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Manuscript received 14 October 1996. Initial reviews completed 3 December 1996. Revision accepted 4 February 1997.
,
Center for Human Nutrition, Department of International Health, The Johns Hopkins School of Public Health, Baltimore, MD 21205; * Ministry of Health, Zanzibar, United Republic of Tanzania; and Schistosomiasis and Intestinal Parasites Unit, Division of Control of Tropical Diseases, World Health Organization, Geneva 27, Switzerland
This paper describes the longitudinal changes in height and weight of children in school grades 1-3 on Pemba Island, Zanzibar, a poor rural population in which parasitic infections and anemia are highly prevalent. Heights and weights of children were measured at base line, and 6 and 12 mo later, and were compared with U.S. reference data. At base line, the prevalence of height-for-age Z-score < 
2 rose from 14% in 7-y-old children to 83% in 13-y-old children. Prevalence of weight-for-age Z-score < 2 in children < 10 y was ~10% or less. Median 6-mo height increments for Pembian boys were around the 5th percentile at age 8 and around the 10th percentile from age 9 to 13 y. Height increments for girls improved from below the 25th percentile to above the median in this age range. Based on the longitudinal yearly gains observed, boys accumulate a height deficit of 11.9 cm and girls 8.5 cm, relative to the reference population. In multivariate analyses, a small part of the variability in growth increments was explained by ascariasis and anemia (for weight gain) and schistosomiasis (for height gain). A review of other growth data from rural African Bantu populations provides supporting evidence that stunting occurs in older as well as younger children. It has been controversial whether school-based health and nutrition interventions could induce catch-up growth in already stunted children. Our results suggest that appropriate interventions might actually prevent stunting in late childhood.
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