Hostname: page-component-745bb68f8f-b95js Total loading time: 0 Render date: 2025-02-03T18:38:01.402Z Has data issue: false hasContentIssue false
  • English
  • Français

Early life risk exposure and stunting in urban South African 2-year old children

Published online by Cambridge University Press:  08 February 2017

W. Slemming ,
J. Kagura ,
H. Saloojee  and
L. M. Richter
W. Slemming*
Affiliation:
Division of Community Paediatrics, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
J. Kagura
Affiliation:
MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
H. Saloojee
Affiliation:
Division of Community Paediatrics, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
L. M. Richter
Affiliation:
DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
*
*Address for correspondence: W. Slemming, Department of Paediatrics and Child Health, Division of Community Paediatrics, University of the Witwatersrand, 7 York Road, Johannesburg 2193, South Africa (Email [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Stunting is a measure of overall nutritional status and is a major public health concern because of its association with child mortality and morbidity and later adult performance. This study examined the effects of pregnancy events, birth characteristics and infant risk exposure on stunting at age 2 years. The study, established in 1990 in Soweto, an urban South African township, included 1098 mother–infant pairs enroled in the Birth to Twenty Plus longitudinal birth cohort study. In total, 22% of children were stunted at age 2 years, with males at greater risk than females [24.8 v. 19.4%, odds ratio (OR)=1.38; 95% confidence interval (CI): 1.03, 1.83]. In unadjusted analysis, male sex, household socio-economic status (SES), overcrowding, maternal age, maternal education, single motherhood, ethnicity, birth weight, gestational age and duration of infant breastfeeding were all significantly associated with stunting. In multivariable analysis, higher birth weight was protective against stunting for both sexes. Higher maternal education was protective for females only (adjusted odds ratio (AOR)=0.35; 95% CI: 0.14, 0.87), whereas wealthier household SES protected males (AOR for richest SES group=0.39; 95% CI: 0.16, 0.92). In this and other similar settings, current stunting prevention efforts focussing on primarily providing targeted proximal interventions, such as food supplements, risk undermining the critical importance of addressing key distal determinants of stunting such as SES and maternal education.

Keywords

childgrowthsexSouth Africastunting
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 8 , Issue 3 , June 2017 , pp. 301 - 310
Check for updates
Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Methods and Development. 2006. World Health Organization: Geneva.Google Scholar
2. Pradhan, M, Sahn, DE, Younger, SD. Decomposing world health inequality. J Health Econ. 2003; 22, 271–293.CrossRefGoogle ScholarPubMed
3. Piwoz, E, Sundberg, S, Rooke, J. Promoting healthy growth: what are the priorities for research and action? Adv Nutr. 2012; 3, 234–241.CrossRefGoogle ScholarPubMed
4. Caulfield, LE, de Onis, M, Blössner, M, Black, RE. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr. 2004; 80, 193–198.Google Scholar
5. Walker, SP, Wachs, TD, Meeks Gardner, J, et al. Child development: risk factors for adverse outcomes in developing countries. Lancet. 2007; 369, 145–157.Google Scholar
6. Liu, Y, Albertsson-Wikland, K, Karlberg, J. Long-term consequences of early linear growth retardation (stunting) in Swedish children. Pediatr Res. 2000; 47, 475–480.CrossRefGoogle ScholarPubMed
7. Victora, CG, Adair, L, Fall, C, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008; 371, 340–357.CrossRefGoogle ScholarPubMed
8. Haas, JD, Murdoch, S, Rivera, J, Martorell, R. Early nutrition and later physical work capacity. Nutr Rev. 1996; 54(S1), S41–S48.Google Scholar
9. Barker, DJ, Eriksson, JG, Forsen, T, Osmond, C. Fetal origins of adult disease: strength of effects and biological basis. Int J Epidemiol. 2002; 31, 1235–1239.Google Scholar
10. Prendergast, AJ, Humphrey, JH. The stunting syndrome in developing countries. Paediatr Int Child Health. 2014; 34, 250–265.CrossRefGoogle ScholarPubMed
11. Black, RE, Victora, CG, Walker, SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013; 382, 427–451.CrossRefGoogle ScholarPubMed
12. Wells, JC, Stock, JT. Re-examining heritability: genetics, life history and plasticity. Trends Endocrinol Metab. 2011; 22, 421–428.CrossRefGoogle ScholarPubMed
13. de Onis, M, Branca, F. Childhood stunting: a global perspective. Matern Child Nutr. 2016; 12, 12–26.Google Scholar
14. Frongillo, EA, de Onis, M, Hanson, KM. Socioeconomic and demographic factors are associated with worldwide patterns of stunting and wasting of children. J Nutr. 1997; 127, 2302–2309.Google Scholar
15. Stewart, CP, Iannotti, L, Dewey, KG, Michaelsen, KF, Onyango, AW. Contextualising complementary feeding in a broader framework for stunting prevention. Matern Child Nutr. 2013; 9(S2), 27–45.CrossRefGoogle Scholar
16. International Food Policy Research Institute. Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030. 2016, IFPRI, Washington, DC: http://dx.doi.org/10.2499/9780896295841.Google Scholar
17. Richter, L, Norris, S, Pettifor, J, Yach, D, Cameron, N. Cohort profile: Mandela’s children: The 1990 Birth to Twenty study in South Africa. Int J Epidemiol. 2007; 36, 504–511.CrossRefGoogle ScholarPubMed
18. Norris, SA, Richter, LM, Fleetwood, SA. Panel studies in developing countries: case analysis of sample attrition over the past 16 years within the Birth to Twenty cohort in Johannesburg, South Africa. J Int Dev. 2007; 19, 1143–1150.CrossRefGoogle Scholar
19. Sheppard, ZA, Norris, SA, Pettifor, JM, Cameron, N, Griffiths, PL. Approaches for assessing the role of household socioeconomic status on child anthropometric measures in urban South Africa. Am J Hum Biol. 2009; 21, 48–54.CrossRefGoogle ScholarPubMed
20. Pitt, B. ‘ Atypical’ depression following childbirth. Br J Psychiatry. 1968; 114, 1325–1335.CrossRefGoogle ScholarPubMed
21. Verkuijl, NE, Richter, L, Norris, SA, et al. Postnatal depressive symptoms and child psychological development at 10 years: a prospective study of longitudinal data from the South African Birth to Twenty cohort. Lancet Psychiatry. 2014; 1, 454–460.Google Scholar
22. Wamani, H, Astrom, AN, Peterson, S, Tumwine, JK, Tylleskar, T. Boys are more stunted than girls in sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys. BMC Pediatr. 2007; 7, 1.Google Scholar
23. Crognier, E, Baali, A, Hilali, MK, Villena, M, Vargas, E. Preference for sons and sex ratio in two non‐western societies. Am J Hum Biol. 2006; 18, 325–334.CrossRefGoogle ScholarPubMed
24. Leslie, J, Ciemins, E, Essama, SB. Female nutritional status across the life-span in sub-Saharan Africa. Food Nutr Bull. 1997; 18, 20–43.Google Scholar
25. Sandman, CA, Glynn, LM, Davis, EP. Is there a viability–vulnerability tradeoff? Sex differences in fetal programming. J Psychosom Res. 2013; 75, 327–335.Google Scholar
26. Tanner, JM, Tanner, JM. Foetus Into Man: Physical Growth From Conception to Maturity. 1990. Harvard University Press: Cambridge MA.Google Scholar
27. Eriksson, JG, Kajantie, E, Osmond, C, Thornburg, K, Barker, DJ. Boys live dangerously in the womb. Am J Hum Biol. 2010; 22, 330–335.Google Scholar
28. Stinson, S. Sex differences in environmental sensitivity during growth and development. Am J Phys Anthropol. 1985; 28(S6), 123–147.CrossRefGoogle Scholar
29. Monden, CW, Smits, J. Maternal education is associated with reduced female disadvantages in under-five mortality in sub-Saharan Africa and southern Asia. Int J Epidemiol. 2013; 42, 211–218.Google Scholar
30. Abuya, BA, Ciera, J, Kimani-Murage, E. Effect of mother’s education on child’s nutritional status in the slums of Nairobi. BMC Pediatr. 2012; 12, 1–10.Google Scholar
31. Stein, AD, Wang, M, Martorell, R, et al. Growth patterns in early childhood and final attained stature: data from five birth cohorts from low‐and middle‐income countries. Am J Hum Biol. 2010; 22, 353–359.Google Scholar
32. Martorell, R, Zongrone, A. Intergenerational influences on child growth and undernutrition. Paediatr Perinat Epidemiol. 2012; 26(S1), 302–314.CrossRefGoogle ScholarPubMed
33. Avan, B, Richter, LM, Ramchandani, PG, Norris, SA, Stein, A. Maternal postnatal depression and children’s growth and behaviour during the early years of life: exploring the interaction between physical and mental health. Arch Dis Child. 2010; 95, 690–695.CrossRefGoogle ScholarPubMed
34. Surkan, PJ, Kennedy, CE, Hurley, KM, Black, MM. Maternal depression and early childhood growth in developing countries: systematic review and meta-analysis. Bull World Health Organ. 2011; 89, 607–615.CrossRefGoogle ScholarPubMed
35. Rahman, A, Iqbal, Z, Bunn, J, Lovel, H, Harrington, R. Impact of maternal depression on infant nutritional status and illness: a cohort study. Arch Gen Psychiatry. 2004; 61, 946–952.Google Scholar
36. Tomlinson, M, Cooper, PJ, Stein, A, Swartz, L, Molteno, C. Post-partum depression and infant growth in a South African peri-urban settlement. Child Care Health Dev. 2006; 32, 81–86.Google Scholar
37. Shapiro-Mendoza, C, Selwyn, BJ, Smith, DP, Sanderson, M. Parental pregnancy intention and early childhood stunting: findings from Bolivia. Int J Epidemiol. 2005; 34, 387–396.Google Scholar
38. Singh, A, Chalasani, S, Koenig, MA, Mahapatra, B. The consequences of unintended births for maternal and child health in India. Popul Stud. 2012; 66, 223–239.CrossRefGoogle ScholarPubMed
39. Marston, C, Cleland, J. Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Popul Stud. 2003; 57, 77–93.Google Scholar
40. Gitau, TM. The association between post-weaning dietary patterns at age 1 and growth at age 2, from the Birth-to-Twenty cohort study, PhD thesis, University of the Witwatersrand, Johannesburg. 2010. Retrieved 23 March 2016 from Wits Institutional Repository Environment on Dspace.Google Scholar
41. De Onis, M, Blössner, M, Borghi, E. Prevalence and trends of stunting among pre-school children, 1990–2020. Public Health Nutr. 2012; 15, 142–148.Google Scholar
42. Said-Mohamed, R, Micklesfield, LK, Pettifor, JM, Norris, SA. Has the prevalence of stunting in South African children changed in 40 years? A systematic review. BMC Public Health. 2015; 15, 1.CrossRefGoogle ScholarPubMed
43. Shisana, O, Rehle, T, Simabyi, L, et al. The South African National Health and Nutrition Examination Survey: SANHANES-1. 2013. HSRC Press: Cape Town.Google Scholar
44. Bhutta, ZA, Das, JK, Rizvi, A, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013; 382, 452–477.CrossRefGoogle ScholarPubMed
45. Monteiro, CA, Benicio, MHDA, Conde, WL, et al. Narrowing socioeconomic inequality in child stunting: the Brazilian experience, 1974-2007. Bull World Health Organ. 2010; 88, 305–311.Google Scholar
46. Bateman, C. A dance of empowerment-lessons for the NHI? S Afr Med J. 2012; 102, 64–66.Google Scholar
47. Johri, M, Subramanian, S, Koné, GK, et al. Maternal health literacy is associated with early childhood nutritional status in India. J Nutr. 2016; 146, 1402–1410.Google Scholar
48. Bassett, L. Can conditional cash transfer programs play a greater role in reducing child undernutrition, Discussion Paper No.0835, World Bank, Washignton, DC, 2008.Google Scholar