Reduce Child Stunting Research Articles

The Effectiveness of Nutrition Education for Overweight/Obese Mother with Stunted Children (NEO-MOM) in Reducing the Double Burden of Malnutrition.

(1) Background: In households experiencing the double burden of malnutrition, stunted children are in a better position for growth improvement when parents are able to direct their resources to support nutrition requirements. This study assesses the effectiveness of maternal nutrition education to reduce child stunting. (2) Methods: This was a Randomized Controlled Trial involving pairs of overweight/obese mothers with stunted children aged 2 to 5 years old in urban Indonesia. Methods: Seventy-one mother-child pairs were randomly assigned to receive either a 12-week nutrition education or printed educational materials. Mixed factorial ANOVA was used to test for between-group differences over time in relation to child’s height, weight, maternal self-efficacy, outcome expectation, and caloric intake. (3) Results: Across groups, there was a significant effect of time on child height and weight but no significant differences were observed between-groups. Maternal self-efficacy, outcome expectations in providing animal protein for the children (p-value = 0.025) and mother’s total caloric intake (p-value = 0.017) favored the intervention group over the comparison group. (4) Conclusions: The behavioral intervention produced strong improvement in maternal self-efficacy to engage in physical activity, eat fruits and vegetables and to provide children with growth-promoting animal protein, but did not significantly influence child height gain.

Factors associated with stunting among children below five years of age in Zambia: evidence from the 2014 Zambia demographic and health survey

BackgroundStunting continues to be a major public health problem globally. Stunting is a manifestation of many factors including inadequate food intake and poor health conditions. However, poor quality nutritional diets during pregnancy, infancy and early childhood lead to inadequate nutrient intake. The prevalence of stunting in Zambia has been over 40% and remains unacceptably high. There is limited information on factors associated with stunting in Zambia. Thus to better understand factors contributing to the high stunting levels, the 2013/14 Zambia Demographic and Health Survey (ZDHS) data was analysed.MethodsData was extracted using a data extraction tool and analysed using Stata version 13. Sample data of 12, 328 children aged 0–59 months was analysed. The analysis involved simple and multiple logistic regression to find associations between independent variables and stunting.ResultsThe prevalence of stunting among under five children in Zambia is 40%. From the 4937 children who were stunted, stunting was higher among male children as compared to female children (42.4 and 37.6% respectively). Additional analysis revealed that children whose source of drinking water was improved (33.7%) were less likely to be stunted compared to children whose source of drinking water was poor (47.7%). Stunting was associated with sex and age of a child; mother’s age and education; residence; wealth and duration of breastfeeding. For instance, children whose mothers had higher education showed a 75% reduction of odds compared to children whose mothers had no education (AOR = 0.35, 95%CI: 0.22, 0.54; p < 0.05). Similarly, wealth status showed an inverse relationship. Children who came from rich households showed a 32% reduction of odds compared to children who came from poor households (AOR = 0.68, 95%CI: 0.57, 0.82; p < 0.05).ConclusionThe study established that the major predictors of stunting among children under 5 years old in Zambia were sex and age of the child; mother’s age and level of education; wealth status; improved source of drinking water; duration of breastfeeding and residence. Therefore, multiple measures targeted at reducing child stunting should be taken in a bid to influence policy and conceiving of programmes.

Does the sectoral composition of growth affect child stunting reductions?

AbstractThis article uses a natural experiment based on random and exogenous variations in temperature to examine whether the sectoral composition of growth has an effect on child stunting reductions. Agricultural growth is central to food security strategies in developing countries, as it is often considered the most effective way to fight (child) undernutrition. The evidence base to support the putative superior role of agricultural growth is, however, relatively weak, possibly because studies have ignored growth faltering. Accounting for the latter, we find that while both agricultural and non‐agricultural growth decrease stunting, agricultural growth is significantly superior to non‐agricultural growth in this regard. The estimated impacts are large, in that a 10% increase in agricultural GDP per capita reduces child stunting by 9.6% (as opposed to 8.4% for non‐agricultural).

How Much Does Economic Growth Contribute to Child Stunting Reductions?

The role of economic growth in reducing child undernutrition remains an open and highly debated question that holds important implications for food security strategies. The empirical evidence has been quite contrasted, primarily in regard to the magnitude of the impacts. Yet, most studies have not (appropriately) accounted for the reverse causality between economic growth and child stunting. Using a dataset of 74 developing countries observed between 1984 and 2014, this paper develops a novel approach accounting for the reverse causal effect of stunting on GDP per capita and finds that the impacts of economic growth are much lower than estimated in most previous studies. A 10% increase in GDP per capita reduces child stunting prevalence by 2.7%. In other words, economic growth is modestly pro-poor. We also estimate that a percentage point increase in child stunting prevalence results in a 0.4% decrease in GDP per capita. A back-of-the-envelope calculation suggests that stunting costs on average about 13.5% of GDP per capita in developing countries.

PROCOMIDA, a Food-Assisted Maternal and Child Health and Nutrition Program, Reduces Child Stunting in Guatemala: A Cluster-Randomized Controlled Intervention Trial

BackgroundFood-assisted maternal and child health and nutrition (FA-MCHN) programs may foster child growth during the first 1000 d (pregnancy and the first 2 y of a child's life), but evidence is scant.ObjectiveWe evaluated the impact of an FA-MCHN program, PROCOMIDA, on linear growth (stunting [length-for-age z score (LAZ) < –2] and length-for-age difference [LAD]) among children aged 1–24 mo. PROCOMIDA was implemented in Guatemala by Mercy Corps and was available to beneficiaries throughout the first 1000 d.MethodsWe used a longitudinal, cluster-randomized controlled trial with groups varying in family ration sizes [full (FFR), reduced (RFR), and none (NFR)] and individual ration types provided to mothers (pregnancy to 6 mo postpartum) and children (6–24 mo of age) [corn-soy blend (CSB), lipid-based nutrient supplement (LNS), micronutrient powder (MNP)]: 1) FFR + CSB (n = 576); 2) RFR + CSB (n = 575); 3) NFR + CSB (n = 542); 4) FFR + LNS (n = 550); 5) FFR + MNP (n = 587); 6) control (n = 574). Program impacts compared with control, and differential impacts between groups varying family ration size or individual ration type, were assessed through the use of linear mixed-effects models and post hoc simple effect tests (significant if P < 0.05).Results PROCOMIDA significantly reduced stunting at age 1 mo in FFR + CSB, RFR + CSB, and FFR + MNP groups compared with control [5.05, 4.06, and 3.82 percentage points (pp), respectively]. Stunting impact increased by age 24 mo in FFR + CSB and FFR + MNP relative to control (impact = 11.1 and 6.5 pp at age 24 mo, respectively). For CSB recipients, the FFR compared with RFR or NFR significantly reduced stunting (6.47–9.68 pp). CSB reduced stunting significantly more than LNS at age 24 mo (8.12 pp).ConclusionsFA-MCHN programs can reduce stunting during the first 1000 d, even in relatively energy/food-secure populations. Large family rations with individual rations of CSB or MNP were most effective. The widening of impact as children age highlights the importance of intervening throughout the full first 1000 d.This trial was registered at clinicaltrials.gov as NCT01072279.

Role of maternal preconception nutrition on offspring growth and risk of stunting across the first 1000 days in Vietnam: A prospective cohort study.

Growing evidence supports the role of preconception maternal nutritional status (PMNS) on birth outcomes; however, evidence of relationships with child growth are limited. We examined associations between PMNS (height, weight and body mass index- BMI) and offspring growth during the first 1000 days. We used prospective cohort data from a randomized-controlled trial of preconception micronutrient supplementation in Vietnam, PRECONCEPT (n = 1409). Poisson regression models were used to examine associations between PMNS and risk of offspring stunting (<-2 HAZ) at 2 years. We used path analytic models to examine associations with PMNS on fetal growth (ultrasound measurements) and offspring HAZ at birth and 2 years. All models were adjusted for child age, sex, gestational weight gain, education, socioeconomic status and treatment group. A third of women had a preconception height < 150cm or weight < 43 kg. Women with preconception height < 150 cm or a weight < 43 kg were at increased risk of having a stunted child at 2 years (incident risk ratio IRR: 1.85, 95% CI 1.51–2.28; IRR 1.35, 95% CI 1.10–1.65, respectively). While the traditional low BMI cut-off (< 18.5 kg/m2) was not significant, lower BMI cut-offs (< 17.5 kg/m2 or < 18.0 kg/m2) were significantly associated with 1.3 times increased risk of child stunting. In path models, PMNS were positively associated with fetal growth (ultrasound measurements) and offspring HAZ at birth and 2 years. For each 1 standard deviation (SD) increase in maternal height and weight, offspring HAZ at 2 years increased by 0.30 SD and 0.23 SD, respectively. In conclusion, PMNS influences both offspring linear growth and risk of stunting across the first 1000 days. These findings underscore the importance of expanding the scope of current policies and strategies to include the preconception period in order to reduce child stunting.

Sanitation and child health in India

Our study contributes to the understanding of key drivers of stunted growth, a factor widely recognized as major impediment to human capital development. Specifically, we examine the effects of sanitation coverage and usage on child height for age in a semi-urban setting in Northern India. Although sanitation – broadly defined as hygienic means of promoting health through prevention of human contact with the hazards of wastes, particularly human waste – has long been acknowledged as an indispensable element of disease prevention and primary health care programmes, a large number of recent impact evaluation studies on sanitation interventions in low income countries fail to find any health improvements. We address endogeneity of sanitation coverage through an instrumental variable approach, exploiting variation in raw material construction prices. Doing so, we find that sanitation coverage plays a significant and positive role in height growth during the first years of life and that this causal relationship holds particularly for girls. Our findings suggest that a policy that aims to increase sanitation coverage in a context such as the one studied here, is not only effective in reducing child stunting but also implicitly targets girls.

Tubaramure, a Food-Assisted Integrated Health and Nutrition Program, Reduces Child Stunting in Burundi: A Cluster-Randomized Controlled Intervention Trial

Food-assisted maternal and child health and nutrition (FA-MCHN) programs are widely used to address undernutrition, but little is known about their effectiveness in improving child linear growth. We assessed the impact of Burundi's Tubaramure FA-MCHN program on linear growth. The program targeted women and their children during the first 1000 d and included 1) food rations, 2) strengthening of health services and promotion of their use, and 3) behavior change communication (BCC). A second objective was to assess the differential effect when varying the timing and duration of receiving food rations. We used a 4-arm, cluster-randomized controlled study to assess program impact with the use of cluster fixed-effects double-difference models with repeated cross-sectional data (baseline and follow-up 4 y later with ∼3550 children in each round). Treatment arms received food rations (corn-soy blend and micronutrient-fortified vegetable oil) for the first 1000 d (T24), from pregnancy through the child reaching 18 mo (T18), or from birth through the child reaching 24 mo ["no food during pregnancy" (TNFP)]. All treatment arms received BCC for the first 1000 d. The control arm received no food rations or BCC. Stunting (height-for-age z score <2 SDs) increased markedly from baseline to follow-up, but Tubaramure had a significant (P<0.05) beneficial effect in the T24 [7.4 percentage points (pp); P<0.05], T18 (5.7 pp; P<0.05), and TNFP (4.6; P=0.09) arms; the differences in effect across arms were not significant (P>0.01). Secondary analyses showed that the effect was limited to children whose mother and head of household had some primary education and who lived in households with above-median assets. FA-MCHN programs are an effective development tool to improve child linear growth and can protect children from political and economic shocks in vulnerable countries such as Burundi. A better understanding of how to improve the nutritional status of children in the worst-off households is needed. This trial was registered at www.clinicaltrials.gov as NCT01072279.

Exposure to Ambient Fine Particulate Air Pollution in Utero as a Risk Factor for Child Stunting in Bangladesh.

Pregnant mothers in Bangladesh are exposed to very high and worsening levels of ambient air pollution. Maternal exposure to fine particulate matter has been associated with low birth weight at much lower levels of exposure, leading us to suspect the potentially large effects of air pollution on stunting in children in Bangladesh. We estimate the relationship between exposure to air pollution in utero and child stunting by pooling outcome data from four waves of the nationally representative Bangladesh Demographic and Health Survey conducted between 2004 and 2014, and calculating children’s exposure to ambient fine particulate matter in utero using high resolution satellite data. We find significant increases in the relative risk of child stunting, wasting, and underweight with higher levels of in utero exposure to air pollution, after controlling for other factors that have been found to contribute to child anthropometric failure. We estimate the relative risk of stunting in the second, third, and fourth quartiles of exposure as 1.074 (95% confidence interval: 1.014–1.138), 1.150 (95% confidence interval: 1.069–1.237, and 1.132 (95% confidence interval: 1.031–1.243), respectively. Over half of all children in Bangladesh in our sample were exposed to an annual ambient fine particulate matter level in excess of 46 µg/m3; these children had a relative risk of stunting over 1.13 times that of children in the lowest quartile of exposure. Reducing air pollution in Bangladesh could significantly contribute to the Sustainable Development Goal of reducing child stunting.

Prevalence and predictors of stunting and underweight among children under 5 years in Tigray, Ethiopia: Implications for nutrition-sensitive agricultural interventions

ABSTRACTUnderstanding local drivers of malnutrition can help improve the design of agricultural interventions intended to reduce child stunting and underweight. This study reports the prevalence of child under-5 stunting and underweight from 10 rural districts in the Tigray region of Ethiopia; analyzes factors associated with child undernutrition; and presents implications for designing and selecting indicators for agricultural programs intended to improve nutrition. Overall prevalence of stunting and underweight was 40.0% and 34.6%, respectively. There was significant variation among the districts in the proportion of children classified as stunted and underweight (p > 0.05). Stunting rates ranged from 26.7% to 66.7%, underweight rates ranged from 13.3% to 63.3%. Geographic location (odd ratio [OR] = 1.99; 95% confidence interval [CI], 0.81–4.87), no maternal history of eye issues (OR = 1.67; 95% CI, 1.01–2.78), and not owning a mobile phone (OR = 1.5; 95% CI, 0.91–2.49) were factors that increased odds of stunting. Geographic location (OR = 1.17; 95% CI, 0.5–2.76) and no maternal history of eye issues (OR = 1.71; 95% CI, 1.01–2.91) increased odds of underweight. The aggregate data masked influential social and behavioral factors affecting nutrition within certain districts and subgroups. Nutrition-specific approaches that target women and children and nutrition-sensitive approaches that strengthen local sources of resilience are needed to accelerate progress toward improved nutrition and reduce health disparities.

Does Community-Based Health Insurance Reduce Child Stunting? Evidence From Rural Uganda

Does Community-Based Health Insurance Reduce Child Stunting? Evidence From Rural Uganda

Handwashing, sanitation and family planning practices are the strongest underlying determinants of child stunting in rural indigenous communities of Jharkhand and Odisha, Eastern India: a cross-sectional study.

The World Health Organisation has called for global action to reduce child stunting by 40% by 2025. One third of the world's stunted children live in India, and children belonging to rural indigenous communities are the worst affected. We sought to identify the strongest determinants of stunting among indigenous children in rural Jharkhand and Odisha, India, to highlight key areas for intervention.We analysed data from 1227 children aged 6–23.99 months and their mothers, collected in 2010 from 18 clusters of villages with a high proportion of people from indigenous groups in three districts. We measured height and weight of mothers and children, and captured data on various basic, underlying and immediate determinants of undernutrition. We used Generalised Estimating Equations to identify individual determinants associated with children's height‐for‐age z‐score (HAZ; p < 0.10); we included these in a multivariable model to identify the strongest HAZ determinants using backwards stepwise methods.In the adjusted model, the strongest protective factors for linear growth included cooking outdoors rather than indoors (HAZ +0.66), birth spacing ≥24 months (HAZ +0.40), and handwashing with a cleansing agent (HAZ +0.32). The strongest risk factors were later birth order (HAZ −0.38) and repeated diarrhoeal infection (HAZ −0.23).Our results suggest multiple risk factors for linear growth faltering in indigenous communities in Jharkhand and Odisha. Interventions that could improve children's growth include reducing exposure to indoor air pollution, increasing access to family planning, reducing diarrhoeal infections, improving handwashing practices, increasing access to income and strengthening health and sanitation infrastructure.

Stop stunting: improving child feeding, women's nutrition and household sanitation in South Asia.

The latest available data indicate that 38% of South Asia's children aged 0–59 months are stunted. Such high prevalence combined with the region's large child population explain why South Asia bears about 40% of the global burden of stunting. Recent analyses indicate that the poor diets of children in the first years of life, the poor nutrition of women before and during pregnancy and the prevailing poor sanitation practices in households and communities are important drivers of stunting, most likely because of underlying conditions of women's status, food insecurity, poverty, and social inequalities. With this evidence in mind, UNICEF Regional Office for South Asia convened the Regional Conference: Stop Stunting: Improving Child Feeding, Women's Nutrition, and Household Sanitation in South Asia (New Delhi, November 10–12, 2014). The Conference provided a knowledge‐for‐action platform with three objectives: (1) share state‐of‐the‐art research findings on the causes of child stunting and its consequences for child growth and development and the sustainable growth and development of nations; (2) discuss better practices and the cost and benefits of scaling up programmes to improve child feeding, women's nutrition, and household sanitation in South Asia; and (3) identify implications for sectoral and cross‐sectoral policy, programme, advocacy and research to accelerate progress in reducing child stunting in South Asia. This overview paper summarizes the rationale for the focus on improving child feeding, women's nutrition, and household sanitation as priority areas for investment to prevent child stunting in South Asia. It builds on the invited papers presented at or developed as a follow on to the Stop Stunting Conference.

Imperatives for reducing child stunting in Bangladesh.

Although there has been a decline in rates of child stunting in Bangladesh, more than one‐third of under‐five children still suffer from impaired linear growth. Results of the demographic health surveys since 2004 show that the rate of stunting decreased by only 1.5 percentage points per year (NIPORT, Mitra and Associates & ICF International, 2015). This is not anticipated, given the impressive results the country has demonstrated in reducing infant and maternal mortality over the past two decades (NIPORT, MEASURE Evaluation, and ICDDR,B 2012). Stunting seems to be pervasive throughout the country and is very high in children in slum settlements. Poverty and lack of education are associated with stunting in Bangladesh as elsewhere; however, 21% children from households belonging to the richest wealth quintiles are also stunted. About one‐third of children of literate mothers also suffer from stunting. Therefore, the aetiology of stunting is still not clear, although data from Bangladesh suggest that factors associated with the condition include poor maternal nutrition, low birthweight (LBW), severe food insecurity, inappropriate complementary feeding, poverty, illiteracy, poor sanitation, and hygiene practices (Ahmed et al, 2012; Psaki et al., 2014). There is increasing evidence that environmental enteropathy, a condition where the small intestinal mucosa is colonized and damaged by pathogenic bacteria, is one cause of malabsorption of nutrients and stunting. This happens when hygiene and sanitation practices are poor and young children are chronically exposed to bacteria in the environment.

The nutrition transition and indicators of child malnutrition

This study examines how the nutrition transition, which involves a westernization of diets and increased consumption of calorie-dense, processed foods, affects child malnutrition in developing countries. It is often assumed that the nutrition transition affects child weight but not child growth, which could be one reason why child underweight decreases faster than child stunting. But these effects have hardly been analyzed empirically. Cross-country panel regressions show that the nutrition transition reduces child underweight, while no consistent effect on child overweight is found. Against common views, our results also suggest that the nutrition transition reduces child stunting. Further research is required to confirm these findings.

Factors Associated with Stunting among Children Aged 6-23 Months in Zambian: Evidence from the 2007 Zambia Demographic and Health Survey

The reduction of child stunting requires an understanding of the major factors that are associated with it most especially before and during infancy of the child. This is because, the velocity of linear growth is highest during first months of life for most infants, and especially in less developed countries like Zambia. Children aged 6–23 months are usually vulnerable to stunting because of various factors such as lack of complementary foods containing the necessary nutrients during the early stages of life which leaves them vulnerable to opportunistic infections resulting in poor health outcomes and outmately stuntedness. The aim of this study was to determine factors associated with stunting among children aged 6–23 months in Zambia. The study used the 2007 Zambia Demographic and Health Survey data, which had data on anthropometric measurements for both children (6–23 months) and women of child bearing age (15–49 years); and various bio-demographic and socio-economic variables. Prevalence of stunting among children 6–23 months was very high 44.5 percent p<0.001. The study further revealed that stunting was associated with various factors. Mothers age was also associated child stunting (AOR=1.756, 95%CI: 1.168, 2.641; p=0.007 and AOR=2.568, 95%CI: 1.268, 5.200; p=0.009). Children whose birth weight was small or average (AOR=1.919, 95%CI: 1.350, 2.727; p<0.001 and AOR=1.365, 95%CI: 1.090, 1.710; p=0.007) were 91.9 percent and 36.5 percent more likely to be stunted compared with children whose birth weight was large at birth. Children whose mothers had not taken iron tablets whilst pregnant (AOR=0.600, 95%CI: 0.405, 0.890; p=0.011) more likely to be stunted than those whose mothers had taken the tablets. Mother and child’s IDDS were also significant predictors of stunting (AOR=1.101, 95%CI: 1.021, 1.186; p=0.012 and AOR=1.101, 95%CI: 1.021, 1.186; p<0.001). Children (6–23 months) who were not being breastfed at the time of the survey were more likely to be stunted compared to those who reported being breastfed at the time of the survey (AOR=1.384, 95%CI: 1.067, 1.796; p=0.014). In Zambia, stunting in children aged 6–23 months is high. Stunting is significantly associated with mothers’ age, Childs’ birth weight, mothers taking iron tablets whilst pregnant and breastfeeding. These findings implies that, measures targeted at reducing child stunting should not be taken in isolation but should include a multifaceted approaching looking at both the mother and the children aged 6–23 months at all societal levels in the country as once this window of opportunity is lost then the problem of stunting shall continue to be a public health problem for unforeseeable future.

Consumption of Micronutrient-Fortified Milk and Noodles is Associated with Lower Risk of Stunting in Preschool-Aged Children in Indonesia

Stunting is highly prevalent in developing countries and is associated with greater morbidity and mortality. Micronutrient deficiencies contribute to stunting, and micronutrient-fortified foods are a potential strategy to reduce child stunting. To examine the relationship between the use of fortified powdered milk and noodles and child stunting in a large, population-based sample of Indonesian children. Consumption of fortified milk and fortified noodles was assessed in children 6 to 59 months of age from 222,250 families living in rural areas and 79,940 families living in urban slum areas in Indonesia. The proportions of children who consumed fortified milk and fortified noodles were 34.0% and 22.0%, respectively, in rural families, and 42.4% and 48.5%, respectively, in urban families. The prevalence of stunting among children from rural and urban families was 51.8% and 48.8%, respectively. Children from rural and urban families were less likely to be stunted if they consumed fortified milk (in rural areas, OR = 0.87; 95% CI, 0.85 to 0.90; p < .0001; in urban areas, OR = 0.80; 95% CI, 0.76 to 0.85; p < .0001) or fortified noodles (in rural areas, OR = 0.95; 95% CI, 0.91 to 0.99;p = .02; in urban areas, OR = 0.95; 95% CI, 0.91 to 1.01; p = .08) in multiple logistic regression models adjusted for potential confounders. In both rural and urban families, the odds of stunting were lower when a child who consumed fortified milk also consumed fortified noodles, or when a child who consumed fortified noodles also consumed fortified milk. The consumption of fortified milk and noodles is associated with decreased odds of stunting among Indonesian children. These findings add to a growing body of evidence regarding the potential benefits of multiple micronutrient fortification on child growth.

P12 Study of reliability of the box and block test for manual dexterity of upper extremity function in patients with rheumatoid arthritis

Our study contributes to the understanding of key drivers of stunted growth, a factor widely recognized as major impediment to human capital development. Specifically, we examine the effects of sanitation coverage and usage on child height for age in a semi-urban setting in Northern India. Although sanitation – broadly defined as hygienic means of promoting health through prevention of human contact with the hazards of wastes, particularly human waste – has long been acknowledged as an indispensable element of disease prevention and primary health care programmes, a large number of recent impact evaluation studies on sanitation interventions in low income countries fail to find any health improvements. We address endogeneity of sanitation coverage through an instrumental variable approach, exploiting variation in raw material construction prices. Doing so, we find that sanitation coverage plays a significant and positive role in height growth during the first years of life and that this causal relationship holds particularly for girls. Our findings suggest that a policy that aims to increase sanitation coverage in a context such as the one studied here, is not only effective in reducing child stunting but also implicitly targets girls.

Maternal depression and early childhood growth in developing countries: systematic review and meta-analysis

To investigate the relationship between maternal depression and child growth in developing countries through a systematic literature review and meta-analysis. Six databases were searched for studies from developing countries on maternal depression and child growth published up until 2010. Standard meta-analytical methods were followed and pooled odds ratios (ORs) for underweight and stunting in the children of depressed mothers were calculated using random effects models for all studies and for subsets of studies that met strict criteria on study design, exposure to maternal depression and outcome variables. The population attributable risk (PAR) was estimated for selected studies. Seventeen studies including a total of 13,923 mother and child pairs from 11 countries met inclusion criteria. The children of mothers with depression or depressive symptoms were more likely to be underweight (OR: 1.5; 95% confidence interval, CI: 1.2-1.8) or stunted (OR: 1.4; 95% CI: 1.2-1.7). Subanalysis of three longitudinal studies showed a stronger effect: the OR for underweight was 2.2 (95% CI: 1.5-3.2) and for stunting, 2.0 (95% CI: 1.0-3.9). The PAR for selected studies indicated that if the infant population were entirely unexposed to maternal depressive symptoms 23% to 29% fewer children would be underweight or stunted. Maternal depression was associated with early childhood underweight and stunting. Rigorous prospective studies are needed to identify mechanisms and causes. Early identification, treatment and prevention of maternal depression may help reduce child stunting and underweight in developing countries.