Height-for-age Z-score Research Articles

When did the substantial loss of child linear growth occur?

Epidemiological studies show that the height-for-age Z-scores (HAZ) falter dramatically shortly after birth until the end of the first two years. Understanding these changes in linear growth in the first two years can help us understand the critical period of child linear growth and propose interventions. This study objectives were to describe the pattern of linear growth faltering and analyze the changes in length-for-age Z-scores (LAZs) throughout the first two years based on birthweight and length status. This study analyzed 408 children, participants in Longitudinal Study on Child Growth and Development in Bogor, Indonesia. The linear growth pattern was described based on birthweight and length status. Birthweight and length status was categorized into normal and Small for Gestational Age (SGA). Changes in LAZs (Δ LAZs) in 0-6 months, 6-12 months, and 12-23 months were calculated. General Linear Model Univariate analysis was conducted to analyze the difference of Δ LAZ between SGA and normal children. Though full-term SGA children have significantly higher linear growth velocity during the first 6 months of the infancy period, full-term SGA children could not catch up with the attained growth/height of normal children throughout the first two years. Thus, full-term SGA children ended up with a higher prevalence of stunted. Both in SGA and normal children, the substantial loss of LAZ occurred between 0-6 months. The finding in this study showed that the first 1000 days of life is still the best period in stunting prevention; however, the stunting prevention program should start earlier, focusing on the first 500 days of life, and potentially the prenatal period.

Growth hormone therapy for children with Duchenne muscular dystrophy and glucocorticoid induced short stature

ObjectiveTo evaluate the outcome of recombinant human Growth Hormone (rhGH) therapy in patients with Duchene Muscular Dystrophy (DMD) and glucocorticoid treatment with compromised growth. DesignFour DMD patients on Deflzacort 0.6–0.85 mg/kg/day or prednisolone 0.625 mg/kg/day recieved rhGH (0.24 mg/kg/week) for 6–18 months. Primary outcomes were Growth velocity and Height for age Z-scores (Height SD). ResultsGrowth velocity increased from 0 to 3.25 cm/year prior to GH therapy to 3.3–7.8 cm/year over a period of 6–18 months. The typical Height SD decline in DMD was reversed in two patients and blunted in one. No adverse events or deterioration in cardiac or respiratory parameters were associated with the rhGH treatment. ConclusionsrhGH appears to be safe and efficient in promoting growth of patients with glucocorticoid induced growth failure in DMD.

The Association of Children's Blood Lead Levels and Prevalence of Stunting in Tin Mining Area in Indonesia.

Metal mining and smelting activities are regarded as major sources of heavy metals such as lead, mercury, arsenic and cadmium in the environment and in humans living at the surrounding area. Among others, lead can enter and accumulate in the human body and be very influential in children's growth and development. This study aims to assess the association between children's blood lead levels and stunting in a mining area in Indonesia. A cross-sectional design was implemented by involving 193 children living in surrounding tin mining in Bangka Island, Indonesia. Venous blood was drawn and blood lead level was measured by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Stunting status was measured by anthropometry standing height and converted to sexand age-specific Z-scores based on World Health Organization (WHO) growth reference. Children's dietary intake was assessed using 24-hour dietary recall method. Statistics of chi-square test and multiple logistic regression were performed for the analyses. The geometric mean of Blood Lead Levels (BLLs) was 5.5 µg/dl (± 2.6 µg/dl; 95% CI: 5.1-5.9). The interquartile range of BLLs and height for age Z-score (HAZ) were 3.0 μg/dl and -1.5, respectively. The data revealed that 23.3% of children were stunted (HAZ < -2). The multiple logistic regression models suggest that elevated BLLs were an independent predictor of the stunting. The odds stunted blood lead concentration was elevated about 10times higher [adjusted odd ratio (AOR) = 9.75 (95% Confidence interval (CI): 3.1-30.7); p < 0.001] in comparison to the odds of normal BLLs.The BLLs of children at ages two to nine years were found associated with stunting after controlling of the mother›s education, residence and the intake of energy, protein, zinc, vitamin A, calcium and phosphorus. The study suggested that living in surrounding tin mining was dangerous for children›s health and their development.

Association of Breastfeeding Duration with Body Composition in Children Aged 3–5 Years

ObjectiveThis study aimed to assess the relationship between the body composition of children aged 3–5 years and breastfeeding status and duration. MethodsThe study was conducted using data from the National Nutrition and Health Systematic Survey for children 0–17 years of age in China (CNHSC), a nationwide cross-sectional study. Breastfeeding information and potential confounders were collected using standardized questionnaires administered through face-to-face interviews. The body composition of preschool children was measured using bioelectrical impedance analysis. A multivariate linear regression model was used to assess the relationship between breastfeeding duration and body composition after adjusting for potential confounders. ResultsIn total, 2,008 participants were included in the study. Of these, 89.2% were ever breastfed and the median duration of breastfeeding was 12 months (IQR 7–15 months). Among children aged 3 years, the height-for-age Z-score (HAZ) for the ever breastfed group was lower than that for never breastfed group (0.12 vs. 0.42, P = 0.043). In addition, the weight-for-age Z-score (WAZ) of the ever breastfed group was lower than that of the never breastfed group (0.31 vs. 0.65, P = 0.026), and the WAZ was lower in children aged 4 years who breastfed between 12 and 23 months than in those who never breastfed. Compared to the formula-fed children, the fat-free mass of breastfed infants was higher for children aged 3 years (12.84 kg vs. 12.52 kg, P = 0.015) and lower for those aged 4 years (14.31 kg vs. 14.64 kg, P = 0.048), but no difference was detected for children aged 5 years (16.40 kg vs. 16.42 kg, P = 0.910) after adjusting for potential confounders. No significant difference was detected in the weight-for-height Z-score (WHZ), body mass index (BMI)-for-age Z-score (BAZ), fat-free mass index, and body fat indicators in the ever breastfed and never breastfed groups and among various breastfeeding duration groups for children aged 3–5 years. ConclusionNo obvious associations were detected between breastfeeding duration, BMI, and fat mass indicators. Future prospective studies should explore the relationship between breastfeeding status and fat-free mass.

Nutritional Status of Female Children in Comparison to Their Male Siblings in India– A Secondary Analysis of National Family Health Survey (NFHS-5) Data

Introduction: As there was little literature available about gender disparities in undernutrition within household, this secondary analysis was performed on a large representative data with an objective to evaluate the Z-score differences, viz., Weight-for-age Z-score (WAZ), Height-for-age Z-score (HAZ), Weight-for-height Z-score (WHZ) and BMI-for-age Z-score (BAZ) of the Indian female under-5 children with their male siblings within same household. Methods: Individual data of 19083 pairs of siblings was analysed from the NFHS -5 data. Differences in the Z-scores of the siblings was calculated as male’s Z-score minus female’s Z-score and factors influencing them were studied. Results: The mean HAZ and WAZ scores were less than -1.4 Standard deviations (SD) for both genders – while the means of WHZ and BAZ scores were ranging between -0.67 to -0.83. The differences in Z scores were more or less distributed equally on both sides of zero, implying no disadvantage to any of the genders. The mean differences in the Z scores were minimal (-0.07 in HAZ, -0.04 in WAZ, -0.06 in WHZ and 0.01 in BAZ). Conclusion: There was little or no difference in the mean z scores of females and male siblings and did not indicate any gender advantage or disadvantage.

Associations between Delayed Introduction of Complementary Foods and Childhood Health Consequences in Exclusively Breastfed Children.

The timing of complementary food (CF) introduction is closely related to childhood health, and it may vary depending on the region, culture, feeding type, or health condition. Despite numerous studies on the benefits of breastfeeding and the optimal timing of CF introduction, there have been limited investigations regarding delayed CF introduction in exclusively breastfed children. We compared an exposed group (CF introduction ≥7 months) with a reference group (CF introduction at 4 -< 7 months) regarding hospital admission, disease burden, and growth until age 10. Data from a nationwide population-based cohort study involving children born between 2008 and 2012 in the South Korea were analyzed. The final cohort comprised 206,248 children (165,925 in the exposed group and 40,323 in the reference group). Inverse probability of treatment weighting with propensity score matching was used to balance baseline health characteristics in the comparison groups. We estimated the incident risk ratios (IRR) for outcomes using modified Poisson regression and weighted odds ratios (weighted ORs) and their 95% confidence intervals (CIs) using multinomial logistic regression. The exposed group was associated with low height-for-age z-score (HAZ) (IRR (95% CI) for -1.64 < HAZ ≤ -1.03: 1.11 (1.08 to 1.14); HAZ ≤ -1.64: 1.21 (1.14 to 1.27)) and frequent (≥6 events) hospitalizations (weighted OR 1.18 (1.09 to 1.29). The rates of hospital admission, death, and specific medical conditions did not differ between groups. However, delaying the introduction of CF until seven months in exclusively breastfed infants was associated with frequent hospitalization events and lower heights.

Tools for assessing child and adolescent stunting: Lookup tables, growth charts and a novel appropriate-technology "MEIRU" wallchart - a diagnostic accuracy study.

Stunting affects 149 million children worldwide and is a form of chronic malnutrition defined by low height-for-age. Surveys and intervention programmes depend on effective assessment and identification of affected individuals. Gold standard assessment is based on height-for-age Z-score (HAZ): HAZ <-2 defines stunting; HAZ <-3 defines severe stunting. However, a major problem for field-based programmes is that Z-scores can be time-intensive and challenging to calculate. We thus developed a novel wallchart that we have coined 'MEIRU wallchart' to easily and accurately identify stunted children and adolescents. Our study aim was to evaluate its performance and acceptability against other methods used in current clinical/field practice. We undertook a non-interventional diagnostic accuracy study in Malawi. We recruited 244 participants aged 8-19 years and determined each individual's stunting status using, in varying order: the MEIRU wallchart, traditional lookup tables, and traditional growth charts. All were compared against 'gold standard' HAZ, calculated using AnthroPlus WHO software. Local community healthcare workers performed all the assessments. The wallchart method was strongly preferred by both participants and staff. It had an overall accuracy of 95.5%(kappa = 0.91) and was faster than lookup tables by an average of 62.5%(41.4sec; p<0.001) per measurement. Lookup tables and growth charts had overall agreements of 59.4%(kappa = 0.36) and 61.9%(kappa = 0.31) respectively. At the HAZ-2 cut-off, the wallchart had a sensitivity of 97.6%(95%CI: 91.5-99.7) and specificity of 96.3%(95%CI: 92.1-98.6). We conclude that the MEIRU wallchart performs well and is acceptable for screening and identification of stunted children/adolescents by community-level health workers. It fulfils key criteria that justify a role in future screening programmes: easy to perform and interpret; acceptable; accurate; sensitive and specific. Potential future uses include: conducting rapid stunting prevalence surveys; identifying affected individuals for interventions. Current field methods, lookup tables and growth charts performed poorly and should be used with caution.

Coexistence of Anaemia and Stunting among Children Aged 6–59 Months in Ethiopia: Findings from the Nationally Representative Cross-Sectional Study

Introduction: Stunting and anaemia, two severe public health problems, affect a significant number of children under the age of five. To date, the burden of and predictive factors for coexisting forms of stunting and anaemia in childhood have not been well documented in Ethiopia, where both the conditions are endemic. The primary aims of the present study were to: (i) determine the prevalence of co-morbid anaemia and stunting (CAS); (ii) and identify factors associated with these co-morbid conditions among children aged 6–59 months in Ethiopia. Methods: The study was based on data from the Ethiopian Demographic and Health Survey (EDHS 2005–2016). The EDHS was a cross-sectional study that used a two-stage stratified cluster sampling technique to select households. A total weighted sample of 21,172 children aged 6–59 months was included in the current study (EDHS-2005 (n = 3898), EDHS-2011 (n = 8943), and EDHS-2016 (n = 8332)). Children with height-for-age z-scores (HAZ) less than −2 SD were classified as stunted. Anaemia status was measured by haemoglobin level with readings below 11.0 g/deciliter (g/dL) categorized as anaemic. A multilevel mixed-effects logistic regression model was used to identify the factors associated with CAS. The findings from the models were reported as adjusted odds ratios (AOR) with 95% confidence intervals (CIs). Results: Almost half of the children were males (51.1%) and the majority were from rural areas (89.2%). The prevalence of CAS was 24.4% [95% CI: (23.8–24.9)]. Multivariate analyses revealed that children aged 12–23 months, 24–35 months, and 36–59 months, and children perceived by their mothers to be smaller than normal at birth had higher odds of CAS. The odds of CAS were significantly higher among children born to anaemic mothers [AOR: 1.25, 95% CI: (1.11–1.41)], mothers with very short stature [AOR: 2.04, 95% CI: (1.44–2.91)], children from households which practiced open defecation [AOR: 1.57, 95% CI: (1.27–1.92)], children born to mothers without education [AOR: 3.66, 95% CI: (1.85–7.22)], and those who reside in rural areas [AOR: 1.41, 95% CI: (1.10, 1.82)]. Male children had 19% lower odds of having CAS compared to female children [AOR: 0.81, 95% CI: (0.73–0.91)]. Children born to mothers who had normal body mass index (BMI) [AOR: 0.82, 95%CI: (0.73–0.92)] reported lower odds of CAS. Conclusions: One in four preschool-age children in Ethiopia had co-morbid anaemia and stunting, which is a significant public health problem. Future interventions to reduce CAS in Ethiopia should target those children perceived to be small at birth, anaemic mothers, and mothers with short stature.

Effect of the SPRING home visits intervention on early child development and growth in rural India and Pakistan: parallel cluster randomised controlled trials.

Almost 250 million children fail to achieve their full growth or developmental potential, trapping them in a cycle of continuing disadvantage. Strong evidence exists that parent-focussed face to face interventions can improve developmental outcomes; the challenge is delivering these on a wide scale. SPRING (Sustainable Programme Incorporating Nutrition and Games) aimed to address this by developing a feasible affordable programme of monthly home visits by community-based workers (CWs) and testing two different delivery models at scale in a programmatic setting. In Pakistan, SPRING was embedded into existing monthly home visits of Lady Health Workers (LHWs). In India, it was delivered by a civil society/non-governmental organisation (CSO/NGO) that trained a new cadre of CWs. The SPRING interventions were evaluated through parallel cluster randomised trials. In Pakistan, clusters were 20 Union Councils (UCs), and in India, the catchment areas of 24 health sub-centres. Trial participants were mother-baby dyads of live born babies recruited through surveillance systems of 2 monthly home visits. Primary outcomes were BSID-III composite scores for psychomotor, cognitive and language development plus height for age z-score (HAZ), assessed at 18 months of age. Analyses were by intention to treat. 1,443 children in India were assessed at age 18 months and 1,016 in Pakistan. There was no impact in either setting on ECD outcomes or growth. The percentage of children in the SPRING intervention group who were receiving diets at 12 months of age that met the WHO minimum acceptable criteria was 35% higher in India (95% CI: 4-75%, p = 0.023) and 45% higher in Pakistan (95% CI: 15-83%, p = 0.002) compared to children in the control groups. The lack of impact is explained by shortcomings in implementation factors. Important lessons were learnt. Integrating additional tasks into the already overloaded workload of CWs is unlikely to be successful without additional resources and re-organisation of their goals to include the new tasks. The NGO model is the most likely for scale-up as few countries have established infrastructures like the LHW programme. It will require careful attention to the establishment of strong administrative and management systems to support its implementation.

Determinants of stunting among children under age five in Burundi: Evidence from the 2016-2017 Burundi Demographic and Health Survey (BDHS 2016-17).

Burundi has one of the highest prevalence of stunting in the world. This study aimed to identify determinants of stunting among children under age five in Burundi. A total of 4993 children with anthropometric measurements from the 2016-2017 Burundi Demographic and Health Survey were included in the study. Stunting was assessed from the height-for-age Z-scores (HAZ). Logistic regression models were analyzed to identify demographic, maternal, child-related, and structural variables that influence stunting. In total, 56.9% of children under age five were stunted, of those 31.0% moderately and 25.9% severely. Multivariable logistic regression indicated that older children, male children (adjusted OR (aOR) = 1.41, 95% CI 1.24-1.61), and children who were perceived as small (aOR = 2.00, 95% CI 1.55-2.59) or very small at birth (aOR = 2.37, 95% CI 1.57-3.59) were significantly more likely to be stunted. Moreover, children of single mothers, with lower levels of education, who were underweight at the time of the survey (aOR = 1.95, 95% CI 1.42-2.68), who had short stature (aOR = 3.76, 95% CI 2.50-5.66) or who conceived more than four children (aOR = 1.22, 95% CI 1.05-1.42) were more commonly stunted. Stunting was more prevalent in rural areas (aOR = 2.53, 95% CI 1.72-3.73) and in households with no access to improved types of toilet facilities (aOR = 1.27, 95% CI 1.10-1.45). The results of this study show that the prevalence of stunting in children under age five in Burundi is alarmingly high and underscores the urgent need for decisive and determined action.

The coexistence of stunting and overweight or obesity in Ethiopian children: prevalence, trends and associated factors

BackgroundDouble burden of childhood malnutrition is a condition where undernutrition (stunting) along with overweight and obesity coexist within individuals, households, and populations. It reflects a new layer of malnutrition and an understudied phenomenon in many low-income settings. To date, the prevalence and factors that are associated with concurrent stunting and overweight or obesity (overweight/obesity) (CSO) in the same children have not been well researched in Ethiopia. Hence, this study aimed to assess the prevalence, trends, and factors associated with the coexistence of stunting and overweight or obesity among children aged 0–59 months in Ethiopia.MethodsPooled data from 2005, 2011 and 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 23,756 (weighted sample) children aged 0–59 months were included in the study. Height-for-age z-scores (HAZ) less than − 2 SD and weight-for-height z-scores (WHZ) above 2 SD were calculated, and children were classified as stunted and overweight/obese, respectively. A child who is simultaneously stunted and overweight/obese was considered as having HAZ below − 2 SD and WHZ above 2 SD computed into a variable named CSO, and reported as a binary outcome (yes or no). Multilevel logistic regression analysis that adjusts for sampling weights and clustering was used to identify factors associated with CSO.ResultsThe prevalence of stunting, overweight or obesity, and CSO among under-five children was 43.12% [95% CI: (42.50, 43.75%)], 2.62% [95% CI: (2.42, 2.83%)], and 1.33% [95% CI: (1.18, 1.48%)], respectively. The percentage of CSO children was reported to have declined from 2.36% [95% CI: (1.94–2.85)] in 2005 to 0.87% [95%CI: (0.07–1.07)] in 2011, and the same appeared to have increased slightly to 1.34% [95%CI: (1.13–1.59)] in 2016. Children who were currently breastfeeding [AOR: 1.64, 95%CI: (1.01–2.72)], born to an overweight mother [AOR: 2.65, 95%CI: (1.19–5.88)], and lived in families with 1–4 household members [AOR: 1.52, 95%CI: (1.02–2.26)] were significantly associated with CSO. At the community level the odds of having CSO were higher among children included from EDHS-2005 [AOR: 4.38, 95%CI: (2.42–7.95)].ConclusionThe study revealed that less than 2% of children had CSO in Ethiopia. CSO was linked to factors at both the individual (i.e. breastfeeding status, maternal overweight, and household size) and community-levels. Overall, the study findings indicated the necessity of focused interventions to simultaneously address double burden of childhood malnutrition in Ethiopia. To further combat the double burden of malnutrition, early identification of at-risk children, including those born to overweight women and children living with multiple household members, is indispensable.

Dietary Determinants of Stunting and Underweight in Under-Five Years Children in Pengasinan Health Center's (Puskesmas) Working Area, Depok, West Java

Stunting and underweight are public health problems especially in under-five children. This study aims to explore the dietary determinants of stunting and underweight. Participants were 52 under-five children who visited Posyandu in Pengasinan and Bedahan, Depok. Body weight for age z-score (WAZ) and height for age z-score (HAZ) were measured with standardized measurement tools by trained operators. Questionnaires were administered to determine sociodemographic, maternal and child health history, sanitation, disease history, and exclusive breastfeeding history. Data on food intake was obtained through the semi-quantitative Food Frequency Questionnaire and 24-hour recall. There was significant correlation between mother’s income with underweight (P=0.01) and milk consumption’s frequency with protein adecuacy (P=0.01 r=0.44) and calcium adequacy (P=0.00 r=0.74). There was a tendency of correlation between children’s zinc intake (P=0.06) and fat intake (P=0.06) with underweight, and milk consumption’s frequency with HAZ (P=0.05 r=0.28) and WAZ (P=0.07 r=0.25). The frequency of sweetened condensed milk consumption was inversely correlated with HAZ (P=0.01 r=-0.34) and WAZ (P=0.01 r=-0.38). Dietary intake and complimentary beverages affect the nutritional status of a child. Sweetened condensed milk consumption did not support child’s growth. Education about children's nutritional status and complimentary beverage consumption is necessary for mothers, mothers’ support system, and cadres.

Complementary and alternative metrics for tracking population-level trends in child linear growth

Stunting prevalence is commonly used to track population-level child nutritional status. However, other metrics derived from anthropometric datasets may be used as alternatives to stunting or provide complementary perspectives on the status of linear growth faltering in low- and middle-income countries (LMICs). Data from 156 Demographic and Health Surveys in 63 LMICs (years 2000 to 2020) were used to generate 2 types of linear growth metrics: (i) measures of location of height distributions (including stunting) for under-5 years (<5y) and 2 to 5 years (2-5y); (ii) model-derived metrics including predicted mean height-for-age z-score (HAZ) at 0, 2, and 5 years; interval slopes of HAZ, height-for-age difference (HAD), and growth delay (GD) from 1 month to 2 years (1mo-2y) and 2-5y; and the SITAR intensity parameter (SITAR-IP) for <5y. Using Spearman's rank correlation coefficient (r), metrics were considered alternatives to stunting if very strongly correlated with stunting (|r|≥0.95) and at least as strongly correlated as stunting with selected population indicators (under 5y mortality, gross domestic product, maternal education). Metrics were considered complementary if less strongly correlated with stunting (|r|<0.95) yet correlated with population indicators. We identified 6 of 15 candidate metrics (stunting 2-5y, mean HAZ <5y and 2-5y, p25 HAZ <5y and 2-5y, predicted HAZ at 2y) as potential alternatives to stunting and 6 as complementary metrics (SITAR-IP, predicted HAZ at 5y, HAZ slope 1m-2y, HAD slope 1m-2y, GD slopes 1m-2y and 2-5y). Three metrics (HAZ slope 2-5y, HAD slope 2-5y years and predicted HAZ at birth) had weak correlations with population indicators (|r| ≤ 0.43). In conclusion, several linear growth metrics could serve as alternatives to stunting prevalence and others may be complementary to stunting in tracking global progress in child health and nutrition. Further research is needed to explore the real-world utility of these alternative and complementary metrics.

Polycyclic aromatic hydrocarbon (PAH) exposure during pregnancy and child anthropometry from birth to 10 years of age: Sex-specific evidence from a cohort study in rural Bangladesh

Polycyclic aromatic hydrocarbons (PAHs) have endocrine disrupting properties and they cross the placental barrier, but studies on gestational exposure and child anthropometry are inconclusive. We aimed to elucidate the impact of early gestational PAH exposure on anthropometry from birth to 10 years of age in 1295 mother-child pairs from a nested sub-cohort of the MINIMat trial in Bangladesh. Several PAH metabolites [1-hydroxyphenanthrene (1-OH-Phe), Σ2-,3-hydroxyphenanthrene (Σ2-,3-OH-Phe), 4-hydroxyphenanthrene (4-OH-Phe), 1-hydroxypyrene (1-OH-Pyr), Σ2-,3-hydroxyfluorene (Σ2-,3-OH-Flu)] were quantified in spot urine collected around gestational week 8 using LC-MS/MS. Child weight and height were measured at 19 occasions from birth to 10 years. Multivariable-adjusted regression models were used to assess associations of maternal PAH metabolites (log2-transformed) with child anthropometry. The median concentration of 1-OH-Phe, Σ2-,3-OH-Phe, 4-OH-Phe, 1-OH-Pyr and Σ2-,3-OH-Flu was 1.5, 1.9, 0.14, 2.5, and 2.0 ng/mL, respectively. All maternal urinary PAH metabolites were positively associated with newborn weight and length and all associations were more pronounced in boys than in girls (p interaction for all <0.14). In boys, the strongest associations were observed with Σ2-,3-OH-Phe and Σ2-,3-OH-Flu for which each doubling increased mean birth weight by 41 g (95% CI: 13; 69 and 12; 70) and length by 0.23 cm (0.075; 0.39) and 0.21 cm (0.045; 0.37), respectively. Maternal urinary PAH metabolites were not associated with child anthropometry at 10 years. In longitudinal analysis, however, maternal urinary PAH metabolites were positively associated with boys' weight-for-age (WAZ) and height-for-age Z-scores (HAZ) from birth to 10 years, but only the association of 4-OH-Phe with HAZ was significant (B: 0.080 Z-scores; 95% CI 0.013, 0.15). No associations were observed with girls’ WAZ or HAZ. In conclusion, gestational PAH exposure was positively associated with fetal and early childhood growth, especially in boys. Further studies are needed to confirm causality and to explore long-term health effects.

"Measuring the Environmental Context of Child Growth in Burkina Faso".

Child growth failure, as indicated by low height-for-age z-scores (HAZ), is an important metric of health, social inequality, and food insecurity. Understanding the environmental pathways to this outcome can provide insight into how to prevent it. While other studies have examined the environmental determinants of HAZ, there is no agreed upon best-practices approach to measure the environmental context of this outcome. From this literature, we derive a large set of potential environmental predictors and specifications including temperature and precipitation levels, anomalies, and counts as well as vegetation anomalies and trends, which we include using linear, nonlinear, and interactive specifications. We compare these measures and specifications using four rounds of DHS survey data from Burkina Faso and a large set of fixed effects regression models, focusing on exposures from the time of conception through the second year of life and relying on joint hypothesis tests and goodness-of-fit measures to determine which approach best explains HAZ. Our analysis reveals that nonlinear and interactive transformations of climate anomalies, as opposed to climate levels or vegetation indices, provide the best explanation of child growth failure. These results underline the complex and nonlinear pathways through which climate change affects child health and should motivate climate-health researchers to more broadly adopt measures and specifications that capture these pathways.

A POOLED DATA ANALYSIS TO DETERMINE RISK FACTORS OF CHILDHOOD STUNTING IN INDONESIA

Background: Stunting among children remains a public health concern in Indonesia, where the prevalence of stunting in rural areas is higher than in urban areas.Objectives: This study aimed to analyze risk factors for stunting and severe stunting among children aged 0-59 months in rural and urban Indonesia.Method: This cross-sectional study used pooled datasets from Indonesia’s Basic Health Research in 2007, 2010, and 2013. Our study samples included 38,246 children aged 0-59 months whose height-for-age Z-score (HAZ) was between -5.99 and 5.99 standard deviations. The primary outcomes were stunting and severe stunting, whereas dependent variables included factors at the child, household, and community levels. We apply Stata 13 for univariate, bivariate, and multivariate analysis.The prevalence of stunting and severe stunting was higher in rural than urban areas. On one hand, risk factors significantly associated with stunting and severe stunting in urban areas were low birth weight, maternal height, informal father’s occupation, low economic level, and children from East Indonesia and Sumatra. Furthermore, the father’s height was only associated with stunting, while the number of children &gt;3 was only associated with severe stunting. On the other hand, risk factors age, low birth weight, maternal height, father’s height, household member 5-9 people, middle and low economic level were significantly associated with stunting and severe stunting in rural areas. Moreover, poor WASH was only associated with stunting, while informal mother occupation, low father education, number of household members &gt; 9 people, and living in Sumatra and East Indonesia were associated with severe stunting in rural areas.Conclusion: Low birth weight, short parents, and economic income were risk factors for stunting and severe stunting children in urban and rural areas. Keywords: Children; Pooled data; Risk factors; Stunting

The effect of extreme weather events on child nutrition and health

This study traces the causal effects of extreme weather events on nutritional and health outcomes among rural children in Uganda using four waves of individual child survey data (2009–2014). A simultaneous regression model was applied for causal inference while also accounting for households’ adaptive responses. The study finds the evidence of a significant negative relationship between extreme weather events and availability of calories and nutrients for children. In particular, droughts reduced calorie, protein and zinc supply, and overall diet diversity by 67%, 37%, 28% and 30%, respectively. We further traced the effects of this reduced calorie and nutrient availability on child health indicators. A 10% decrease in zinc supply decreased height-for-age z-scores (HAZ) by around 0.139 - 0.164 standard deviations (SD), and increased probability of stunting ranging from 3.1 to 3.5 percentage points. Both boys and girls HAZ and stunting rates were sensitive to nutrient inadequacies. Different coping and adaptation strategies significantly influenced rural households’ ability to safeguard children’s nutrition and health against the effects of extreme weather. The findings of this study provide specific insights for building ex-ante resilience against extreme weather events, particularly when compared to ex-post, unsustainable, and often costlier relief actions.

Nutritional status and psychosocial stimulation associated with cognitive development in preschool children: A cross-sectional study at Western Terai, Nepal.

Quality education at the age of foundation to produce dynamic manpower is a public concern in developing countries including Nepal. Preschool children do not get proper care and support from their parents due to insufficient knowledge of proper feeding habits, nutrition status and methods of psychosocial stimulation, which may affect their proper cognitive development. This study aimed to identify the factors that influence cognitive development in preschool children aged 3-5 years in Rupandehi district of western Terai, Nepal. In this school based cross-sectional survey, a total of 401 preschool children were selected using a multistage random sampling technique. The study was conducted from 4th February to 12th April, 2021 in Rupandehi district of Nepal. Data on the children's socio-economic and demographic status, level of psychosocial stimulation, nutritional status, and stage of cognitive development were collected through scheduled interviews and direct observation. Stepwise regression analysis was performed to determine the predictors of cognitive development in preschool children. A p-value less than 0.05 considered as statistical significance. Of 401 participants, 44.1% had a normal nutritional status based on height for age Z-score (HAZ). Only 1.2% of primary caregivers provided their children with high levels of psychosocial stimulation, and 49.1% of children had a medium level of cognitive development. Furthermore, cognitive development in preschoolers is positively associated with nutritional status based on the height for age z score (β = 0.280; p<0.0001), psychological stimulation from caregivers (β = 0.184; p<0.0001), and advantageous castes/ethnicity (β = 0.190; p<0.0001), but negatively associated with the child's age (β = - 0.145; p = 0.002) and family type (β = -0.157; p = 0.001). Nutritional status and psychosocial stimulation appear to be major factors affecting cognitive development of preschoolers. Nutritional promotion strategies, as well as techniques for optimal psychosocial stimulation behavior, may play an important role in enhancing preschoolers' cognitive development.

Normal values of respiratory oscillometry in South African children and adolescents.

Noninvasive measurement of respiratory impedance by oscillometry can be used in young children aged from 3 years and those unable to perform forced respiratory manoeuvres. It can discriminate between healthy children and those with respiratory disease. However, its clinical application is limited by the lack of reference data for African paediatric populations. The aim of the present study was to develop reference equations for oscillometry outcomes in South African children and adolescents. Healthy subjects, enrolled in the Drakenstein Child Health Study, HIV-uninfected adolescents in the Cape Town Adolescent Antiretroviral Cohort and healthy children attending surgical outpatient clinics at Red Cross War Memorial Children's Hospital were measured with conventional spectral (6-32 Hz) and intra-breath (10 Hz) oscillometry. Stepwise linear regression was used to assess the relationship between respiratory variables and anthropometric predictors (height, sex, ancestry) to generate reference equations. A total of 692 subjects, 48.4% female, median age of 5.2 years (range: 3-17 years) were included. The median (interquartile range (IQR)) for weight for age z-score and height for age z-score was -0.42 (-1.11-0.35) and -0.65 (-1.43-0.35), respectively. Stepwise regression demonstrated that all the variables were significantly dependent on height only. Comparison to previous reference data indicated slightly higher resistance and lower compliance values in the smallest children. We established the first respiratory oscillometry reference equations for African children and adolescents, which will facilitate use in early identification and management of respiratory disease. Our results suggest differences in oscillometry measures by ancestry but also highlight the lack of standardisation in methodology.

Post-malnutrition growth and its associations with child survival and non-communicable disease risk: a secondary analysis of the Malawi 'ChroSAM' cohort.

To explore patterns of post-malnutrition growth (PMGr) during and after treatment for severe malnutrition and describe associations with survival and non-communicable disease (NCD) risk 7 years post-treatment. Six indicators of PMGr were derived based on a variety of timepoints, weight, weight-for-age z-score and height-for-age z-score (HAZ). Three categorisation methods included no categorisation, quintiles and latent class analysis (LCA). Associations with mortality risk and seven NCD indicators were analysed. Secondary data from Blantyre, Malawi between 2006 and 2014. A cohort of 1024 children treated for severe malnutrition (weight-for-length z-score < 70 % median and/or MUAC (mid-upper arm circumference) < 110 mm and/or bilateral oedema) at ages 5-168 months. Faster weight gain during treatment (g/d) and after treatment (g/kg/day) was associated with lower risk of death (adjusted OR 0·99, 95 % CI 0·99, 1·00; and adjusted OR 0·91, 95 % CI 0·87, 0·94, respectively). In survivors (mean age 9 years), it was associated with greater hand grip strength (0·02, 95 % CI 0·00, 0·03) and larger HAZ (6·62, 95 % CI 1·31, 11·9), both indicators of better health. However, faster weight gain was also associated with increased waist:hip ratio (0·02, 95 % CI 0·01, 0·03), an indicator of later-life NCD risk. The clearest patterns of association were seen when defining PMGr based on weight gain in g/d during treatment and using the LCA method to describe growth patterns. Weight deficit at admission was a major confounder. A complex pattern of benefits and risks is associated with faster PMGr. Both initial weight deficit and rate of weight gain have important implications for future health.