Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 Demographic and Health Surveys from 64 countries (1993–2015)
Summary: Background: The causes of early childhood linear growth faltering (known as stunting) in low-income and middle-income countries remain inadequately understood. We aimed to determine if the progressive postnatal decline in mean height-for-age Z score (HAZ) in low-income and middle-income co...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2017-12-01
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| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X17304187 |
| _version_ | 1818160352205996032 |
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| author | Daniel E Roth, PhD Aditi Krishna, ScD Michael Leung, MSc Joy Shi, MSc Diego G Bassani, PhD Aluisio J D Barros, ProfPhD |
| author_facet | Daniel E Roth, PhD Aditi Krishna, ScD Michael Leung, MSc Joy Shi, MSc Diego G Bassani, PhD Aluisio J D Barros, ProfPhD |
| author_sort | Daniel E Roth, PhD |
| collection | DOAJ |
| description | Summary: Background: The causes of early childhood linear growth faltering (known as stunting) in low-income and middle-income countries remain inadequately understood. We aimed to determine if the progressive postnatal decline in mean height-for-age Z score (HAZ) in low-income and middle-income countries is driven by relatively slow growth of certain high-risk children versus faltering of the entire population. Methods: Distributions of HAZ (based on WHO growth standards) were analysed in 3-month age intervals from 0 to 36 months of age in 179 Demographic and Health Surveys from 64 low-income and middle-income countries (1993–2015). Mean, standard deviation (SD), fifth percentiles, and 95th percentiles of the HAZ distribution were estimated for each age interval in each survey. Associations between mean HAZ and SD, fifth percentile, and 95th percentile were estimated using multilevel linear models. Stratified analyses were performed in consideration of potential modifiers (world region, national income, sample size, year, or mean HAZ in the 0–3 month age band). We also used Monte Carlo simulations to model the effects of subgroup versus whole-population faltering on the HAZ distribution. Findings: Declines in mean HAZ from birth to 3 years of age were accompanied by declines in both the fifth and 95th percentiles, leading to nearly symmetrical narrowing of the HAZ distributions. Thus, children with relatively low HAZ were not more likely to have faltered than taller same-age peers. Inferences were unchanged in surveys regardless of world region, national income, sample size, year, or mean HAZ in the 0–3 month age band. Simulations showed that the narrowing of the HAZ distribution as mean HAZ declined could not be explained by faltering limited to a growth-restricted subgroup of children. Interpretation: In low-income and middle-income countries, declines in mean HAZ with age are due to a downward shift in the entire HAZ distribution, revealing that children across the HAZ spectrum experience slower growth compared to the international standard. Efforts to mitigate postnatal linear growth faltering in low-income and middle-income countries should prioritise action on community-level determinants of childhood HAZ trajectories. Funding: Bill & Melinda Gates Foundation. |
| first_indexed | 2024-12-11T16:00:30Z |
| format | Article |
| id | doaj.art-c1b83396a8f44f55980d6c9a351ecffb |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-12-11T16:00:30Z |
| publishDate | 2017-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-c1b83396a8f44f55980d6c9a351ecffb2022-12-22T00:59:19ZengElsevierThe Lancet Global Health2214-109X2017-12-01512e1249e1257Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 Demographic and Health Surveys from 64 countries (1993–2015)Daniel E Roth, PhD0Aditi Krishna, ScD1Michael Leung, MSc2Joy Shi, MSc3Diego G Bassani, PhD4Aluisio J D Barros, ProfPhD5Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada; Correspondence to: Daniel E Roth, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON M5G0A4, CanadaCentre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, ON, CanadaCentre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, ON, CanadaHarvard T H Chan School of Public Health, Boston, MA, USADepartment of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, ON, CanadaInternational Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, BrazilSummary: Background: The causes of early childhood linear growth faltering (known as stunting) in low-income and middle-income countries remain inadequately understood. We aimed to determine if the progressive postnatal decline in mean height-for-age Z score (HAZ) in low-income and middle-income countries is driven by relatively slow growth of certain high-risk children versus faltering of the entire population. Methods: Distributions of HAZ (based on WHO growth standards) were analysed in 3-month age intervals from 0 to 36 months of age in 179 Demographic and Health Surveys from 64 low-income and middle-income countries (1993–2015). Mean, standard deviation (SD), fifth percentiles, and 95th percentiles of the HAZ distribution were estimated for each age interval in each survey. Associations between mean HAZ and SD, fifth percentile, and 95th percentile were estimated using multilevel linear models. Stratified analyses were performed in consideration of potential modifiers (world region, national income, sample size, year, or mean HAZ in the 0–3 month age band). We also used Monte Carlo simulations to model the effects of subgroup versus whole-population faltering on the HAZ distribution. Findings: Declines in mean HAZ from birth to 3 years of age were accompanied by declines in both the fifth and 95th percentiles, leading to nearly symmetrical narrowing of the HAZ distributions. Thus, children with relatively low HAZ were not more likely to have faltered than taller same-age peers. Inferences were unchanged in surveys regardless of world region, national income, sample size, year, or mean HAZ in the 0–3 month age band. Simulations showed that the narrowing of the HAZ distribution as mean HAZ declined could not be explained by faltering limited to a growth-restricted subgroup of children. Interpretation: In low-income and middle-income countries, declines in mean HAZ with age are due to a downward shift in the entire HAZ distribution, revealing that children across the HAZ spectrum experience slower growth compared to the international standard. Efforts to mitigate postnatal linear growth faltering in low-income and middle-income countries should prioritise action on community-level determinants of childhood HAZ trajectories. Funding: Bill & Melinda Gates Foundation.http://www.sciencedirect.com/science/article/pii/S2214109X17304187 |
| spellingShingle | Daniel E Roth, PhD Aditi Krishna, ScD Michael Leung, MSc Joy Shi, MSc Diego G Bassani, PhD Aluisio J D Barros, ProfPhD Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 Demographic and Health Surveys from 64 countries (1993–2015) The Lancet Global Health |
| title | Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 Demographic and Health Surveys from 64 countries (1993–2015) |
| title_full | Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 Demographic and Health Surveys from 64 countries (1993–2015) |
| title_fullStr | Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 Demographic and Health Surveys from 64 countries (1993–2015) |
| title_full_unstemmed | Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 Demographic and Health Surveys from 64 countries (1993–2015) |
| title_short | Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 Demographic and Health Surveys from 64 countries (1993–2015) |
| title_sort | early childhood linear growth faltering in low income and middle income countries as a whole population condition analysis of 179 demographic and health surveys from 64 countries 1993 2015 |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X17304187 |
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