Elevation and Child Linear Growth in Nepal

Gerald Shively,Timothy Smith,Megan Paskey

doi:10.1659/mrd-journal-d-19-00063.1

Gerald Shively, Timothy Smith + Show 1 more

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https://doi.org/10.1659/mrd-journal-d-19-00063.1

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Abstract

The relationship between elevation of residence and a child's linear growth was studied using data for 8824 children below the age of 5 years born between 2001 and 2016 at elevations ranging from 50 to 3200 m above sea level in Nepal. Multiple regression was used to measure the role of a variety of household and community factors in explaining the observed elevation effect. A negative association was found between elevation and linear growth that varied substantially across the sample but retained a significant marginal effect across model specifications. Controlling for household wealth, access to markets, indoor air quality, and a range of other factors associated with elevation, for each 1000 m gain in elevation, height for age z score (HAZ) declined by between 0.10 and 0.20 points for an average child, and by between 0.35 and 0.42 points for a child with the characteristics of those living at the highest elevations. Results underscore the potential developmental risks for children living at high elevations and call attention to factors that help to mitigate these risks.

Highlights

Background and motivationUnderstanding the role of the physical environment in a child’s nutrition, growth, and development is important for targeting public interventions and for assessing trade-offs and synergies associated with potential interventions
We examined the relationship between child growth and elevation in Nepal, with an emphasis on evaluating the extent to which other factors, remoteness, household resources, and indoor air pollution, mediate or explain the observed negative relationship
This suggests that elevation is strongly associated with child growth in Nepal, and that some forms of development could help to ameliorate this effect, defining and validating an exact mechanism that would let us make a credible causal case are outside the scope of this study

Summary

Introduction

Background and motivationUnderstanding the role of the physical environment in a child’s nutrition, growth, and development is important for targeting public interventions and for assessing trade-offs and synergies associated with potential interventions. In Nepal, where a large percentage of the population lives a kilometer or more above sea level, the topography creates substantial challenges to providing infrastructure, delivering basic services, and improving agriculture. One empirical consequence of these development challenges is a strong observed relationship between elevation and rates of child stunting. High rates of stunting in the mountains is often interpreted as an artifact of factors associated with elevation. We investigated the relationship between elevation and linear growth directly, using height for age z scores (HAZs) for 8824 children below the age of 5 years born between 2001 and 2016 at elevations ranging from 50 to 3200 m above sea level (masl). We focused on HAZ because impaired growth resulting from long-term malnutrition undermines an individual’s lifetime health and human capital accumulation, with implications for lifetime earnings and a country’s long-term economic development (Almond et al 2018)

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