Child stunting starts in utero: Growth trajectories and determinants in Ugandan infants
Loading...
Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Maternal & Child Nutrition
Abstract
Childhood stunting remains a public health burden worldwide. Although many
studies have examined early life and in‐utero risk factors; most have been
observational and have used analytic techniques that make inferences limited to
population means, thereby obscuring important within‐group variations. This study
addressed that important gap. Using data from a birth cohort of Ugandan infants
(n = 4528), we applied group‐based trajectory modelling to assess diverse patterns of
growth among children from birth to 1‐year old. A multinomial regression model was
conducted to understand the relationship between risk factors and observed
patterns across groups. We found that the onset of stunting occurred before birth
and followed four distinct growth patterns: chronically stunted (Group 1), recovery
(Group 2), borderline stunted (Group 3) and normal (Group 4). The average lengthfor‐
age z‐score (LAZ) at birth was −2.6, −3.9, −0.6 and 0.5 for Groups 1–4,
respectively. Although both Groups 1 and 2 were stunted at birth, stunting persisted
in Group 1 while children in Group 2 recovered by the fourth month. Group 3
exhibited mild stunting while Group 4 was normal. Wasting and underweight were
observed in all groups, with the highest prevalence of underweight in Group 1.
Wasting gradually increased among children born already stunted (Groups 1 and 2).
This showed the importance of distinguishing children by their growth patterns
rather than aggregating them and only comparing population averages against global
growth standards. The design of nutrition interventions should consider the
differential factors and potential for growth gains relative to different risks within
each group.
Description
Keywords
Child growth, Group‐based trajectories, Growth trajectories, Stunting, Wasting
Citation
Namirembe, G., Ghosh, S., Ausman, L. M., Shrestha, R., Zaharia, S., Bashaasha, B., ... & Webb, P. (2022). Child stunting starts in utero: Growth trajectories and determinants in Ugandan infants. Maternal & Child Nutrition, e13359. https://doi.org/10.1111/mcn.13359