Multiple anthropometric failures and early child development in 34 low- and middle-income countries

Abstract

Background: Child stunting is negatively associated with early child development (ECD) outcomes. However, less is known regarding the associations between multiple co-occurring anthropometric failures and ECD. The objective of this study was to determine the association between categories of anthropometric failures (CAF)—disaggregating single, double, and triple failures—with ECD among children in lowand middle-income countries (LMICs). Methods: We combined data from the Multiple Indicator Cluster Surveys for 98,189 children aged 36–59 months in 34 LMICs. Height-for-age, weight-for-height, and weight-for-age were calculated using the 2006 World Health Organization growth standards. Children were classified into 7 mutually exclusive categories: no deficits; stunted only; wasted only; underweight only; stunted and underweight but not wasted; wasted and underweight but not stunted; and stunted, wasted, and underweight. ECD was measured using the Early Childhood Development Index (ECDI), an index of cognitive, literacy-numeracy, socioemotional, and physical development milestones for preschool-aged children. We used multivariable linear regression models to estimate the association between CAF and ECDI z-scores. Results: Overall, 20.4% of children had a single failure (17.9% stunted only, 1.0% wasted only, and 1.5% underweight only), 13.7% had double failures (12.0% stunted and underweight, 1.7% wasted and underweight), and 1.5% had triple failures. Compared to children with no deficits, children with a single failure of stunting only (β = −0.08; 95% confidence interval [CI], −0.10 to −0.07), double failure of stunting and underweight (β = −0.17; 95% CI, −0.19 to −0.15), and triple failure of stunting, wasting, and underweight (β = −0.15; 95% CI, −0.20 to −0.10) were associated with statistically significant lower ECDI z-scores. Conclusion: We found a potentially additive relationship between multiple anthropometric failures and ECD. Findings highlight the importance of integrated interventions that support mild to severe malnutrition as a key component of nurturing care approaches to improve ECD in LMICs.