form is in the first 24 months of the child’s life. “Act here,” he urged. Dividends in the child’s health dwindle in the later months. “Maternal and child undernutrition have adverse consequences for adult and health capital.”

Some of the fallout emerge from comparison of data. Malnourished pregnant mothers result in “stunting, lower attained schooling, reduced adult income” and wizened “underweight offspring.”

“Children who are undernourished in early life, and then gain weight rapidly after infancy, are at high risk of chronic disease,” Linda Richter from South Africa’s University of the Witwatersrand reported. “Prevention of maternal and child undernutrition is a long-term investment. (It) benefits both the current generation and their children…”

Members differed in patterns of child growth, in both length and height. “Guatemala and Cebu showed marked growth failure in early childhood. Brazil growth hewed to international standards. South Africa and India showed intermediate patterns.”

Data from the five participating countries underscore that children from low- and middle-income countries, who are assisted in the “first and possibly in the second year of life, show improved human capital indicators as adults.” They are also less prone to the “increased risk of chronic diseases in later life.”

Present Consortium findings “in a format that policymakers can understand,” urged Florentino Solon of the Nutrition Center of the Philippines, who conceptualized CLHNS with the late SVD Fr. Wilhelm Flieger: “Policymaking is in the hands of politicians. How do you convince these politicians (to implement) these?”

For a start, slam them with the American psychiatrist Karl Menninger’s warning in his book “The Human Mind”: “What’s done to children, they will do to society.”

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