Not water, sanitation and hygiene practice, but timing of stunting is associated with recovery from stunting at 24 months: results from a multi-country birth cohort study

Abstract

Objectives: To measure the role of water, sanitation and hygiene (WASH) practices on recovery from stunting and assess the role of timing of stunting on the reversal of this phenomenon.

Design: Data from the MAL-ED multi-country birth cohort study was used for the current analysis. Generalised linear mixed-effects models were used to estimate the probability of reversal of stunting with WASH practice and timing of stunting as the exposures of interest.

Setting: Seven different countries across three continents.

Participants: A total of 612 children <2 years of age.

Results: We found that not WASH practice but timing of stunting had statistically significant association with recovery from stunting. In comparison with the children who were stunted at 6 months, children who were stunted at 12 months had 1·9 times (β = 0·63, P = 0·03) more chance of recovery at 24 months of age. And, children who were stunted at 18 months of age even had higher odds (adjusted OR = 3·01, β = 1·10, P < 0·001) of recovery than children who were stunted at 6 months. Additionally, mother's height (β = 0·59, P = 0·04) and household income (β = 0·02, P < 0·05) showed statistically significant associations with the outcome.

Conclusions: The study provided evidence for the role of timing of stunting on the recovery from the phenomenon. This novel finding indicates that the programmes to promote linear growth should be directed at the earliest possible timepoints in the course of life.

Keywords: Generalised linear mixed-effects models; Multi-country birth cohort study; Recovery from stunting; Timing of stunting; Water, sanitation and hygiene.

Fig. 1

Conceptual framework depicting the water, sanitation and hygiene (WASH)–stunting causal pathway

Fig. 2

Comparison of length-for-age z-score (LAZ) trajectory between recovered and non-recovered children from birth to 24 months of age (BG (): Bangladesh; BR (): Brazil; IN, (): India; NP (): Nepal; PE (): Peru; SA (): South Africa; TZ (): Tanzania; All (): all countries combined). The dotted lines indicate the LAZ score at −2 level. Numbers presented in each graph represent the sample size of recovered (R) and non-recovered (NR) groups. Recovered: , No; , Yes

Fig. 3

Multi-panel scatter plots presenting the rate and trend of recovery from stunting. Dotted lines indicate the length-for-age z-score (LAZ) at −2 level, and the fourth quadrant of each of the plot (marked ‘A’) represents children who were stunted at 6, 12 and 18 months of age, but not at 24 months of age. ‘r’ represents the correlation coefficient between LAZ at 24 months and LAZ scores at 6, 12 and 18 months, respectively. Reversed: , No; , Yes