Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan 13;4(1):e001155.
doi: 10.1136/bmjgh-2018-001155. eCollection 2019.

Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso

Elizabeth L Prado  1 , Elizabeth Yakes Jimenez  2 , Stephen Vosti  3 , Robert Stewart  4 , Christine P Stewart  1 , Jérôme Somé  1   5 , Anna Pulakka  6 , Jean Bosco Ouédraogo  5 , Harriet Okronipa  1 , Eugenia Ocansey  1 , Brietta Oaks  1   7 , Kenneth Maleta  8 , Anna Lartey  9 , Emma Kortekangas  10 , Sonja Y Hess  1 , Kenneth Brown  1   11 , Jaden Bendabenda  8 , Ulla Ashorn  10 , Per Ashorn  10   12 , Mary Arimond  13 , Seth Adu-Afarwuah  9 , Souheila Abbeddou  1 , Kathryn Dewey  1
Affiliations

Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso

Elizabeth L Prado et al. BMJ Glob Health. .

Abstract

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.

Keywords: Africa; Linear growth; childhood; path analysis; pregnancy; prospective cohort; stunting.

PubMed Disclaimer

Conflict of interest statement

Competing interests: KHB has worked as a consultant and later as employee for the Bill & Melinda Gates Foundation.

Figures

Figure 1
Figure 1
Conceptual model.
Figure 2
Figure 2
Data collection timeline in each cohort.
Figure 3
Figure 3
Mediation analysis.
Figure 4
Figure 4
Path diagram of factors associated with18-month LAZ in four iLiNS cohorts. 1Measured in one cohort. 2Measured in two cohorts. 3Measured in three cohorts. AGP, alpha-1-acid glycoprotein; BMI, body mass index; Hb, haemoglobin; iLiNS International Lipid-Based Nutrient Supplements; LAZ, length-for-age z-score.
Figure 5
Figure 5
Coefficients of direct and indirect effects on 18-month LAZ in the final structural equation models. BMI, body mass index; Hb, haemoglobin; LAZ, length-for-age z-score.
See this image and copyright information in PMC

References

    1. Adair LS, Fall CH, Osmond C, et al. . Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet 2013;382:525–34. 10.1016/S0140-6736(13)60103-8 - DOI - PMC - PubMed
    1. Grantham-McGregor S, Cheung YB, Cueto S, et al. . Developmental potential in the first 5 years for children in developing countries. Lancet 2007;369:60–70. 10.1016/S0140-6736(07)60032-4 - DOI - PMC - PubMed
    1. WHO Multicentre Growth Reference Study Group WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: World Health Organization, 2006.
    1. United Nations Children’s Fund, World Health Organization, World Bank Group , 2018. Levels and trends in child malnutrition: key findings of the 2018 edition of the joint child malnutrition estimates. Available from: <data.unicef.org/nutrition&gt;<www.who.int/nutgrowthdb>;<data
    1. Black RE, Victora CG, Walker SP, et al. . Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013;382:427–51. 10.1016/S0140-6736(13)60937-X - DOI - PubMed

LinkOut - more resources