title: Schooling and wage income losses due to early-childhood growth faltering in developing countries: national, regional, and global estimates.
abstract: The growth of >300 million children <5 y old was mildly, moderately, or severely stunted worldwide in 2010. However, national estimates of the human capital and financial losses due to growth faltering in early childhood are not available.
  
  
  
  We quantified the economic cost of growth faltering in developing countries.
  
  
  
  We combined the most recent country-level estimates of linear growth delays from the Nutrition Impact Model Study with estimates of returns to education in developing countries to estimate the impact of early-life growth faltering on educational attainment and future incomes. Primary outcomes were total years of educational attainment lost as well as the net present value of future wage earnings lost per child and birth cohort due to growth faltering in 137 developing countries. Bootstrapped standard errors were computed to account for uncertainty in modeling inputs.
  
  
  
  Our estimates suggest that early-life growth faltering in developing countries caused a total loss of 69.4 million y of educational attainment (95% CI: 41.7 million, 92.6 million y) per birth cohort. Educational attainment losses were largest in South Asia (27.6 million y; 95% CI: 20.0 million, 35.8 million y) as well as in Eastern (10.3 million y; 95% CI: 7.2 million, 12.9 million y) and Western sub-Saharan Africa (8.8 million y; 95% CI: 6.4 million, 11.5 million y). Globally, growth faltering in developing countries caused a total economic cost of $176.8 billion (95% CI: $100.9 billion, $262.6 billion)/birth cohort at nominal exchange rates, and $616.5 billion (95% CI: $365.3 billion, $898.9 billion) at purchasing power parity-adjusted exchange rates. At the regional level, economic costs were largest in South Asia ($46.6 billion; 95% CI: $33.3 billion, $61.1 billion), followed by Latin America ($44.7 billion; 95% CI: $19.2 billion, $74.6 billion) and sub-Saharan Africa ($34.2 billion; 95% CI: $24.4 billion, $45.3 billion).
  
  
  
  Our results indicate that the annual cost of early-childhood growth faltering is substantial. Further investment in scaling up effective interventions in this area is urgently needed and likely to yield long run benefits of $3 for every $1 invested.
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA; gfink@hsph.harvard.edu.
authors.forename: Günther
authors.initials: G
authors.lastname: Fink
authors.affiliation: Rand Corporation, Santa Monica, CA;
authors.forename: Evan
authors.initials: E
authors.lastname: Peet
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA;
authors.forename: Goodarz
authors.initials: G
authors.lastname: Danaei
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA;
authors.forename: Kathryn
authors.initials: K
authors.lastname: Andrews
authors.affiliation: Harvard Graduate School of Education, Cambridge, MA;
authors.forename: Dana Charles
authors.initials: DC
authors.lastname: McCoy
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA;
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Sudfeld
authors.affiliation: Harvard Medical School, Boston, MA; and.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Smith Fawzi
authors.affiliation: MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA;
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D001208:Asia; D002675:Child, Preschool; D017281:Cost of Illness; D003906:Developing Countries; D004493:Education; D004522:Educational Status; D014943:Global Health; D006128:Growth; D006130:Growth Disorders / Q000191:economics*; D006801:Humans; D007182:Income; D007223:Infant; D007843:Latin America; D012456:Salaries and Fringe Benefits
keywords: child nutrition; developmental potential; educational attainment; global estimates; growth faltering