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Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels

PLoS medicine, 2016-11, Vol.13 (11), p.e1002164-e1002164 [Peer Reviewed Journal]

COPYRIGHT 2016 Public Library of Science ;COPYRIGHT 2016 Public Library of Science ;2016 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Danaei G, Andrews KG, Sudfeld CR, Fink G, McCoy DC, Peet E, et al. (2016) Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels. PLoS Med 13(11): e1002164. doi:10.1371/journal.pmed.1002164 ;2016 Danaei et al 2016 Danaei et al ;2016 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Danaei G, Andrews KG, Sudfeld CR, Fink G, McCoy DC, Peet E, et al. (2016) Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels. PLoS Med 13(11): e1002164. doi:10.1371/journal.pmed.1002164 ;ISSN: 1549-1676 ;ISSN: 1549-1277 ;EISSN: 1549-1676 ;DOI: 10.1371/journal.pmed.1002164 ;PMID: 27802277

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  • Title:
    Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels
  • Author: Danaei, Goodarz ; Andrews, Kathryn G ; Sudfeld, Christopher R ; Fink, Günther ; McCoy, Dana Charles ; Peet, Evan ; Sania, Ayesha ; Smith Fawzi, Mary C ; Ezzati, Majid ; Fawzi, Wafaie W
  • Tumwine, James K.
  • Subjects: Age ; Analysis ; Biology and Life Sciences ; Child malnutrition ; Child, Preschool ; Children & youth ; Comparative analysis ; Confidence intervals ; Control ; Demographic aspects ; Developing countries ; Developing Countries - statistics & numerical data ; Epidemiology ; Growth Disorders - epidemiology ; Growth Disorders - etiology ; Health aspects ; Health risk assessment ; HIV ; Human immunodeficiency virus ; Humans ; Infections ; LDCs ; Malnutrition in children ; Medicine and Health Sciences ; Nutrition ; People and Places ; Population ; Premature birth ; Prevalence studies (Epidemiology) ; Public health ; Risk Factors ; Sanitation ; Standard deviation ; Studies
  • Is Part Of: PLoS medicine, 2016-11, Vol.13 (11), p.e1002164-e1002164
  • Description: Stunting affects one-third of children under 5 y old in developing countries, and 14% of childhood deaths are attributable to it. A large number of risk factors for stunting have been identified in epidemiological studies. However, the relative contribution of these risk factors to stunting has not been examined across countries. We estimated the number of stunting cases among children aged 24-35 mo (i.e., at the end of the 1,000 days' period of vulnerability) that are attributable to 18 risk factors in 137 developing countries. We classified risk factors into five clusters: maternal nutrition and infection, teenage motherhood and short birth intervals, fetal growth restriction (FGR) and preterm birth, child nutrition and infection, and environmental factors. We combined published estimates and individual-level data from population-based surveys to derive risk factor prevalence in each country in 2010 and identified the most recent meta-analysis or conducted de novo reviews to derive effect sizes. We estimated the prevalence of stunting and the number of stunting cases that were attributable to each risk factor and cluster of risk factors by country and region. The leading risk worldwide was FGR, defined as being term and small for gestational age, and 10.8 million cases (95% CI 9.1 million-12.6 million) of stunting (out of 44.1 million) were attributable to it, followed by unimproved sanitation, with 7.2 million (95% CI 6.3 million-8.2 million), and diarrhea with 5.8 million (95% CI 2.4 million-9.2 million). FGR and preterm birth was the leading risk factor cluster in all regions. Environmental risks had the second largest estimated impact on stunting globally and in the South Asia, sub-Saharan Africa, and East Asia and Pacific regions, whereas child nutrition and infection was the second leading cluster of risk factors in other regions. Although extensive, our analysis is limited to risk factors for which effect sizes and country-level exposure data were available. The global nature of the study required approximations (e.g., using exposures estimated among women of reproductive age as a proxy for maternal exposures, or estimating the impact of risk factors on stunting through a mediator rather than directly on stunting). Finally, as is standard in global risk factor analyses, we used the effect size of risk factors on stunting from meta-analyses of epidemiological studies and assumed that proportional effects were fairly similar across countries. FGR and unimproved sanitation are the leading risk factors for stunting in developing countries. Reducing the burden of stunting requires a paradigm shift from interventions focusing solely on children and infants to those that reach mothers and families and improve their living environment and nutrition.
  • Publisher: United States: Public Library of Science
  • Language: English
  • Identifier: ISSN: 1549-1676
    ISSN: 1549-1277
    EISSN: 1549-1676
    DOI: 10.1371/journal.pmed.1002164
    PMID: 27802277
  • Source: GFMER Free Medical Journals
    MEDLINE
    PubMed Central
    Public Library of Science (PLoS)
    ProQuest Central
    DOAJ Directory of Open Access Journals
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