Elevation and Child Linear Growth in Nepal

Abstract

The relationship between elevation of residence and a child's linear growth was studied using data for 8824 children below the age of 5 years born between 2001 and 2016 at elevations ranging from 50 to 3200 m above sea level in Nepal. Multiple regression was used to measure the role of a variety of household and community factors in explaining the observed elevation effect. A negative association was found between elevation and linear growth that varied substantially across the sample but retained a significant marginal effect across model specifications. Controlling for household wealth, access to markets, indoor air quality, and a range of other factors associated with elevation, for each 1000 m gain in elevation, height for age z score (HAZ) declined by between 0.10 and 0.20 points for an average child, and by between 0.35 and 0.42 points for a child with the characteristics of those living at the highest elevations. Results underscore the potential developmental risks for children living at high elevations and call attention to factors that help to mitigate these risks.

Altitude and early child growth in 47 countries

“…Whether altitude independently contributes to child growth or simply serves as a proxy for differences in underlying patterns of economic development has obvious relevance for targeting policy and project interventions. For example, using data from Nepal, a country with a substantial number of children living at high altitudes, Shively et al (2020) find that household wealth and maternal BMI mitigate the altitude-HAZ relationship. Our confidence that altitude signals underlying drivers in a child's Fig.…”

“…Work from Nepal supports this conjecture. A number of studies find that height for age z scores (HAZ) and stunting rates have improved for children below age 5 since 2000, but gains have been largest for children from wealthier and more educated households (Budhathoki et al, 2020;Dorsey et al, 2018;Hanley-Cook et al, 2020;Nepali et al, 2019;Shively, et al, 2020). Characteristics of children and households explain most of the variance in HAZ and weight for height z scores (WHZ) in Nepal, with relatively smaller but statistically significant contributions from community-level factors (Smith & Shively, 2019).…”

Effective nutrition governance is correlated with better nutrition outcomes in Nepal

“…The prevalence of wasting in children under 5 years of age is estimated at 6.1% in the Mountains, 6.4% in the Hills, but 12.2% in the Terai [ 3 ]. A study by Shively et al, showed that “for each 1000 m gain in elevation, height-for-age Z-scores (HAZ) declined by between 0.1 and 0.2 points for an average child and by between 0.35 and 0.42 points for a child with the characteristics of those living at the highest elevations” [ 4 ]. The authors cited several factors beyond economic isolation as potentially contributing to the high stunting rates observed in the mountains, including differences in agricultural production and micronutrient deficiencies (zinc and iron).…”