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

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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.

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

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