Factors associated with normal linear growth among pre-school children living in better-off households: a multi-country analysis of nationally representative data

Abstract

25This study examined the positive and negative determinants of normal linear growth among pre-26 school children living in better-off households, using survey data from Ghana, Kenya, Nigeria, 27 Mozambique and Democratic Republic of Congo (DRC). The main outcome variable was child 28 height-for-age z-scores (HAZ), categorized into HAZ≥-2SD (normal growth/not stunted) and 29 HAZ<-2 (stunted). Logistic regression was utilized in the analysis. We estimated adjusted odd 30 ratios (aORs) of the determinants of normal growth. Higher maternal weight (measured by body 31 mass index) was associated with increased odds of normal growth in Mozambique, DRC, Kenya 32 and Nigeria. A unit increase in maternal years of education was associated with increased odds 33 in normal growth in DRC (aOR=1.06, 95% CI=1.03, 1.09), Ghana (aOR=1.08, 95% CI=1.04, 1.12), 34 Mozambique (aOR=1.08, 95% CI=1.05, 1.11) and Nigeria (aOR=1.07, 95% CI=1.06, 1.08). A year 35 increase in maternal age was associated positively with normal growth in all the five countries. 36 Breastfeeding was associated with increased odds of normal growth in Nigeria (aOR= 1.30, 95% 37 CI=1.16, 1.46) and Kenya (aOR=1.37, 95% CI=1. 05, 1.79). Children of mothers who were working 38 had 25% (aOR=0.75, 95% CI=0.60, 0.93) reduced odds of normal growth in DRC. A unit change in 39 maternal parity was associated with 10% (aOR=0.90, 95% CI=0.84, 0.97), 23% (aOR=0.77, 95% 40 CI=0.63, 0.93), 25% (aOR=0.75, 95% CI=0.69, 0.82), 6% (aOR=0.94, 95% CI=0.89, 0.99) and 5% 41 (aOR=0.95, 95% CI=0.92, 0.99) reduced odds of normal growth in DRC, Ghana, Kenya, 42 Mozambique and Nigeria respectively. A child being a male was associated with 16% (aOR=0.82, 43 95% CI=0.68, 0.98), 40% (aOR=0.60, 95% CI=0.40, 0.89), 37% (aOR=0.63, 95% CI=0.51, 0.77) and 44 21% (aOR=0.79, 95% CI=0.71, 0.87) reduced odds of normal child growth in DRC, Ghana, Kenya 45 and Nigeria respectively. In conclusion, maternal education, weight, age, breastfeeding and 3 46 antenatal care are positive determinants of normal child growth, while maternal parity, 47 employment, and child sex and age are negative determinants. Interventions to promote child 48 growth should take into account these differential effects. 49 50

Early childhood development and its association with maternal parity

“…Unfavourable social determinants of health increase exposure among young children to biological and psychosocial risks that subsequently affect development (Amugsi et al, 2020;Walker et al, 2007). In wealthy countries, maternal parity may not have a significant impact on early childhood development because the negative effects of high parity can be offset by the positive effects of factors such as good nutrition, educated mothers, healthy environments and access to early childhood education.…”