Malnutrition and microcephaly in Australian Aboriginal children

Objective: To examine the association between malnutrition and microcephaly in the first two years of life. Design: Cross-sectional study. Setting and participants: Royal Darwin Hospital (a tertiary referral centre); 157 of 165 previously studied Aboriginal children aged under two years who were admitted with diarrhoea between May 1990 and April 1991. Birth weight, birth length, birth head circumference, admission head circumference and admission nutritional status were examined. Nutritional status was categorised according to World Health Organization (WHO) criteria for wasting (thinness) and stunting (shortness). Microcephaly on admission was defined as a head circumference less than the second percentile on Australian reference charts. Small-for-gestational-age (SGA) and birth microcephaly were defined as being less than the tenth percentile for an Australian hospitalised population, corrected for gestational age at confinement. Low birth weight (LBW) was defined as less than 2500 g. Main outcome measure: Microcephaly on admission. Results: Of the 157 children, 76 (48%) were wasted, 36 (23%) stunted and 37 (24%) microcephalic on admission. A total of 26 (17%) children had been of LBW, 17 (11%) SGA and 21 (13%) microcephalic at birth. On univariate analysis, microcephaly on admission was associated with wasting (crude odds ratios [OR], 3.91; 95% confidence interval [Cl], 1.6-9.7; P < 0.005), but not stunting. There were no significant associations between microcephaly on admission and LBW, being SGA, microcephaly at birth, age or sex. With multivariate analysis, birth head circumference was significantly associated with microcephaly on admission (adjusted OR, 3.62; 95% Cl, 1.28-10.23; P < 0.05), as was wasting (adjusted OR, 4.38; 95% Cl, 1.88-10.20; P < 0.001). Conclusions: Wasting was significantly associated with microcephaly, independent of intrauterine growth retardation (as measured by being SGA) and LBW. As malnutrition in critical periods of both intra- and extrauterine development may have irreversible effects on intellectual potential and behaviour, the emphasis on improved nutrition must begin during pregnancy, and should continue in infancy and early childhood.