Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level

Chunling Lu, Maureen M Black, Linda M Richter, Chunling Lu, Maureen M Black, Linda M Richter

Abstract

Background: A 2007 study published in The Lancet estimated that approximately 219 million children aged younger than 5 years were exposed to stunting or extreme poverty in 2004. We updated the 2004 estimates with the use of improved data and methods and generated estimates for 2010.

Methods: We used country-level prevalence of stunting in children younger than 5 years based on the 2006 Growth Standards proposed by WHO and poverty ratios from the World Bank to estimate children who were either stunted or lived in extreme poverty for 141 low-income and middle-income countries in 2004 and 2010. To avoid counting the same children twice, we excluded children jointly exposed to stunting and extreme poverty from children living in extreme poverty. To examine the robustness of estimates, we also used moderate poverty measures.

Findings: The 2007 study underestimated children at risk of poor development. The estimated number of children exposed to the two risk factors in low-income and middle-income countries decreased from 279·1 million (95% CI 250·4 million-307·4 million) in 2004 to 249·4 million (209·3 million-292·6 million) in 2010; prevalence of children at risk fell from 51% (95% CI 46-56) to 43% (36-51). The decline occurred in all income groups and regions with south Asia experiencing the largest drop. Sub-Saharan Africa had the highest prevalence in both years. These findings were robust to variations in poverty measures.

Interpretation: Progress has been made in reducing the number of children exposed to stunting or poverty between 2004 and 2010, but this is still not enough. Scaling up of effective interventions targeting the most vulnerable children is urgently needed.

Funding: National Institutes of Health, Bill & Melinda Gates Foundation, Hilton Foundation, and WHO.

Conflict of interest statement

Declaration of interests

We declare no competing interests.

Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Number of children exposed to stunting or extreme poverty by country income group
Figure 2
Figure 2
Prevalence of children at risk of poor development by country income group in 2004 and 2010 using extreme and moderate poverty measures
Figure 3
Figure 3
Country-level percentage of children younger than 5 years at risk of poor development in 141 countries (A) Reduction between 2004 and 2010. (B) Prevalence in 2010.

References

    1. Shonkoff J, Richter L, Van Der Gaag J, Bhutta Z. An integrated scientific framework for child survival and early childhood development. Pediatrics. 2012;129:e460–72.
    1. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B. Developmental potential in the first 5 years for children in developing countries. Lancet. 2007;369:60–70.
    1. Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet. 2008;371:411–16.
    1. Victora CG, Adair L, Fall C, et al. for the Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371:340–57.
    1. 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;22:353–59.
    1. Chang SM, Walker SP, Grantham-McGregor S, Powell CA. Early childhood stunting and later behaviour and school achievement. J Child Psychol Psychiatry. 2002;43:775–83.
    1. Adair LS, Fall CH, Osmond C, et al. Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income countries: findings from five birth cohort studies. Lancet. 2013;382:525–34.
    1. Hoddinott J, Behrman JR, Maluccio JA, et al. Adult consequences of growth failure in early childhood. Am J Clin Nutr. 2013;98:1170–78.
    1. Denboba A, Sayre RK, Wodon Q, Elder L, Rawlings L, Lombardi J. Stepping up early childhood development: investing in young children with high returns. Washington, DC: The World Bank; 2014.
    1. Gertler P, Heckman J, Pinto R, et al. Labor market returns to an early childhood stimulation intervention in Jamaica. Science. 2014;1014:998–1001.
    1. WHO, Multicentre Growth Reference Study Group. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: World Health Organization; 2006.
    1. Chen S, Ravallion M. The developing world is poorer than we thought, but no less successful in the fight against poverty. Q J Econ. 2010;125:1577–625.
    1. Chen S, Ravallion M. How have the world’s poorest fared since the early 1980s? World Bank Res Obs. 2004;19:141–70.
    1. World Bank. [accessed Sept 6, 2014];World Bank list of economies. 2011 Jan; .
    1. World Bank. [accessed Sept 29, 2014];Poverty headcount ratio at $1·90 a day (2011 PPP) (% of population) . DDAY.
    1. Stevens GA, Finucane MM, Paciorek CJ, et al. Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data. Lancet. 2012;380:824–34.
    1. Olinto P, Beegle K, Sobrado C, Uematsu H. The state of the poor: where are the poor, where is extreme poverty harder to end, and what is the current profile of the world’s poor? Washington, DC: World Bank; 2013.
    1. United States Agency for International Development. [accessed Sept 6, 2014];Demographic and Health Surveys, data.
    1. UNICEF. [accessed Oct 8, 2014];Multiple indicator cluster surveys. 2014 .
    1. Walker SP, Wachs TD, Gardner JM, et al. Child development: risk factors for adverse outcomes in developing countries. Lancet. 2007;369:145–57.
    1. Carvalho L. Childhood circumstances and the intergenerational transmission of socioeconomic status. Demography. 2012;49:913–38.
    1. Child Protection Monitoring and Evaluation Reference Group. [accessed Sept 6, 2014];Measuring violence against children: inventory and assessment of quantitative studies. 2014 .
    1. Stoltenborgh M, Bakermans-Kranenburg MJ, Alink Lenneke RA, IJzendoorn MH. The prevalence of child maltreatment across the globe: review of a series of meta-analyses. Child Abuse Rev. 2015;24.1:37–50.
    1. Evans G, Li D, Sepanski WS. Cumulative risks and child development. Psychol Bull. 2013;139:1342–96.
    1. Richter LM, Darmstadt G, Daelmans B, et al. with the Paper 3 Working Group, for the Lancet Early Childhood Development Series Steering Committee Investing in the foundation of sustainable development: pathways to scale up for early childhood development. Lancet. 2016 published online Oct 4. .
    1. Engle PL, Fernald LC, Alderman H, et al. Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries. Lancet. 2011;378:1339–53.
    1. 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;382:452–77.
    1. Bhutta ZA, Das JK, Rizvi A, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384:347–70.
    1. Ruel MT, Alderman H, the Maternal and Child Nutrition Study Group Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet. 2013;382:536–51.
    1. Lassi ZS, Das JK, Salam RA, Bhutta ZA. Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings. Reprod Health. 2014;11(suppl 2):S2.

Source: PubMed

3
Abonnere