Identifying Faltering of Growth Velocity and Associated Risk Factors Among Preschool Aged Children in Nepal

Abstract

Abstract Objectives Linear growth failure is often assessed as a height-for-age z-score (HAZ) < −2, which defines stunting. Faltering growth velocity on the other hand reveals a dynamic process, for which improving risk factors could help prevent poor growth, regardless of HAZ. Our aim was to reveal rates and risk factors of growth faltering in Nepali preschool children using a novel linear growth velocity (LGV) reference. Methods We assessed length/height in children under-five from 2013–16 during the same season in 21 wards across the plains (Tarai) of Nepal (n = 4439). Annualized LGVs were calculated from paired measures and stratified into interval-initiating ages of <6, 6–11, 12–23, 24–35, 36–47, 48–59 mo. An annualized, age-sex-specific LGV reference was derived by combining the WHO Growth Standards (for intervals starting <12 mo) and the Tanner Height Velocity Reference (for intervals starting later) using linear restricted cubic spline regression models, from which LGV z-scores (LGVZ) were derived and used to evaluate Nepali child growth. Community, household and individual risk factors were assessed during interval-initiating visits and subjected to multivariable logistic regression models to examine associations with LGVZ < −2 (growth faltering) vs > 2. Results LGV faltering affected 29.8% and 34.8% of boys and girls <24 months, and 6.8% and 7.1% 24–60 months, respectively. Girls were at higher odds of faltering, although 95% CI excluded 1 only for the interval starting at 12–23 mo (OR: 1.77; 95% CI: 1.26, 2.50). Children <24 mo whose weight-for-height z- score was > the WHO median had lower odds of faltering than thinner children (OR: 0.25 - 0.40, all upper 95% CLs < 1). Children of short (<150 cm) mothers had higher odds of faltering, with 95% CIs excluding 1 for interval-initiating ages < 6, 12–23 and 24–35 mo. Above 36 mo, community characteristics such as proximity to market, and access to roads and schools were stronger in their protective growth association than individual or household factors. Conclusions Growth faltering can be assessed across all preschool years by this WHO-Tanner linear growth velocity reference. Nepali children exhibited substantial growth faltering <24 months. Females, children who were thin, and born to short mothers were at an increased risk of growth faltering. Funding Sources USAID, Sight and Life, and Procter & Gamble.