Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso
Stunting prevalence is an indicator of a country’s progress towards United Nations’ Sustainable Development Goal 2, which is to end hunger and achieve improved nutrition. Accelerating progress towards reducing stunting requires a deeper understanding of the factors that contribute to linear growth f...
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BMJ Publishing Group
2019-02-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/1/e001155.full |
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| author | Anna Pulakka Robert Stewart Elizabeth L Prado Elizabeth Yakes Jimenez Stephen Vosti Christine P Stewart Jérôme Somé Jean Bosco Ouédraogo Harriet Okronipa Eugenia Ocansey Brietta Oaks Kenneth Maleta Anna Lartey Emma Kortekangas Sonja Y Hess Kenneth Brown Jaden Bendabenda Ulla Ashorn Per Ashorn Mary Arimond Seth Adu-Afarwuah Souheila Abbeddou Kathryn Dewey |
| author_facet | Anna Pulakka Robert Stewart Elizabeth L Prado Elizabeth Yakes Jimenez Stephen Vosti Christine P Stewart Jérôme Somé Jean Bosco Ouédraogo Harriet Okronipa Eugenia Ocansey Brietta Oaks Kenneth Maleta Anna Lartey Emma Kortekangas Sonja Y Hess Kenneth Brown Jaden Bendabenda Ulla Ashorn Per Ashorn Mary Arimond Seth Adu-Afarwuah Souheila Abbeddou Kathryn Dewey |
| author_sort | Anna Pulakka |
| collection | DOAJ |
| description | Stunting prevalence is an indicator of a country’s progress towards United Nations’ Sustainable Development Goal 2, which is to end hunger and achieve improved nutrition. Accelerating progress towards reducing stunting requires a deeper understanding of the factors that contribute to linear growth faltering. We conducted path analyses of factors associated with 18-month length-for-age z-score (LAZ) in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements Project in Ghana (n=1039), Malawi (n=684 and 1504) and Burkina Faso (n=2619). In two cohorts, women were enrolled during pregnancy. In two other cohorts, infants were enrolled at 6 or 9 months. We examined the association of 42 indicators of environmental, maternal, caregiving and child factors with 18-month LAZ. Using structural equation modelling, we examined direct and indirect associations through hypothesised mediators in each cohort. Out of 42 indicators, 2 were associated with 18-month LAZ in three or four cohorts: maternal height and body mass index (BMI). Six factors were associated with 18-month LAZ in two cohorts: length for gestational age z-score (LGAZ) at birth, pregnancy duration, improved household water, child dietary diversity, diarrhoea incidence and 6-month or 9-month haemoglobin concentration. Direct associations were more prevalent than indirect associations, but 30%–62% of the associations of maternal height and BMI with 18-month LAZ were mediated by LGAZ at birth. Factors that were not associated with LAZ were maternal iron status, illness and inflammation during pregnancy, maternal stress and depression, exclusive breast feeding during 6 months post partum, feeding frequency and child fever, malaria and acute respiratory infections. These findings may help in identifying interventions to accelerate progress towards reducing stunting; however, much of the variance in linear growth status remained unaccounted for by these 42 individual-level factors, suggesting that community-level changes may be needed to achieve substantial progress. |
| format | Article |
| id | doaj-art-146c3fe530b245ebae37c0d4d7489cd0 |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-02-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-146c3fe530b245ebae37c0d4d7489cd02025-08-20T01:56:34ZengBMJ Publishing GroupBMJ Global Health2059-79082019-02-014110.1136/bmjgh-2018-001155Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina FasoAnna Pulakka0Robert Stewart1Elizabeth L Prado2Elizabeth Yakes Jimenez3Stephen Vosti4Christine P Stewart5Jérôme Somé6Jean Bosco Ouédraogo7Harriet Okronipa8Eugenia Ocansey9Brietta Oaks10Kenneth Maleta11Anna Lartey12Emma Kortekangas13Sonja Y Hess14Kenneth Brown15Jaden Bendabenda16Ulla Ashorn17Per Ashorn18Mary Arimond19Seth Adu-Afarwuah20Souheila Abbeddou21Kathryn Dewey22Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, FinlandDepartment of Psychological Medicine, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UKNutrition, University of California Davis, Davis, California, USADepartments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico, Albuquerque, California, USA3 Department of Agricultural and Resource Economics, University of California Davis, 2135 Social Sciences and Humanities, Davis, California, USA1 Department of Nutrition, University of California Davis, Davis, California, USA1 Department of Nutrition, University of California Davis, Davis, California, USA5 Institut de Recherche en Sciences de la Santé, Avenue de la Liberté, Burkina Faso1 Department of Nutrition, University of California Davis, Davis, California, USA1 Department of Nutrition, University of California Davis, Davis, California, USA1 Department of Nutrition, University of California Davis, Davis, California, USASchool of Public Health, University of Malawi College of Medicine, Blantyre, Malawi9 Department of Nutrition and Food Science, University of Ghana, Legon, Ghana10 Center for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, University of Tampere, Tampere, Finland4 Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA1 Department of Nutrition, University of California Davis, Davis, California, USA8 School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, MalawiUniversity of Tampere, Tampere, Pirkanmaa, FinlandCenter for Child Health Research, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Pirkanmaa, Finland13 Intake, Center for Dietary Assessment, Seattle, Washington, USA9 Department of Nutrition and Food Science, University of Ghana, Legon, Ghana1 Department of Nutrition, University of California Davis, Davis, California, USA1 Department of Nutrition, University of California Davis, Davis, California, USAStunting prevalence is an indicator of a country’s progress towards United Nations’ Sustainable Development Goal 2, which is to end hunger and achieve improved nutrition. Accelerating progress towards reducing stunting requires a deeper understanding of the factors that contribute to linear growth faltering. We conducted path analyses of factors associated with 18-month length-for-age z-score (LAZ) in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements Project in Ghana (n=1039), Malawi (n=684 and 1504) and Burkina Faso (n=2619). In two cohorts, women were enrolled during pregnancy. In two other cohorts, infants were enrolled at 6 or 9 months. We examined the association of 42 indicators of environmental, maternal, caregiving and child factors with 18-month LAZ. Using structural equation modelling, we examined direct and indirect associations through hypothesised mediators in each cohort. Out of 42 indicators, 2 were associated with 18-month LAZ in three or four cohorts: maternal height and body mass index (BMI). Six factors were associated with 18-month LAZ in two cohorts: length for gestational age z-score (LGAZ) at birth, pregnancy duration, improved household water, child dietary diversity, diarrhoea incidence and 6-month or 9-month haemoglobin concentration. Direct associations were more prevalent than indirect associations, but 30%–62% of the associations of maternal height and BMI with 18-month LAZ were mediated by LGAZ at birth. Factors that were not associated with LAZ were maternal iron status, illness and inflammation during pregnancy, maternal stress and depression, exclusive breast feeding during 6 months post partum, feeding frequency and child fever, malaria and acute respiratory infections. These findings may help in identifying interventions to accelerate progress towards reducing stunting; however, much of the variance in linear growth status remained unaccounted for by these 42 individual-level factors, suggesting that community-level changes may be needed to achieve substantial progress.https://gh.bmj.com/content/4/1/e001155.full |
| spellingShingle | Anna Pulakka Robert Stewart Elizabeth L Prado Elizabeth Yakes Jimenez Stephen Vosti Christine P Stewart Jérôme Somé Jean Bosco Ouédraogo Harriet Okronipa Eugenia Ocansey Brietta Oaks Kenneth Maleta Anna Lartey Emma Kortekangas Sonja Y Hess Kenneth Brown Jaden Bendabenda Ulla Ashorn Per Ashorn Mary Arimond Seth Adu-Afarwuah Souheila Abbeddou Kathryn Dewey Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso BMJ Global Health |
| title | Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso |
| title_full | Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso |
| title_fullStr | Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso |
| title_full_unstemmed | Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso |
| title_short | Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso |
| title_sort | path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in ghana malawi and burkina faso |
| url | https://gh.bmj.com/content/4/1/e001155.full |
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