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Abstract
Child chronic undernutrition, as measured by stunting, is prevalent in low- and middle-income countries and is among the major threats to child development. While stunting and its implications for cognitive development have been considered irreversible beyond early childhood there is a lack of consensus in the literature on this, as there is some evidence of recovery from stunting and that this recovery may be associated with improvements in cognition. Less is known however, about the drivers of growth recovery and the aspects of recovery linked to cognitive development. In this paper we investigate the factors associated with growth recovery and faltering through age 12 years and the implications of the incidence, timing, and persistence of post-infancy recovery from stunting for cognitive development using longitudinal data from Ethiopia, India, Peru, and Vietnam. We find that the factors most systematically associated with accelerated growth both before and after early childhood and across countries include mother's height, household living standards and shocks, community wages, food prices, and garbage collection. Our results suggest that post-infancy recovery from stunting is more likely to be systematically associated with higher achievement scores across countries when it is persistent and that associations between growth trajectories and cognitive achievement in middle childhood do not persist through early adolescence across countries. Overall, our findings indicate that growth after early childhood is responsive to changes in the household and community environments and that growth promotion after early childhood may yield improvements in child cognitive development.
Highlights
Child undernutrition is one of the key risk factors to child survival, health, and development in low- and middle-income countries (LMICS) (Prendergast and Humphrey, 2014)
A number of studies have highlighted that stunting and its consequences for cognitive development are largely irreversible after early childhood (Victora et al, 2010), there is evidence both from the economics and the biomedical literature suggesting that growth recovery is possible beyond this period (Alderman et al, 2006; Prentice et al, 2013) and that it is positively associated with cognitive achievement (Crookston et al, 2013; Georgiadis et al, 2016)
We examine whether the incidence, timing, and persistence of growth recovery, as measured by recovery from stunting, through middle childhood are significantly associated with cognitive achievement in this period and whether these associations persist through early adolescence
Summary
Child undernutrition is one of the key risk factors to child survival, health, and development in low- and middle-income countries (LMICS) (Prendergast and Humphrey, 2014). Studies investigating predictors of growth recovery and faltering (Adair, 1999; Coly et al, 2006; Schott et al, 2013; see Schott et al (2013) for a survey of this literature) seem to explain a limited share of the variation in compensatory growth after early childhood, possibly because they consider a limited set of community predictors of catch-up growth This seems to be an important gap in the literature, as aspects of the local environment such as standards of living and infrastructure have changed dramatically in recent years in low- and middle-income countries and are important policy levers linked to the reduction in stunting in several of these countries (Christiaensen and Alderman, 2004; Headey et al, 2016)
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