Early life risk exposure and stunting in urban South African 2-year old children.
Stunting is a measure of overall nutritional status and is a major public health concern because of its association with child mortality and morbidity and later adult performance. This study examined the effects of pregnancy events, birth characteristics and infant risk exposure on stunting at age 2 years. The study, established in 1990 in Soweto, an urban South African township, included 1098 mother-infant pairs enroled in the Birth to Twenty Plus longitudinal birth cohort study. In total, 22% of children were stunted at age 2 years, with males at greater risk than females [24.8 v. 19.4%, odds ratio (OR)=1.38; 95% confidence interval (CI): 1.03, 1.83]. In unadjusted analysis, male sex, household socio-economic status (SES), overcrowding, maternal age, maternal education, single motherhood, ethnicity, birth weight, gestational age and duration of infant breastfeeding were all significantly associated with stunting. In multivariable analysis, higher birth weight was protective against stunting for both sexes. Higher maternal education was protective for females only (adjusted odds ratio (AOR)=0.35; 95% CI: 0.14, 0.87), whereas wealthier household SES protected males (AOR for richest SES group=0.39; 95% CI: 0.16, 0.92). In this and other similar settings, current stunting prevention efforts focussing on primarily providing targeted proximal interventions, such as food supplements, risk undermining the critical importance of addressing key distal determinants of stunting such as SES and maternal education.
1Division of Community Paediatrics,Department of Paediatrics and Child Health,University of the Witwatersrand,Johannesburg,South Africa.
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Slemming
2MRC/Wits Developmental Pathways for Health Research Unit,Department of Paediatrics and Child Health,University of the Witwatersrand,Johannesburg,South Africa.
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J
Kagura
1Division of Community Paediatrics,Department of Paediatrics and Child Health,University of the Witwatersrand,Johannesburg,South Africa.
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H
Saloojee
3DST-NRF Centre of Excellence in Human Development,University of the Witwatersrand,Johannesburg,South Africa.
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LM
Richter
D000328:Adult; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006130:Growth Disorders / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009752:Nutritional Status / Q000502:physiology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult
South Africa; child; growth; sex; stunting