Mapping child growth failure across low- and middle-income countries

Kinyoki, D.K. and Osgood-Zimmerman, A.E. and Pickering, B.V. and Schaeffer, L.E. and Marczak, L.B. and Lazzar-Atwood, A. and Collison, M.L. and Henry, N.J. and Abebe, Z. and Adamu, A.A. and Adekanmbi, V. and Ahmadi, K. and Ajumobi, O. and Al-Eyadhy, A. and Al-Raddadi, R.M. and Alahdab, F. and Alijanzadeh, M. and Alipour, V. and Altirkawi, K. and Amini, S. and Andrei, C.L. and Antonio, C.A.T. and Arabloo, J. and Aremu, O. and Asadi-Aliabadi, M. and Atique, S. and Ausloos, M. and Avila, M. and Awasthi, A. and Quintanilla, B.P.A. and Azari, S. and Badawi, A. and Bärnighausen, T.W. and Bassat, Q. and Baye, K. and Bedi, N. and Bekele, B.B. and Bell, M.L. and Bhattacharjee, N.V. and Bhattacharyya, K. and Bhattarai, S. and Bhutta, Z.A. and Biadgo, B. and Bikbov, B. and Briko, A.N. and Britton, G. and Burstein, R. and Butt, Z.A. and Car, J. and Castañeda-Orjuela, C.A. and Castro, F. and Cerin, E. and Chipeta, M.G. and Chu, D.-T. and Cork, M.A. and Cromwell, E.A. and Cuevas-Nasu, L. and Dandona, L. and Dandona, R. and Daoud, F. and Gupta, R.D. and Weaver, N.D. and Leo, D.D. and Neve, J.-W.D. and Deribe, K. and Desalegn, B.B. and Deshpande, A. and Desta, M. and Diaz, D. and Dinberu, M.T. and Doku, D.T. and Dubey, M. and Durães, A.R. and Dwyer-Lindgren, L. and Earl, L. and Effiong, A. and Zaki, M.E.S. and Tantawi, M.E. and El-Khatib, Z. and Eshrati, B. and Fareed, M. and Faro, A. and Fereshtehnejad, S.-M. and Filip, I. and Fischer, F. and Foigt, N.A. and Folayan, M.O. and Fukumoto, T. and Gebrehiwot, T.T. and Gezae, K.E. and Ghajar, A. and Gill, P.S. and Gona, P.N. and Gopalani, S.V. and Grada, A. and Guo, Y. and Haj-Mirzaian, A. and Haj-Mirzaian, A. and Hall, J.B. and Hamidi, S. and Henok, A. and Prado, B.H. and Herrero, M. and Herteliu, C. and Hoang, C.L. and Hole, M.K. and Hossain, N. and Hosseinzadeh, M. and Hu, G. and Islam, S.M.S. and Jakovljevic, M. and Jha, R.P. and Jonas, J.B. and Jozwiak, J.J. and Kahsay, A. and Kanchan, T. and Karami, M. and Kasaeian, A. and Khader, Y.S. and Khan, E.A. and Khater, M.M. and Kim, Y.J. and Kimokoti, R.W. and Kisa, A. and Kochhar, S. and Kosen, S. and Koyanagi, A. and Krishan, K. and Defo, B.K. and Kumar, G.A. and Kumar, M. and Lad, S.D. and Lami, F.H. and Lee, P.H. and Levine, A.J. and Li, S. and Linn, S. and Lodha, R. and El Razek, H.M.A. and Abd El Razek, M.M. and Majdan, M. and Majeed, A. and Malekzadeh, R. and Malta, D.C. and Mamun, A.A. and Mansournia, M.A. and Martins-Melo, F.R. and Masaka, A. and Massenburg, B.B. and Mayala, B.K. and Mejia-Rodriguez, F. and Melku, M. and Mendoza, W. and Mensah, G.A. and Miazgowski, T. and Miller, T.R. and Mini, G.K. and Mirrakhimov, E.M. and Moazen, B. and Darwesh, A.M. and Mohammed, S. and Mohebi, F. and Mokdad, A.H. and Moodley, Y. and Moradi, G. and Moradi-Lakeh, M. and Moraga, P. and Morrison, S.D. and Mosser, J.F. and Mousavi, S.M. and Mueller, U.O. and Murray, C.J.L. and Mustafa, G. and Naderi, M. and Naghavi, M. and Najafi, F. and Nangia, V. and Ndwandwe, D.E. and Negoi, I. and Ngunjiri, J.W. and Nguyen, H.L.T. and Nguyen, L.H. and Nguyen, S.H. and Nie, J. and Nnaji, C.A. and Noubiap, J.J. and Shiadeh, M.N. and Nyasulu, P.S. and Ogbo, F.A. and Olagunju, A.T. and Olusanya, B.O. and Olusanya, J.O. and Ortiz-Panozo, E. and Otstavnov, S.S. and P. A, M. and Pana, A. and Pandey, A. and Pati, S. and Patil, S.T. and Patton, G.C. and Perico, N. and Pigott, D.M. and Pirsaheb, M. and Piwoz, E.G. and Postma, M.J. and Pourshams, A. and Prakash, S. and Quintana, H. and Radfar, A. and Rafiei, A. and Rahimi-Movaghar, V. and Rai, R.K. and Rajati, F. and Rawaf, D.L. and Rawaf, S. and Rawat, R. and Remuzzi, G. and Renzaho, A.M.N. and Rios-González, C. and Roever, L. and Ross, J.M. and Rostami, A. and Sadat, N. and Safari, Y. and Safdarian, M. and Sahebkar, A. and Salam, N. and Salamati, P. and Salimi, Y. and Salimzadeh, H. and Samy, A.M. and Sartorius, B. and Sathian, B. and Schipp, M.F. and Schwebel, D.C. and Senbeta, A.M. and Sepanlou, S.G. and Shaikh, M.A. and Levy, T.S. and Shamsi, M. and Sharafi, K. and Sharma, R. and Sheikh, A. and Shil, A. and Silva, D.A.S. and Singh, J.A. and Sinha, D.N. and Soofi, M. and Sudaryanto, A. and Sufiyan, M.B. and Tabarés-Seisdedos, R. and Tadesse, B.T. and Temsah, M.-H. and Terkawi, A.S. and Tessema, Z.T. and Thorne-Lyman, A.L. and Tovani-Palone, M.R. and Tran, B.X. and Tran, K.B. and Ullah, I. and Uthman, O.A. and Vaezghasemi, M. and Vaezi, A. and Valdez, P.R. and Vanderheide, J. and Veisani, Y. and Violante, F.S. and Vlassov, V. and Vu, G.T. and Vu, L.G. and Waheed, Y. and Walson, J.L. and Wang, Y. and Wang, Y.-P. and Wangia, E.N. and Werdecker, A. and Xu, G. and Yamada, T. and Yisma, E. and Yonemoto, N. and Younis, M.Z. and Yousefifard, M. and Yu, C. and Zaman, S.B. and Zamani, M. and Zhang, Y. and Kassebaum, N.J. and Hay, S.I. and of Disease Child Growth Failure Collaborators, Local Burden (2020) Mapping child growth failure across low- and middle-income countries. Nature, 577 (7789). pp. 231-234.

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Abstract

Childhood malnutrition is associated with high morbidity and mortality globally1. Undernourished children are more likely to experience cognitive, physical, and metabolic developmental impairments that can lead to later cardiovascular disease, reduced intellectual ability and school attainment, and reduced economic productivity in adulthood2. Child growth failure (CGF), expressed as stunting, wasting, and underweight in children under five years of age (0�59 months), is a specific subset of undernutrition characterized by insufficient height or weight against age-specific growth reference standards3�5. The prevalence of stunting, wasting, or underweight in children under five is the proportion of children with a height-for-age, weight-for-height, or weight-for-age z-score, respectively, that is more than two standard deviations below the World Health Organization�s median growth reference standards for a healthy population6. Subnational estimates of CGF report substantial heterogeneity within countries, but are available primarily at the first administrative level (for example, states or provinces)7; the uneven geographical distribution of CGF has motivated further calls for assessments that can match the local scale of many public health programmes8. Building from our previous work mapping CGF in Africa9, here we provide the first, to our knowledge, mapped high-spatial-resolution estimates of CGF indicators from 2000 to 2017 across 105 low- and middle-income countries (LMICs), where 99 of affected children live1, aggregated to policy-relevant first and second (for example, districts or counties) administrative-level units and national levels. Despite remarkable declines over the study period, many LMICs remain far from the ambitious World Health Organization Global Nutrition Targets to reduce stunting by 40 and wasting to less than 5 by 2025. Large disparities in prevalence and progress exist across and within countries; our maps identify high-prevalence areas even within nations otherwise succeeding in reducing overall CGF prevalence. By highlighting where the highest-need populations reside, these geospatial estimates can support policy-makers in planning interventions that are adapted locally and in efficiently directing resources towards reducing CGF and its health implications. © 2020, The Author(s).

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