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. 2019 Jan 10;4(1):e001144.
doi: 10.1136/bmjgh-2018-001144. eCollection 2019.

Lifetime economic impact of the burden of childhood stunting attributable to maternal psychosocial risk factors in 137 low/middle-income countries

Mary C Smith Fawzi  1 , Kathryn G Andrews  2 , Günther Fink  3 , Goodarz Danaei  2   4 , Dana Charles McCoy  5 , Christopher R Sudfeld  2 , Evan D Peet  6 , Jeanne Cho  7 , Yuanyuan Liu  8 , Jocelyn E Finlay  9 , Majid Ezzati  10 , Sylvia F Kaaya  11 , Wafaie W Fawzi  2   4   12
Affiliations

Lifetime economic impact of the burden of childhood stunting attributable to maternal psychosocial risk factors in 137 low/middle-income countries

Mary C Smith Fawzi et al. BMJ Glob Health. .

Abstract

Introduction: The first 1000 days of life is a period of great potential and vulnerability. In particular, physical growth of children can be affected by the lack of access to basic needs as well as psychosocial factors, such as maternal depression. The objectives of the present study are to: (1) quantify the burden of childhood stunting in low/middle-income countries attributable to psychosocial risk factors; and (2) estimate the related lifetime economic costs.

Methods: A comparative risk assessment analysis was performed with data from 137 low/middle-income countries throughout Asia, Latin America and the Caribbean, North Africa and the Middle East, and sub-Saharan Africa. The proportion of stunting prevalence, defined as <-2 SDs from the median height for age according to the WHO Child Growth Standards, and the number of cases attributable to low maternal education, intimate partner violence (IPV), maternal depression and orphanhood were calculated. The joint effect of psychosocial risk factors on stunting was estimated. The economic impact, as reflected in the total future income losses per birth cohort, was examined.

Results: Approximately 7.2 million cases of stunting in low/middle-income countries were attributable to psychosocial factors. The leading risk factor was maternal depression with 3.2 million cases attributable. Maternal depression also demonstrated the greatest economic cost at $14.5 billion, followed by low maternal education ($10.0 billion) and IPV ($8.5 billion). The joint cost of these risk factors was $29.3 billion per birth cohort.

Conclusion: The cost of neglecting these psychosocial risk factors is significant. Improving access to formal secondary school education for girls may offset the risk of maternal depression, IPV and orphanhood. Focusing on maternal depression may play a key role in reducing the burden of stunting. Overall, addressing psychosocial factors among perinatal women can have a significant impact on child growth and well-being in the developing world.

Keywords: childhood stunting; depression; intimate partner violence; maternal education; orphanhood; psychosocial; risk factors.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The number of attributable stunting cases in children aged 2 in 137 low/middle-income countries in 2010, by risk factor and region. Effects are not additive because each case of stunting can be attributed to more than one risk factor.
Figure 2
Figure 2
Stunting prevalence attributable to (A) low maternal education, (B) maternal depression, (C) intimate partner violence and (D) orphanhood.
Figure 3
Figure 3
Stunting prevalence attributable to the combined effect of maternal depression, intimate partner violence and low maternal education.
See this image and copyright information in PMC

References

    1. Black MM, Hurley KM. Investment in early childhood development. The Lancet 2014;384:1244–5. 10.1016/S0140-6736(14)60607-3 - DOI - PubMed
    1. Walker SP, Wachs TD, Meeks Gardner J, et al. Child development: risk factors for adverse outcomes in developing countries. The Lancet 2007;369:145–57. 10.1016/S0140-6736(07)60076-2 - DOI - PubMed
    1. Grantham-McGregor S, Cheung YB, Cueto S, et al. Developmental potential in the first 5 years for children in developing countries. The Lancet 2007;369:60–70. 10.1016/S0140-6736(07)60032-4 - DOI - PMC - PubMed
    1. Shonkoff JP, Garner AS. The committee on psychosocial aspects of child and family health, committee on early childhood, adoption, and dependent care, and section on developmental and behavioral pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics 2011;129:232–46. - PubMed
    1. Walker SP, Wachs TD, Grantham-McGregor S, et al. Inequality in early childhood: risk and protective factors for early child development. The Lancet 2011;378:1325–38. 10.1016/S0140-6736(11)60555-2 - DOI - PubMed