Abstract
BackgroundGrowth faltering largely occurs in the first 23 months after birth and is thought to be largely determined by various harmful or protective socioeconomic conditions. Children 23 months or younger, however, have only been partially exposed to these conditions, implying that statistical associations between these conditions and child growth may be substantially smaller in samples that include younger children.ObjectivesTo test the prediction that associations between child anthropometric outcomes and various socioeconomic conditions are systematically different for older and younger children.MethodsWe analyzed data for 699,421 children aged 0–59 months, drawn from 125 DHS implemented between 1992 and 2014 in 57 countries. The outcome variables were height-for-age Z scores (HAZ) and stunting (HAZ<-2), and weight-for-height z scores (WHZ) and wasting (WHZ<-2). Independent variables included household wealth, parental education, maternal height, demographic factors, and exposure to WASH and health services. We used age-disaggregated regressions to examine how the associations between dependent and independent variables vary across different child age ranges.ResultsNon-parametric regression results reaffirmed that most linear growth faltering and wasting takes place prior to 23 months of age. Estimates of the magnitude of association with wealth, education and improved toilet use from HAZ regressions are systematically larger in the sample of children 24–59 months than in the 0–23 month or 0–59 month samples; the reverse is true for WHZ regressions.ConclusionsPrevious observational analyses appear to substantially underestimate the protective impacts of a wide range of underlying determinants on stunting. Conversely, wasting rates are typically low for children 24–59 months, implying that associations between underlying conditions and wasting may be stronger for children 0–23 months of age.Such analyses should pay closer attention to age disaggregation; researchers should be aware of the age effect reported in the current study and present analysis stratified by age.
Highlights
Influential research by Victora et al and Shrimpton et al [1, 2] graphically demonstrated that growth faltering using the commonly employed metric of height-for-age Z scores (HAZ) among young children in developing countries largely occurs prior to a child’s second birthday
Estimates of the magnitude of association with wealth, education and improved toilet use from HAZ regressions are systematically larger in the sample of children 24–59 months than in the 0–23 month or 0–59 month samples; the reverse is true for weight-for-height z scores (WHZ) regressions
Growth faltering can continue beyond 24 months, which is obscured by using HAZ in these analyses [3], there is little doubt that infants and young children are exceptionally vulnerable to poor diets and infection during these first 1000 days
Summary
Influential research by Victora et al and Shrimpton et al [1, 2] graphically demonstrated that growth faltering using the commonly employed metric of height-for-age Z scores (HAZ) among young children in developing countries largely occurs prior to a child’s second birthday. The relative scarcity of panel surveys on child nutrition means that relatively few studies use longitudinal data to ascertain the role of underlying determinants of undernutrition [20, 21]. Countless other studies explore the cross-sectional determinants of stunting using single surveys, including several hundred studies using Demographic Health Survey (DHS) data on child nutrition [22, 23]. Children 23 months or younger, have only been partially exposed to these conditions, implying that statistical associations between these conditions and child growth may be substantially smaller in samples that include younger children
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
