Relative contributions of the correlates of stunting in explaining the mean length-for-age z-score difference between 24-month-old stunted and non-stunted children living in a slum of Dhaka, Bangladesh: results from a decomposition analysis

Abstract

ObjectiveUsing MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) Bangladesh birth cohort data, we sought to measure the relative contributions of the most predictive correlates of stunting to mean length-for-age z (LAZ) score difference between stunted and non-stunted children at 24 months of age.SettingDhaka, BangladeshParticipants211 slum-dwelling children enrolled within 17 days of their birth.Variables and methodThe explanatory variables were identified from the following groups: maternal characteristics, birth characteristics, macronutrient intake, socioeconomic status, morbidity and serum micronutrient level. At step 1, predictive correlates of stunting were identified longitudinally (from 9 to 24 months of age) using generalized estimating equations (GEE) model. Then, the relative contributions of the most predictive correlates of stunting to mean LAZ score difference between stunted and non-stunted children at 24 months of age was measured using Blinder-Oaxaca decomposition analysisResultsThe GEE multivariable model identified maternal height, birth weight, people per room, gender, having separate room for kitchen and energy intake as the most predictive correlates of stunting. At 24 months, mean LAZ score difference between stunted and non-stunted children was 1.48. The variable by variable decomposition of the LAZ gap identified maternal height (coefficient: −3.04; 95% CI: 0.35 to -6.44), birth weight (coefficient: −0.21; 95% CI: 0.88 to -1.30), people per room (coefficient: 0.31; 95% CI: 0.92 to -0.30) and energy intake (coefficient: −0.12; 95% CI: 0.22 to -0.46) as the top most factors responsible for the mean LAZ score difference between stunted and non-stunted children at 24 months of age.ConclusionsThe relative contributions of maternal height and birth weight to LAZ gap signifies that improvement in nutritional status of a women during her adolescence and pregnancy would have an impact on birth weight of her offspring, and ultimately, on linear growth of the child.

Evaluating association of vaccine response to low serum zinc and vitamin D levels in children of a birth cohort study in Dhaka

“…The study had a well-defined recruitment protocol [15] . Between February 2010 and February 2012, within 17 days of birth 265 healthy newborn children were enrolled by field workers upon visiting their respective households; and these children were followed until 24 months of age [16] . Here 208 participants’ data were available for analysis after total recruitment at 7 and 15 months of age ( Fig.…”

“…Blood samples were collected for measuring serum zinc, vitamin D, and inflammation-adjusted serum ferritin and retinol status at 7 and 15 months of age. Serum zinc, ferritin, and vitamin D and A levels were measured by using atomic absorption spectrometry and chemiluminescence immunoassay, respectively [16] , [22] . Serum zinc was assessed as the measure of zinc status.…”

“…We evaluated 2 common illnesses - acute lower respiratory infection (ALRI) and diarrhea using standard definitions of illness onset and episodes. Diarrhea is defined as having three or more abnormally loose stools in 24 h or at least one loose stool with blood reported by the mother [16] , [32] . Two or more diarrhea-free days marked separate diarrheal episodes [33] .…”

“…Acute lower respiratory infection (ALRI) is defined as the presence of cough and/or difficulty in breathing plus age-specific high respiratory rate. This definition is commonly used to identify children in resource-poor settings who may benefit from treatment [16] , [34] . The average of two respiratory rates (one minute for each measurement) was used, and different rates were considered high based on different age groups (<2 months of age: ≥60 breaths/minute; 2 to < 12 months of age: ≥50 breaths/minute; ≥12 months of age: ≥40 breaths/minute) [16] .…”

“…This definition is commonly used to identify children in resource-poor settings who may benefit from treatment [16] , [34] . The average of two respiratory rates (one minute for each measurement) was used, and different rates were considered high based on different age groups (<2 months of age: ≥60 breaths/minute; 2 to < 12 months of age: ≥50 breaths/minute; ≥12 months of age: ≥40 breaths/minute) [16] . At least 15 ALRI-free days are marked as separate ALRI episodes [16] .…”