Early-childhood linear growth faltering in low- and middle-income countries
Jade Benjamin‐Chung, Andrew Mertens, John M. Colford, Alan Hubbard, Mark J. van der Laan, Jeremy Coyle, Oleg Sofrygin, Weixin Cai, Anna Nguyen, Nolan N. Pokpongkiat, Stephanie Djajadi, Anmol Seth, Wendy Jilek, Esther Jung, Esther O. Chung, Sonali Rosete, Nima S. Hejazi, Ivana Malenica, Haodong Li, Ryan Hafen, Vishak Subramoney, Jonas Häggström, Thea Norman, Kenneth H. Brown, Parul Christian, Benjamin F. Arnold, Souheila Abbeddou, Linda S. Adair, Tahmeed Ahmed, Asad Ali, Hasmot Ali, Per Ashorn, Rajiv Bahl, Maurício L. Barreto, France Bégin, Pascal Bessong, Maharaj Kishan Bhan, Nita Bhandari, Santosh K. Bhargava, Zulfiqar A Bhutta, Robert E. Black, Ladaporn Bodhidatta, Delia B. Carba, Inés González-Casanova, William Checkley, Jean E. Crabtree, Kathryn G. Dewey, Christopher Duggan, Caroline Fall, Abu Syed Golam Faruque, Wafaie Fawzi, José Quirino da Silva Filho, Robert H. Gilman, Richard L. Guerrant, Rashidul Haque, Sonja Y. Hess, Eric R. Houpt, Jean H. Humphrey, Najeeha Talat Iqbal, Elizabeth Yakes Jimenez, Jacob John, Sushil Matthew John, Gagandeep Kang, Margaret Kosek, Michael S. Kramer, Alain Labrique, Sang Lee, Aldo Â. M. Lima, Mustafa Mahfuz, Tjale Cloupas Mahopo, Kenneth Maleta, Dharma Manandhar, Karim Manji, Reynaldo Martorell, Sarmila Mazumder, Estomih Mduma, Venkata Raghava Mohan, Sophie E. Moore, Ishita Mostafa, Robert Ntozini, Mzwakhe Emanuel Nyathi, Maribel Paredes Olórtegui, William A. Petri, Prasanna Samuel, Andrew M. Prentice, Najeeb Rahman, Harshpal Singh Sachdev, Kamran Sadiq, Rajiv Sarkar, Naomi Saville, Saijuddin Shaikh, Bhim P. Shrestha, Sanjaya K. Shrestha, Alberto M. Soares, Bakary Sonko, Aryeh D. Stein, Erling Svensen, Sana Syed, Fayaz Umrani, Honorine Ward
Abstract
. Stunting, a form of linear growth faltering, increases the risk of illness, impaired cognitive development and mortality. Global stunting estimates rely on cross-sectional surveys, which cannot provide direct information about the timing of onset or persistence of growth faltering-a key consideration for defining critical windows to deliver preventive interventions. Here we completed a pooled analysis of longitudinal studies in low- and middle-income countries (n = 32 cohorts, 52,640 children, ages 0-24 months), allowing us to identify the typical age of onset of linear growth faltering and to investigate recurrent faltering in early life. The highest incidence of stunting onset occurred from birth to the age of 3 months, with substantially higher stunting at birth in South Asia. From 0 to 15 months, stunting reversal was rare; children who reversed their stunting status frequently relapsed, and relapse rates were substantially higher among children born stunted. Early onset and low reversal rates suggest that improving children's linear growth will require life course interventions for women of childbearing age and a greater emphasis on interventions for children under 6 months of age.