Peer-reviewed article

Multiple anthropometric failures and early child development in 34 low- and middle-income countries

Joshua Jeong, Rockli Kim, S. V. Subramanian · 1 Jan 2019

Abstract

Background: Child stunting is negatively associated with early child development (ECD) outcomes.However, less is known regarding the associations between multiple co-occurring anthropometric failures and ECD.The objective of this study was to determine the association between categories of anthropometric failures (CAF)-disaggregating single, double, and triple failures-with ECD among children in low-and middle-income countries (LMICs).Methods: We combined data from the Multiple Indicator Cluster Surveys for 98,189 children aged 36-59 months in 34 LMICs.Height-for-age, weight-for-height, and weight-for-age were calculated using the 2006 World Health Organization growth standards.Children were classified into 7 mutually exclusive categories: no deficits; stunted only; wasted only; underweight only; stunted and underweight but not wasted; wasted and underweight but not stunted; and stunted, wasted, and underweight.ECD was measured using the Early Childhood Development Index (ECDI), an index of cognitive, literacy-numeracy, socioemotional, and physical development milestones for preschool-aged children.We used multivariable linear regression models to estimate the association between CAF and ECDI z-scores.Results: Overall, 20.4% of children had a single failure (17.9% stunted only, 1.0% wasted only, and 1.5% underweight only), 13.7% had double failures (12.0%stunted and underweight, 1.7% wasted and underweight), and 1.5% had triple failures.Compared to children with no deficits, children with a single failure of stunting only (β = -0.08;95% confidence interval [CI], -0.10 to -0.07), double failure of stunting and underweight (β = -0.17;95% CI, -0.19 to -0.15), and triple failure of stunting, wasting, and underweight (β = -0.15;95% CI, -0.20 to -0.10) were associated with statistically significant lower ECDI z-scores.Conclusion: We found a potentially additive relationship between multiple anthropometric failures and ECD.Findings highlight the importance of integrated interventions that support mild to severe malnutrition as a key component of nurturing care approaches to improve ECD in LMICs.