Anthropometric failure in children related to intra-population variation in health determinants

1. Differences in health determinants within populations have a greater effect on anthropometric status of children than differences in population level health determinants in low- and middle-income countries (LMICs).

2. Household wealth and maternal education had the greatest impact on anthropometric status variation between populations in LMICs.

Evidence Rating Level: 4 (Below Average)

Study Rundown: Despite ongoing international emphasis on improving nutrition in young children living in LMICs, growth failure continues to be a major cause of life-long morbidity in this population. Developing strategies to combat anthropometric failure requires an understanding of differences in disease patterns and health determinants between populations (B_pop) and between individuals within a population (W_pop). In this study, researchers evaluated measures of maternal and child health and socioeconomic status to determine the relationship between anthropometric failure between differences in B_pop and W_pop health determinants. Results showed that W_pop differences were responsible for more than 80% of anthropometric variation among children, while B_pop differences played a more minor role. Country differences, and differences in household wealth had the greatest contribution to anthropometric variation at the B_pop level. This study was limited by lack of race/ethnicity data which previous studies suggest may independently affect certain health outcomes. Results from this study can be used to develop targeted strategies for reducing growth failure in children n LMICs.

Click to read the study, published today in Pediatrics

Relevant reading: Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

In-depth [cross-sectional study]: This study analyzed health and nutrition data collected on mothers (aged 15-49 years) and their children (aged <5 years) as part of the Demographic and Health Surveys program in 57 countries between 2001 and 2015. Researchers defined B_pop using measures related to communities, regions, and countries while W_pop was defined using metrics related to mothers and children. Anthropometric status was defined using z-scores, with failure defined as z-score of < -2 for height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ). Results showed that W_pop differences were responsible for 89%, 83%, and 85% of differences in HAZ, WAZ, and WHZ, respectively. Conversely, 11%, 17%, and 15% of variation in HAZ, WAZ, and WHZ were associated with B_pop differences. B_pop differences in HAZ and WAZ were most heavily affected by household wealth and maternal education (27%-41% and 20-31%, respectively). Most of the B_pop variation in HAZ, WAZ, and WHZ was associated with country level differences (41%, 63%, and 53%), followed by community level differences (37%, 23%, and 32%) and regional level differences (22%, 13%, and 15%).

Image: PD

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