Risk Factors for Childhood Stunting in 137 Developing Countries

A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels

Datos Bibliográficos

ID23387690
AutoresGoodarz Danaei (0000-0003-2456-5463, Harvard University, autor de correspondencia), Kathryn Andrews (0000-0002-7782-1152, Harvard Global Health Institute), Kathryn G Andrews, Christopher R Sudfeld (0000-0002-3203-3638, Harvard Global Health Institute), Günther Fink (0000-0001-7525-3668, Harvard Global Health Institute), Dana Charles Mccoy (0000-0002-0896-1813), Evan D Peet (0000-0001-6147-3475, RAND Corporation), Ayesha Sania (0000-0002-6445-9481, Harvard Global Health Institute), Mary C Smith Fawzi (0000-0003-4208-3708, Harvard University), Majid Ezzati (0000-0002-2109-8081, Imperial College London), Wafaie W Fawzi (0000-0002-2908-600X, Harvard University)
EditoresJames K Tumwine
Año2016
Volumen13
Número11
Páginase1002164
Fecha de publicación2016-11-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaPLoS Medicine (JOURNAL)
Identificadores de la revistaISSN: 1549-1277 • E-ISSN: 1549-1676
EditorialPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pmed.1002164
PMID27802277
OpenAlexW2547553770
IdiomaEN
Citas recibidas90
Referencias citadas51

BACKGROUND: 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. METHODS AND FINDINGS: 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. CONCLUSIONS: 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.

Attributable risk · Cluster (spacecraft) · Confidence interval · Developing country · Environmental health · Malnutrition · Population · Public health · Relative risk · Risk factor · Sanitation · Breastfeeding Practices and Influences · Child Nutrition and Water Access · Demography · Epidemiology · Global Maternal and Child Health · Medicine · Pediatrics