Abstract
Despite documented associations between stunting and cognitive development, few population-level studies have measured both indicators in individual children or assessed stunting's associations with other developmental domains. Meta-analysis using publicly available data from fifteen Multiple Indicator Cluster Surveys (MICS-4) to assess the association between stunting and development, controlling for maternal education, family wealth, books in the home, developmentally supportive parenting and sex of the child, stratified by country prevalence of breast-feeding ('low BF'<90 %, 'high BF' ≥90 %). Ten-item Early Childhood Development Index (ECDI) scores assessed physical, learning, literacy/numeracy and socio-emotional developmental domains. Children on track in three or four domains were considered 'on-track' overall. Fifteen low- and middle-income countries. Publically available data from 58 513 children aged 36-59 months. Severe stunting (height-for-age Z-score <-3) was negatively associated with on-track development (OR=0·75; 95 % CI 0·67, 0·83). Any stunting (Z-score <-2) was negatively associated with on-track development in countries with high BF prevalence (OR=0·82; 95 % CI 0·75, 0·89). Severe and any stunting were negatively associated with physical development (OR=0·77; 95 % CI 0·66, 0·89 and OR=0·82; 95 % CI 0·74, 0·91, respectively) and literacy/numeracy development in high BF countries (OR=0·45; 95 % CI 0·38, 0·53 and OR=0·59, 95 % CI 0·51, 0·68, respectively), but not low BF countries (OR=0·93; 95 % CI 0·70, 1·23 and OR=0·95, 95 % CI 0·79, 1·12, respectively). Any stunting was negatively associated with learning (OR=0·79; 95 % CI 0·72, 0·88). There was no clear association between stunting and socio-emotional development. Stunting is associated with many but not all developmental domains across a diversity of countries and cultures. However, associations varied by country breast-feeding prevalence and developmental domain.
Highlights
Stunting is associated with many but not all developmental domains across a diversity of countries and cultures
Associations varied by country breast-feeding prevalence and developmental domain
Multiple Indicator Cluster Survey (MICS) capture both anthropometric and early child development data, providing the opportunity to assess whether cross-sectional associations between stunting and developmental delay overall and within specific domains hold true across countries
Summary
We compared Multiple Indicator Cluster Survey (MICS) round 4 data from fifteen low- and middle-income countries (Fig. 1, Table 1). MICS is a UNICEF-sponsored questionnaire developed to measure the burden of specific maternal and child health conditions in low- and middle-income countries[19]. The survey sample is designed to provide estimates of maternal and child health indicators at the national level and sometimes at the regional level (i.e. state, district, etc.). MICS capture both anthropometric and early child development data, providing the opportunity to assess whether cross-sectional associations between stunting and developmental delay overall and within specific domains hold true across countries. The MICS-4 includes a specific series of questions designed to be an internationally comparable population indicator – the Early Child Development Index (ECDI)(20,21). MICS-4 data sets were included in the current analysis if they were
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