Peer-reviewed article
Comparative Models of Biological and Social Pathways to Predict Child Growth through Age 2 Years from Birth Cohorts in Brazil, India, the Philippines, and South Africa
Linda Richter, Frederick Mark Orkin, Gabriela D Roman, Darren Lawrence Dahly, Bernardo Lessa Horta et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed data from nearly 14,000 children across four countries to understand why some children fail to grow properly in their first two years of life. Using statistical modelling, researchers found that stunting (poor growth) is caused by both biological factors like maternal height and birthweight, and social factors like family wealth and access to community services. Biological factors explained 59% of the variation in child height at age 2, while social factors explained 41%. The patterns were similar across Brazil, India, the Philippines, and South Africa, suggesting that both types of factors matter everywhere, though stunting rates varied widely by country.
Key points
- Stunting prevalence at 24 months ranged from 14.0% in Brazil to 67.7% in the Philippines
- Maternal height and birthweight were strong predictors of child height at 24 months across all four sites
- Three social-environmental factors were identified: child circumstances, family socioeconomic status, and community facilities
- Biological pathways accounted for 59% of explained variance; social-environmental pathways for 41%
- Path coefficients were broadly similar across the four countries, suggesting common determinants of early growth
Limitations
This is an observational study using structural equation modelling that establishes associations but cannot prove causation. The study describes which factors predict growth but does not test whether modifying these factors would actually improve child growth outcomes.
Abstract
Background: Early growth faltering accounts for one-third of child deaths, and adversely impacts the health and human capital of surviving children. Social as well as biological factors contribute to growth faltering, but their relative strength and interrelations in different contexts have not been fully described. Objective: The aim of this study was to use structural equation modelling to explore social and biological multidetermination of child height at age 2 y in longitudinal data from 4 birth cohort studies in low- and middle-income countries. Methods: We analyzed data from 13,824 participants in birth cohort studies in Brazil, India, the Philippines, and South Africa. We used exploratory structural equation models, with height-for-age at 24 mo as the outcome to derive factors, and path analysis to estimate relations among a wide set of social and biological variables common to the 4 sites. Results: The prevalence of stunting at 24 mo ranged from 14.0% in Brazil to 67.7% in the Philippines. Maternal height and birthweight were strongly predictive of height-for-age at 24 mo in all 4 sites (all P values <0.001). Three social-environmental factors, which we characterized as "child circumstances," "family socioeconomic status," and "community facilities," were identified in all sites. Each social-environmental factor was also strongly predictive of height-for-age at 24 mo (all P values <0.001), with some relations partly mediated through birthweight. The biological pathways accounted for 59% of the total explained variance and the social-environmental pathways accounted for 41%. The resulting path coefficients were broadly similar across the 4 sites. Conclusions: Early child growth faltering is determined by both biological and social factors. Maternal height, itself a marker of intergenerational deprivation, strongly influences child height at 2 y, including indirect effects through birthweight and social factors. However, concurrent social factors, many of which are modifiable, directly and indirectly contribute to child growth. This study highlights opportunities for interventions that address both biological and social determinants over the long and short term.