title: Using growth velocity to predict child mortality.
abstract: BACKGROUND
  Growth assessment based on the WHO child growth velocity standards can potentially be used to predict adverse health outcomes. Nevertheless, there are very few studies on growth velocity to predict mortality.
  
  
  OBJECTIVE
  We aimed to determine the ability of various growth velocity measures to predict child death within 3 mo and to compare it with those of attained growth measures.
  
  
  METHODS
  Data from 5657 children <5 y old who were enrolled in a cohort study in the Democratic Republic of Congo were used. Children were measured up to 6 times in 3-mo intervals, and 246 (4.3%) children died during the study period. Generalized estimating equation (GEE) models informed the mortality risk within 3 mo for weight and length velocity z scores and 3-mo changes in midupper arm circumference (MUAC). We used receiver operating characteristic (ROC) curves to present balance in sensitivity and specificity to predict child death.
  
  
  RESULTS
  GEE models showed that children had an exponential increase in the risk of dying with decreasing growth velocity in all 4 indexes (1.2- to 2.4-fold for every unit decrease). A length and weight velocity z score of <-3 was associated with an 11.8- and a 7.9-fold increase, respectively, in the RR of death in the subsequent 3-mo period (95% CIs: 3.9, 35.5, and 3.9, 16.2, respectively). Weight and length velocity z scores had better predictive abilities [area under the ROC curves (AUCs) of 0.67 and 0.69] than did weight-for-age (AUC: 0.57) and length-for-age (AUC: 0.52) z scores. Among wasted children (weight-for-height z score <-2), the AUC of weight velocity z scores was 0.87. Absolute MUAC performed best among the attained indexes (AUC: 0.63), but longitudinal assessment of MUAC-based indexes did not increase the predictive value.
  
  
  CONCLUSIONS
  Although repeated growth measures are slightly more complex to implement, their superiority in mortality-predictive abilities suggests that these could be used more for identifying children at increased risk of death.
authors: Center for International Health, Department of Global Public Health and Primary Care, and c.schwinger@uib.no.
authors: Catherine
authors: C
authors: Schwinger
authors: Center for International Health, Department of Global Public Health and Primary Care, and Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
authors: Lars T
authors: http://orcid.org/0000-0001-8757-2092
authors: LT
authors: Fadnes
authors: Center for International Health, Department of Global Public Health and Primary Care, and.
authors: Jan
authors: J
authors: Van den Broeck
mesh_terms: D000886:Anthropometry; D019540:Area Under Curve; D001837:Body Weights and Measures; D046688:Child Mortality; D002675:Child, Preschool; D015331:Cohort Studies; D015023:Democratic Republic of the Congo; D005260:Female; D006128:Growth; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008954:Models, Biological; D012372:ROC Curve; D019282:Wasting Syndrome / Q000401:mortality
keywords: WHO growth velocity standards; anthropometry; longitudinal growth; mortality; prediction