Abstract
Efforts to reduce the impact of stunting have been largely independent of interventions to reduce the impact of wasting, despite the observation that the conditions can coexist in the same child and increase risk of death. To optimize the management of malnourished children—who can be wasted, stunted, or both—the relationship between stunting and wasting should be elaborated. We aimed to describe the relationship between concurrent weight and height gain during and after rehabilitation from severe wasting. We conducted a secondary analysis of a randomized trial for the outpatient treatment of severe wasting, including 1,542 children who recovered and were followed for 12 weeks. We described the overlap of stunting and severe wasting and the change in stunting over time. We showed the relationship between concurrent weight and height gain using adjusted generalized estimating equations and calculated the mean rate of change in weight‐for‐height z score (WHZ) and height‐for‐age z score (HAZ) during and after rehabilitation. At baseline, 79% (n = 1,223/1,542) and 49% (n = 757/1,542) of children were stunted and severely stunted, respectively. Prevalence increased over time among children <24 months. During rehabilitation when weight was not yet fully recovered, we found rapid WHZ gain but limited HAZ gain. Following successful rehabilitation, WHZ gain slowed. The rate of HAZ gain was negative after rehabilitation but increased relative to the period during treatment. The potential relationship between weight and height gain calls for increased coverage of wasting treatment to not only prevent child mortality but also reduce linear growth faltering.
Highlights
Linear growth faltering in children, characterized by falling below the height‐for‐age trajectory of the World Health Organization (WHO) Child Growth Standards, has been the focus of increasing policy, program, and research attention
weight‐for‐height z score (WHZ) gain slowed whereas height‐for‐age z score (HAZ) gain increased relative to the period before recovery
We found that recovery in linear growth was overall limited in this population, marked by a mean decrease in HAZ over time, and HAZ gain was modulated by WHZ/nutritional recovery
Summary
Linear growth faltering in children, characterized by falling below the height‐for‐age trajectory of the World Health Organization (WHO) Child Growth Standards, has been the focus of increasing policy, program, and research attention (de Onis & Branca, 2016; Galasso & Wagstaff, 2016; World Bank, 2014). Linear growth faltering and stunting are considered a manifestation of chronic undernutrition caused by a number of complex factors, including chronic nutrient deficiency and exposure to poor environmental conditions. Programs to prevent stunting in the first 1,000 days of life have included interventions to improve maternal nutrition; infant and young child feeding practices; care‐seeking behaviour; and water, sanitation, and hygiene (Bhutta et al, 2008; Black et al, 2013; Luby et al, 2018; Null et al, 2018). Likely due to the multitude of and possible interaction between, risk factors for stunting, evidence on the effectiveness of individual interventions has been mixed (Dewey, 2016; Goudet, Griffiths, Bogin, & Madise, 2017; Subramanian, Mejia‐Guevara, & Krishna, 2016)
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