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  • Title: Age-specific determinants of stunting in Filipino children.
    Author: Adair LS, Guilkey DK.
    Journal: J Nutr; 1997 Feb; 127(2):314-20. PubMed ID: 9039833.
    Abstract:
    This study identifies age-specific factors related to new cases of stunting that develop in Filipino children from birth to 24 mo of age. Data come from nearly 3000 participants in the Cebu Longitudinal Health and Nutrition Survey, a community-based study conducted from 1983 to 1995. Length, morbidity, feeding and health-related data were collected bimonthly during home visits. Stunting (length >2 SD below the WHO age- and sex-specific medians) occurred in 69% of rural and 60% of urban children by 24 mo of age. We used a multivariate discrete time hazard model to estimate the likelihood of becoming stunted in each 2-mo interval. The likelihood of stunting was significantly increased by diarrhea, febrile respiratory infections, early supplemental feeding and low birth weight. The effect of birth weight was strongest in the first year. Breast-feeding, preventive health care and taller maternal stature significantly decreased the likelihood of stunting. Males were more likely to become stunted in the first year, whereas females were more likely to become stunted in the second year of life. Because stunting is strongly related to poor functional outcomes such as impaired intellectual development during childhood, and to short stature in adulthood, these results emphasize the need for prevention of growth retardation through promotion of prenatal care and breast-feeding, as well as control of infectious diseases. The age-specific factors related to new cases of stunting that developed in Filipino children from birth to 24 months of age were identified. The initial cohort included all pregnant women who gave birth during 1983-1984. Data were derived from the Cebu Longitudinal Health and Nutrition Survey conducted from 1983 to 1995. 3080 single live births were followed bimonthly for 24 months and then revisited in 1991 and 1995. Length, morbidity, feeding and health-related data were collected bimonthly during home visits. Stunting (length 2 months below the World Health Organization's age- and sex-specific medians) occurred in 69% of rural and 60% of urban children by 24 months of age. A multivariate discrete time hazard model was used to estimate the likelihood of becoming stunted in each 2-month interval, analyzing the data of 2859 infants with length data at 2 months of age. By 12 months of age, 37.7% of rural and 35.1% of urban children were stunted. By 24 months, 68.8% of rural and 61.9% of urban children were stunted. The likelihood of stunting was significantly increased by diarrhea, febrile respiratory infections, early supplemental feeding, and low birth weight ( 2500 g). The effect of birth weight was strongest in the first year. The likelihood of stunting was dramatically higher for low-birth-weight infants throughout the first 2 years. Breast-feeding, preventive health care (maternal education and immunization) and taller maternal stature decreased the likelihood of stunting. Males were more likely to become stunted in the first year, whereas females were more likely to become stunted in the second year of life. The combined effects of morbidity and feeding showed at 12 months the likelihood of stunting of 0.25 for the low morbidity, optimal feeding group, whereas it was 0.51 in the high morbidity, inappropriately fed group. The prevention of growth retardation through the promotion of prenatal care and breast-feeding as well as the control of infectious diseases is stressed.
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