RT Journal Article
SR Electronic
T1 Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso
JF BMJ Global Health
FD BMJ Publishing Group Ltd
SP e001155
DO 10.1136/bmjgh-2018-001155
VO 4
IS 1
A1 Elizabeth L Prado
A1 Elizabeth Yakes Jimenez
A1 Stephen Vosti
A1 Robert Stewart
A1 Christine P Stewart
A1 Jérôme Somé
A1 Anna Pulakka
A1 Jean Bosco Ouédraogo
A1 Harriet Okronipa
A1 Eugenia Ocansey
A1 Brietta Oaks
A1 Kenneth Maleta
A1 Anna Lartey
A1 Emma Kortekangas
A1 Sonja Y Hess
A1 Kenneth Brown
A1 Jaden Bendabenda
A1 Ulla Ashorn
A1 Per Ashorn
A1 Mary Arimond
A1 Seth Adu-Afarwuah
A1 Souheila Abbeddou
A1 Kathryn Dewey
YR 2019
UL http://gh.bmj.com/content/4/1/e001155.abstract
AB Stunting prevalence is an indicator of a country’s progress towards United Nations’ Sustainable Development Goal 2, which is to end hunger and achieve improved nutrition. Accelerating progress towards reducing stunting requires a deeper understanding of the factors that contribute to linear growth faltering. We conducted path analyses of factors associated with 18-month length-for-age z-score (LAZ) in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements Project in Ghana (n=1039), Malawi (n=684 and 1504) and Burkina Faso (n=2619). In two cohorts, women were enrolled during pregnancy. In two other cohorts, infants were enrolled at 6 or 9 months. We examined the association of 42 indicators of environmental, maternal, caregiving and child factors with 18-month LAZ. Using structural equation modelling, we examined direct and indirect associations through hypothesised mediators in each cohort. Out of 42 indicators, 2 were associated with 18-month LAZ in three or four cohorts: maternal height and body mass index (BMI). Six factors were associated with 18-month LAZ in two cohorts: length for gestational age z-score (LGAZ) at birth, pregnancy duration, improved household water, child dietary diversity, diarrhoea incidence and 6-month or 9-month haemoglobin concentration. Direct associations were more prevalent than indirect associations, but 30%–62% of the associations of maternal height and BMI with 18-month LAZ were mediated by LGAZ at birth. Factors that were not associated with LAZ were maternal iron status, illness and inflammation during pregnancy, maternal stress and depression, exclusive breast feeding during 6 months post partum, feeding frequency and child fever, malaria and acute respiratory infections. These findings may help in identifying interventions to accelerate progress towards reducing stunting; however, much of the variance in linear growth status remained unaccounted for by these 42 individual-level factors, suggesting that community-level changes may be needed to achieve substantial progress.