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- Title
Prevalence, Incidence, and Reversal Pattern of Childhood Stunting From Birth to Age 2 Years in Ethiopia.
- Authors
Goddard, Frederick G. B.; Hunegnaw, Bezawit Mesfin; Luu, Jonathan; Haneuse, Sebastien J. P. A.; Zeleke, Mesfin; Mohammed, Yahya; Bekele, Chalachew; Tadesse, Daniel; Solomon, Meles; Bekele, Delayehu; Chan, Grace J.
- Abstract
This cohort study analyzes the prevalence, incidence, and reversal of stunting among children aged 0 to 24 months in Ethiopia. Key Points: Question: What is the burden, incidence, and reversal pattern of childhood stunting in Ethiopia? Findings: In this cohort study that included 3674 children, the prevalence of stunting at 2 years of age was 57.4%. Incidence of stunting was highest between the ages of 12 to 24 months (51.0%) and rates of stunting reversal were highest by 6 months of age (63.5%). Meaning: These findings suggest that understanding patterns of linear growth and onset of growth faltering or recovery serves as a critical input to meet national and global targets of ending malnutrition. Importance: Although there has been a reduction in stunting (low-height-for-age and low-length-for-age), a proxy of malnutrition, the prevalence of malnutrition in Ethiopia is still high. Child growth patterns and estimates of stunting are needed to increase awareness and resources to improve the potential for recovery. Objective: To estimate the prevalence, incidence, and reversal of stunting among children aged 0 to 24 months. Design, Setting, and Participants: This population-based cohort study of the Birhan Maternal and Child Health cohort in North Shewa Zone, Amhara, Ethiopia, was conducted between December 2018 and November 2020. Eligible participants included children aged 0 to 24 months who were enrolled during the study period and had their length measured at least once. Data analysis occurred from Month Year to Month Year. Main Outcomes and Measures: The primary outcome of this study was stunting, defined as length-for-age z score (LAZ) at least 2 SDs below the mean. Z scores were also used to determine the prevalence, incidence, and reversal of stunting at each key time point. Growth velocity was determined in centimeters per month between key time points and compared with global World Health Organization (WHO) standards for the same time periods. Heterogeneity was addressed by excluding outliers in sensitivity analyses using modeled growth trajectories for each child. Results: A total of 4354 children were enrolled, out of which 3674 (84.4%; 1786 [48.7%] female) had their length measured at least once and were included in this study. The median population-level length was consistently below WHO growth standards from birth to 2 years of age. The observed prevalence of stunting was highest by 2 years of age at 57.4% (95% CI, 54.8%-9 60.0%). Incidence of stunting increased over time and reached 51.0% (95% CI, 45.3%-56.6%) between ages 12 and 24 months. Reversal was 63.5% (95% CI, 54.8%-71.4%) by age 6 months and 45.2% (95% CI, 36.0%-54.8%) by age 2 years. Growth velocity point estimate differences were slowest compared with WHO standards during the neonatal period (−1.4 cm/month for girls and −1.6 cm/month for boys). There was substantial heterogeneity in anthropometric measurements. Conclusions and Relevance: The evidence from this cohort study highlights a chronically malnourished population with much of the burden associated with growth faltering during the neonatal periods as well as after 6 months of age. To end all forms of malnutrition, growth faltering in populations such as that in young children in Amhara, Ethiopia, needs to be addressed.
- Subjects
ETHIOPIA; WORLD Health Organization; STATURE; CONFIDENCE intervals; AGE distribution; CONVALESCENCE; ANTHROPOMETRY; COGNITION; COMPARATIVE studies; RESEARCH funding; MALNUTRITION; DESCRIPTIVE statistics; DATA analysis software; GROWTH disorders; LONGITUDINAL method; GOAL (Psychology)
- Publication
JAMA Network Open, 2024, Vol 7, Issue 1, pe2352856
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.52856