Exploring the relationships between wasting and stunting among a cohort of children under two years of age in Niger

Kristin Kohlmann, Christopher R Sudfeld, Souna Garba, Ousmane Guindo, Rebecca F Grais, Sheila Isanaka, Kristin Kohlmann, Christopher R Sudfeld, Souna Garba, Ousmane Guindo, Rebecca F Grais, Sheila Isanaka

Abstract

Background: Wasting and stunting, physical growth manifestations of child undernutrition, have historically been considered separately with distinct interventions at the program, policy, and financing levels despite similar risk factors, overlapping burdens and multiplicative risk of death when the conditions are concurrent. The aim of this study was to elucidate shared risk factors and the temporal relationship between wasting and stunting among children under 2 years of age in rural Niger.

Methods: From August 2014 to December 2019, anthropometric data were collected every 4 weeks from 6 to 8 weeks to 24 months of age for 6567 children comprising 139,529 visits in Madarounfa, Niger. Children were defined as wasted if they had a weight-for-length Z-score < - 2 and stunted if they had a length-for-age Z-score < - 2 using the 2006 World Health Organization child growth standards. Parental, child, and socioeconomic risk factors for wasting and stunting at 6 and 24 months of age and the relationship between episodes of wasting, stunting and concurrent wasting-stunting were assessed using general estimating equations.

Results: Half of children (50%) were female, and 8.3% were born low birthweight (< 2500 g). Overall, at 24 months of age, 14% of children were wasted, 80% were stunted and 12% were concurrently wasted-stunted. We found that maternal short stature, male sex, and low birthweight were risk factors for wasting and stunting at 6 and 24 months, whereas higher maternal body mass index and household wealth were protective factors. Wasting at 6 and 24 months was predicted by a prior episodes of wasting, stunting, and concurrent wasting-stunting. Stunting at 6 and 24 months was similarly predicted by prior episodes of stunting and concurrent wasting-stunting at any prior age but only by prior episodes of wasting after 6 months of age.

Conclusions: These data support a complex and dynamic bi-directional relationship between wasting and stunting in young children in rural Niger and an important burden of concurrent wasting-stunting in this setting. Further research to better understand the inter-relationships and mechanisms between these two conditions is needed in order to develop and target interventions to promote child growth.

Trial registration: ClinicalTrials.gov Identifier: NCT02145000 .

Keywords: Child; Concurrence; Growth; Niger; Stunting; Undernutrition; Wasting.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Wasting, stunting and concurrent wasting-stunting prevalence from 6 to 8 weeks up to 24 months of age. Panel A depicts growth outcomes of the entire study population. Panel B depicts growth outcomes by low birthweight status for the sub-sample of children with birthweight data. WHO growth standards (2006) were used to calculate Weight-for-Length Z-score (WLZ) and Length-for-Age Z-score (LAZ) for ages 1 to 24 months. Wasting was defined as WLZ 

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