Determinants of linear growth and predictors of severe stunting during infancy in rural Malawi

Abstract

Stunting is common among children under 5 y of age in sub‐Saharan Africa. Several risk factors have been associated with poor growth but few studies have prospectively addressed the development of linear growth faltering and stunting during the first year of life. The present study was designed to analyse typical growth among rural Malawian infants, focusing particularly on the impact of birth size, adherence to feeding guidelines and morbidity in the development of severe stunting during infancy. A community‐based cohort of 613 singleton newborns was prospectively followed by monthly home visits. Data were collected on the children's socioeconomic background, maternal size and weight gain during pregnancy, birth events, morbidity, breastfeeding and complementary feeding, growth and mortality. Univariate and multivariate analyses were used to determine associations between predictor variables and poor linear growth. The proportions of stunted infants (Height‐for‐age Z‐score > –2) at 3, 6 and 9 mo of age were 27%, 51%, and 63%, respectively. At 1 y of age, over two‐thirds (71%) of the infants were at least moderately (HAZ > –2) and 31% severely stunted (HAZ > –3). Conclusion: The strongest predictor of severe stunting at 12 mo of age was small birth size. Other variables independently associated with this outcome included inappropriate complementary feeding, high morbidity, maternal short stature, male gender, and home delivery. Faltering of linear growth started soon after birth and continued throughout infancy. Interventions increasing birth size could have a significant role in the prevention of early childhood stunting. The ideal strategy should also emphasize the importance of appropriate infant feeding and decreasing the number of illness episodes amongst the infants.

The impact of an integrated community-based micronutrient and health programme on stunting in Malawian preschool children

“…Others have shown that severe stunting is associated with preterm birth (,37 gestational weeks), maternal short stature (,160 cm), maternal failure to gain .200 g/week during pregnancy, inappropriate complementary feeding practices, frequent illnesses such as diarrhoea, home delivery and paternal illiteracy (3) , which may also have influenced the present results.…”

“…Stunting, which primarily affects children in their second year of life (2)(3)(4) , is a result of chronic inadequate intake of energy and nutrients, as well as frequent infections (1) .…”

Determinants of child malnutrition in rural and urban Ecuadorian highlands

“…Prematurity is a common cause of infant mortality and its prevention has been suggested as crucial for the application of stunting management strategies (36,37) . Our results also demonstrated the influence of preterm delivery on stunting for the pooled sample.…”

Fatores determinantes do sobrepeso em crianças menores de 4 anos de idade

“…The results obtained are consistent with current evidence that suggests no strong correlation between breastfeeding and childhood overweight, 20 although some published studies have stressed the protective effect of breast milk against development of obesity. [21][22][23][24][25] Notably, breastfeeding has been extensively reported as having real influence on child growth and nutritional status up to the first year of life. [21][22][23][24][25] On the other hand, a study conducted among preschoolers aged 2 to 6 years in the city of São Paulo found a protective effect against overweight and obesity with 6 months of exclusive breastfeeding and 24 months or more of any breastfeeding.…”