Inequities in Physical Development Among Israeli Children from Birth to Age 13 in 8 Birth Cohorts.

Background. The emotional, social and physical development of young children has a direct effect on their overall development and on the adult they will become. Child malnutrition is a global health problem with health consequences on future life and one of the main UNICEF goal of ending it by 2030.

Objective. To examine growth parameters by gender, district and religion in Israeli children from birth to age 13y in 2004-2011 national birth cohorts.

Methods. A retrospective cohort study was conducted among 610,223 full-term normal birthweight children from computerized Maternal and Child Health Clinics (MCHC) of Ministry of Health, routinely measured from birth to aged 13y by public health nurse in MCHC and school. Linear mixed models were performed to determine factors affecting child growth. Weight-for-age (WAZ), height-for-age (HAZ) z-scores were calculated using 2006 WHO child growth standards at 6m (+1m), 12m (+1m), 18m (+3m), 24m (+3m), 6y (+6m) and 13y (+6m).

Results. 541,128 (88%) children were included in the study, representing 70% of Israeli child population (49% girls and 51% boys). Mean birth weight was higher in boys than in girls (3,320±460g and 3,190±440g, respectively (p<0.001). Mean WAZ and HAZ were significantly lowest from birth to age 13y in Jerusalem and Southern districts (p<0.001). Fig 1. Mean WAZ and HAZ decreased significantly from 18m to 13y with lowest values in the “Ultra-religious” versus “secular” schools, (p<0.001) Fig 2. Gender was found as a determinant of growth with different influence during the first 2 years of life and at age 13y (p<0.001).

Discussion. The subpopulations at risk for growth impairments among children with normal birth weight live in southern and Jerusalem districts of Israel, belong to the ultra-religious population. It is crucial to understand the reasons for described inequities in order to put efforts in development, implantation, and evaluation appropriate intervention programs.