Menu ENN Search

Causes and consequences of child growth failure in low- and middle-income countries

View this article as a pdf

Click here to listen to an interview with one of the authors on the ENN podcast channel

Research snapshot1

Wasting and stunting contribute to child mortality, adult morbidity, poor cognitive outcomes and negative adult economic outcomes. Current estimates attribute > 250,000 deaths annually to stunting and > 1 million deaths annually to wasting. Despite extensive recognition of the importance of improving growth outcomes for public health benefits, preventative interventions have shown only limited success. This may point to an incomplete understanding of the optimal time and ways to intervene to prevent wasting and stunting. Understanding the relationships between child, parental and household characteristics and causes and timing of child growth failure may offer insights into how to improve interventions and which higher risk children might benefit most. In this study the authors analysed 35 longitudinal cohorts (108,336 children aged 0 to 24 months) from South Asia, Africa, Latin America and Eastern Europe to quantify the effect of early growth failure on severe outcomes in children. Cohorts were assembled as part of the Knowledge Integration (ki) initiative of the Bill & Melinda 220 Gates Foundation.

Maternal and child characteristics at birth accounted for the largest attributable differences in growth. Maternal anthropometry was a key predictor for early childhood growth failure, particularly when growth faltering began at birth. Yet, postnatal growth failure was larger than differences at birth, and characteristics of the child’s household environment were additional determinants of growth failure after age 6 months. Children who experienced early ponderal or linear growth failure were at much higher risk of persistent growth failure and were 2.0 to 4.8 times more likely to die by age 24 months. Longer length of child at birth, higher maternal weight, earlier child birth order, higher maternal education level and more rooms in the household were five of the top population-level predictors of higher length-for-age and weight-for-length at 24 months. The dry season of the year was an important predictor of higher child weight for length and taller height in mothers was important for higher child length for age. In older infants and children a key predictor was previous growth failure (before six months of age). All measures of early growth failure were significantly associated with later, more serious growth failure, with wasting indicators among the strongest of predictors.

High attributable risk from prenatal causes, and severe consequences for children who experienced early growth failure, support a focus on pre-conception and pregnancy as key opportunities for new preventive interventions. Targeting postnatal interventions by season or population sub-group (defined by risk characteristics) could reduce the persistent burden of postnatal growth failure. The results also suggest that broad improvements in wellbeing will be necessary to eliminate growth failure in low resource settings, but that screening based on weight could help identify children at highest risk of death before age 24 months.

Read more...

1 Mertens, A., et al. (2020). Causes and consequences of child growth failure in low- and middle-income countries. medRxiv: 2020.2006.2009.20127100. www.medrxiv.org/content/10.1101/2020.06.09.20127100v1

More like this

FEX: Early childhood linear growth failure in low- and middle-income countries

View this article as a pdf Research snapshot1 Stunting affects approximately 149 million children under five years old globally.2 However, estimates rely on cross-sectional...

FEX: Child wasting and concurrent stunting in low- and middle-income countries

View this article as a pdf Click here to listen to an interview with one of the authors on the ENN podcast channel Summary of research1 What we know: Cross-sectional,...

FEX: Relationships between wasting and stunting and their concurrent occurrence in Ghanaian pre-school children

Summary of research* Location: Ghana. What we know: Wasting is a short-term health issue, but repeated episodes may lead to stunting (long-term or chronic malnutrition). This...

FEX: The Paediatric Development Clinic: A model to improve medical, nutritional and developmental outcomes for high-risk children aged under-five in rural Rwanda

By Kathryn Beck, Catherine M Kirk, Jessica Bradford, Christine Mutaganzwa, Evrard Nahimana and Olivier Bigirumwami View this article as a pdf Kathryn Beck is the Nutrition...

FEX: Managing at risk mothers and infants under six months in India – no time to waste

View this article as a pdf By Praveen Kumar, Sila Deb, Arjan de Wagt, Piyush Gupta, Nita Bhandari, Neha Sareen and Satinder Aneja Praveen Kumar is a paediatrician working as...

FEX: Growth faltering in rural Gambian children after four decades of interventions: a retrospective cohort study

Summary of Research1 Nabwera HM, Fulford AJ, Moore SE and Prentice AM. (2017). Growth faltering in rural Gambian children after four decades of interventions: a retrospective...

FEX: South Asia and child wasting – unravelling the conundrum

View this article as a pdf By Harriet Torlesse and Minh Tram Le Background Each annual release of the Joint Malnutrition Estimates by United Nations Children's Fund...

FEX: The relationship between wasting and stunting: a retrospective cohort analysis of longitudinal data in Gambian children from 1976 to 2016

View this article as a pdf Summary of research1 Location: Gambia What we know: There are gaps in understanding the relationship between wasting and stunting that often...

FEX: The link between foetal and childhood nutrition and adult non-communicable disease: lessons from birth cohort studies in India

View this article as a pdf Research summary1 Location: India What we know: Non-communicable diseases (NCDs) are rising in prevalence globally and they particularly affect...

FEX: Growth faltering in early infancy: highlights from a two-day scientific consultation

View this article as a pdf Report summary1 Growth faltering among babies less than six months of age remains a significant concern in India which has not so far received...

FEX: Improving maternal nutrition in South Asia: Implications for child wasting prevention efforts

View this article as a pdf By Zivai Murira and Harriet Torlesse Zivai Murira is Nutrition Specialist at United Nations Children's Fund (UNICEF) Regional Office for South Asia...

FEX: Wasting and Stunting Technical Interest Group (WaSt TIG) meeting

On the 15th of January 2018 the Wasting and Stunting (WaSt) Technical Interest Group (TIG) held their third face-to-face meeting at Trinity College, Oxford. This group of 30...

FEX: Editorial

View this article as a pdf A warm welcome to our 63rd edition of Field Exchange, focused on child wasting in South Asia. The idea for this issue came out of a meeting in New...

FEX: Higher heights: a greater ambition for maternal and child nutrition in South Asia

Research Summary 1 Poor nutrition in early life threatens the growth and development of children, which has a knock-on effect on the sustainable development of nations. This...

FEX: Summary of Lancet Series on Maternal and Child Undernutrition

Below are short summaries of the recently launched Lancet series of papers on Maternal and Child Undernutrition1. This high profile series focuses on the disease burden...

FEX: Diluted F100 v infant formula in treatment of severely malnourished infants < 6 months

By Caroline Wilkinson and Sheila Isanaka Caroline Wilkinson was Nutrition Advisor with Action Contre la Faim - France (ACF-F), until November 2008. She spent most of 2007 in...

FEX: Making connections: Joint meeting of WaSt Technical Interest Group and MAMI Special Interest Group

ENN coordinates two international technical groups, the Management of at-risk Mothers and Infants under six months Special Interest Group (MAMI SIG) and the Wasting and...

FEX: Chronic disease outcomes after SAM in Malawian children (ChroSAM): A cohort study

Summary of research* Location: Malawi What we know: Little is known about the long-term health effects of survivors of severe acute malnutrition (SAM), particularly risk of...

FEX: Using IMRs to inform policy decisions on infant feeding and HIV

Summary of published research1 Feeding bottles in a camp in Pakistan A recently published paper presents an analysis of the impact of WHO infant feeding recommendations in...

FEX: The impact of intensive counselling and a mass media campaign on complementary feeding practices and child growth in Bangladesh

Summary of research* Location: Bangladesh. What we know: In Bangladesh there has been little to no progress in improving children's diets and little evidence available on...

Close

Reference this page

Causes and consequences of child growth failure in low- and middle-income countries. Field Exchange 63, October 2020. p74. www.ennonline.net/fex/63/growthfailurecausesconsequences

(ENN_6803)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.