Timing of growth faltering: a critical window for healthy growth

The Targets for Stunting Prevention Policies in Papua, Indonesia: What Mothers' Characteristics Matter?

The study aimed to analyze the most appropriate maternal characteristics for stunting prevention policies. The study employed secondary data from the 2017 Indonesia Nutritional Status Monitoring Survey. The study obtained weighted samples of 11,887 Papuan children under five years of age. On the other hand, the study used the nutritional status as an outcome variable and maternal characteristics as an exposure variable. The research employed the following four control variables: residence, region, under-five age, and gender. The study occupied the binary logistic regression. The results show that mothers who graduated from primary school and under were 1.263 times more likely than mothers with a college education to have stunted children. Mothers who graduated from junior high school are 1.222 times more likely than mothers with a college education to have stunted children. Mothers who graduated from senior high school were 1.122 times more likely than mothers with a college education to have stunted children. Mothers with a never-married status have a 1.138 times greater probability than divorced/widowed mothers to have stunted children. Meanwhile, married mothers are 0.936 times more likely than divorced/widowed mothers to have stunted children. The study concluded that the target group for stunting prevention policies are mothers with poor education and who are single.

Pathway Analysis of Growth Faltering Pattern Based on Height for Age in Children Under Five in Indonesia Based on Indonesian National Health Survey 2013

Growth failure has a severe impact on public health problems. Stunting is a particular growth failure contributing to the child mortality and morbidity of non-communicable diseases in adults. Objective: To analyze the determinants of growth failure patterns in children under five years in Indonesia. The further analysis was taken from 6,020 samples, based on the Indonesian National Health Survey (Riskesdas) 2013 (cross-sectional survey with a multistage cluster sampling method). Inclusion criteria are data that have completed records. The exclusion criteria were data having no outlier in anthropometric measurement. Nutrition status is analyzed using WHO AnthroPlus 2009. Data analysis is taken by path analysis in SPSS 21. The growth curve height for the under five-year children in Indonesia is less than the WHO growth standard. The mean height for age z-score (HAZ) has declined in linear patterns among the first five years of life. The determinant of growth is divided into two age groups. Overall, socioeconomic status has an indirect effect adjusted by both age and gender with r 0.10. In children <36 mo, the nutrition status of the mother has a direct and indirect effect on the birth nutrition status with r 0.17, while low birth weight, breastfeeding status, infectious disease, and immunization are the direct factor to HAZ score. In children aged 37-59 mo, infectious disease is a direct factor. Socioeconomic status, BMI of a mother, breastfeeding status, immunization, and infectious disease are the determinants of growth failure patterns in Indonesia.

Characterizing early child growth patterns of height-for-age in an urban slum cohort of Bangladesh with functional principal component analysis

Background

Early childhood is a critical stage of physical and cognitive growth that forms the foundation of future wellbeing. Stunted growth is presented in one of every 4 children worldwide and contributes to developmental impairment and under-five mortality. Better understanding of early growth patterns should allow for early detection and intervention in malnutrition. We aimed to characterize early child growth patterns and quantify the change of growth curves from the World Health Organization (WHO) Child Growth Standards.

Methods

In a cohort of 626 Bangladesh children, longitudinal height-for-age z-scores (HAZ) were modelled over the first 24 months of life using functional principal component analysis (FPCA). Deviation of individual growth from the WHO standards was quantified based on the leading functional principal components (FPCs), and growth faltering was detected as it occurred. The risk factors associated with growth faltering were identified in a linear regression.

Results

Ninety-eight percent of temporal variation in growth trajectories over the first 24 months of life was captured by two leading FPCs (FPC1 for overall growth and FPC2 for change in growth trajectory). A derived index, adj-FPC2, quantified the change in growth trajectory (i.e., growth faltering) relative to the WHO standards. In addition to HAZ at birth, significant risk factors associated with growth faltering in boys included duration of breastfeeding, family size and income and in girls maternal weight and water source.

Conclusions

The underlying growth patterns of HAZ in the first 2 years of life were delineated with FPCA, and the deviations from the WHO standards were quantified from the two leading FPCs. The adj-FPC2 score provided a meaningful measure of growth faltering in the first 2 years of life, which enabled us to identify the risk factors associated with poor growth that would have otherwise been missed. Understanding faltering patterns and associated risk factors are important in the development of effective intervention strategies to improve childhood growth globally.

Trial registration

ClinicalTrials.gov Identifier: NCT02734264, registered 22 March, 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-017-0831-y) contains supplementary material, which is available to authorized users.

Incidence and course of child malnutrition according to clinical or anthropometrical assessment: a longitudinal study from rural DR Congo

Background

Longitudinal studies describing incidence and natural course of malnutrition are scarce. Studies defining malnutrition clinically [moderate clinical malnutrition (McM) marasmus, kwashiorkor] rather than anthropometrically are rare. Our aim was to address incidence and course of malnutrition among pre-schoolers and to compare patterns and course of clinically and anthropometrically defined malnutrition.

Methods

Using a historical, longitudinal study from Bwamanda, DR Congo, we studied incidence of clinical versus anthropometrical malnutrition in 5 657 preschool children followed 3-monthly during 15 months.

Results

Incidence rates were highest in the rainy season for all indices except McM. Incidence rates of McM and marasmus tended to be higher for boys than for girls in the dry season. Malnutrition rates increased from the 0–5 to the 6 – 11 months age category. McM and marasmus had in general a higher incidence at all ages than their anthropometrical counterparts, moderate and severe wasting. Shifts back to normal nutritional status within 3 months were more frequent for clinical than for anthropometrical malnutrition (62.2-80.3% compared to 3.4-66.4.5%). Only a minority of moderately stunted (30.9%) and severely stunted children (3.4%) shifted back to normal status. Alteration from severe to mild malnutrition was more characteristic for anthropometrically than for clinically defined malnutrition.

Conclusions

Our data on age distribution of incidence and course of malnutrition underline the importance of early life intervention to ward off malnutrition. In principle, looking at incidence may yield different findings from those obtained by looking at prevalence, since incidence and prevalence differ approximately differ by a factor “duration”. Our findings show the occurrence dynamics of general malnutrition, demonstrating that patterns can differ according to nutritional assessment method. They suggest the importance of applying a mix of clinical and anthropometric methods for assessing malnutrition instead of just one method. Functional validity of characterization of aspects of individual nutritional status by single anthropometric scores or by simple clinical classification remain issues for further investigation.

Nutritional status of young children in Mumbai slums: a follow-up anthropometric study

Background

Chronic childhood malnutrition remains common in India. As part of an initiative to improve maternal and child health in urban slums, we collected anthropometric data from a sample of children followed up from birth. We described the proportions of underweight, stunting, and wasting in young children, and examined their relationships with age.

Methods

We used two linked datasets: one based on institutional birth weight records for 17 318 infants, collected prospectively, and one based on follow-up of a subsample of 1941 children under five, collected in early 2010.

Results

Mean birth weight was 2736 g (SD 530 g), with a low birth weight (<2500 g) proportion of 22%. 21% of infants had low weight for age standard deviation (z) scores at birth (<−2 SD). At follow-up, 35% of young children had low weight for age, 17% low weight for height, and 47% low height for age. Downward change in weight for age was greater in children who had been born with higher z scores.

Discussion

Our data support the idea that much of growth faltering was explained by faltering in height for age, rather than by wasting. Stunting appeared to be established early and the subsequent decline in height for age was limited. Our findings suggest a focus on a younger age-group than the children over the age of three who are prioritized by existing support systems.

Funding

The trial during which the birth weight data were collected was funded by the ICICI Foundation for Inclusive Growth (Centre for Child Health and Nutrition), and The Wellcome Trust (081052/Z/06/Z). Subsequent collection, analysis and development of the manuscript was funded by a Wellcome Trust Strategic Award: Population Science of Maternal and Child Survival (085417ma/Z/08/Z). D Osrin is funded by The Wellcome Trust (091561/Z/10/Z).