Child stunting from birth to age two years: The Birhan Cohort in Ethiopia

ABSTRACT Objective Although there has been a reduction in stunting (low height/length for age), the prevalence of malnutrition in Ethiopia is still high. Child growth patterns and estimates of stunting are needed to determine vulnerabilities and potential for recovery. We collected longitudinal data to determine the prevalence, incidence and reversal of stunting among children aged 0-24 months. Methods We conducted a cohort study of 4,354 children between December 2018 and November 2020 in the Birhan maternal and child health cohort in North Shewa Zone, Amhara Ethiopia. Children who had their length measured at least once were included in this study. Results Among the 4,354 children enrolled, 3,674 (84.4%) were included. Our findings indicate that median population-level length is consistently below global standards from birth to age two. Growth velocity was slowest compared to global standards during the neonatal period and after children reached six months of age. The observed prevalence of stunting was highest at age two (57.9%). Incidence of stunting increased over time and reversal was highest between the ages of birth to six months. We found substantial heterogeneity in anthropometric measurements, which we addressed by fitting modeled growth trajectories for each child. Conclusion Overall, the evidence from this study highlights a chronically malnourished population with much of the burden driven by growth faltering during the neonatal periods as well as after 6 months of age. To end all forms of malnutrition, growth faltering in populations such as that in young children in Amhara, Ethiopia needs to be addressed. Article Summary Through longitudinal anthropometry data from birth to two years of age, we provide rigorous evidence on the burden, incidence and reversal pattern of childhood stunting. What is Known on This Subject There is a high prevalence of childhood stunting in Ethiopia. Prior studies show high spatial heterogeneity with highest prevalence in the Amhara region. Ethiopia aims to reduce stunting in children under 5 to meet global targets but remains off track. What This Study Adds We provide longitudinal data and modeled trajectories to describe patterns of linear growth and onset of growth faltering or recovery. The evidence generated serves as critical input to meet national and global targets of ending malnutrition. Contributors Statement Page Dr Frederick G. B. Goddard conceptualized and designed the study, curated the data, carried out the initial analyses and interpretation of data, drafted the manuscript and critically reviewed and revised the manuscript for important intellectual content. Dr Bezawit M. Hunegnaw conceptualized and designed the study, designed the data collection instruments, supervised data collection, contributed to analyses and interpretation of data, drafted the manuscript and critically reviewed and revised the manuscript for important intellectual content. Dr Sebastien Haneuse and Jonathan Luu contributed to analysis and interpretation of data, and critically reviewed and revised the manuscript for important intellectual content. Dr Mesfin Zeleke, Yahya Mohammed, Chalachew Bekele and Daniel Tadesse contributed to the design of data collection instruments, supervised data collection and critically reviewed and revised the manuscript for important intellectual content. Meles Solomon contributed to the interpretation of data and critically reviewed and revised the manuscript for important intellectual content. Dr Delayehu Bekele oversaw study implementation, contributed to the design of data collection instruments, critically reviewed and revised the manuscript for important intellectual content. Dr Grace J. Chan obtained funding, conceptualized and designed the study, contributed to analyses and interpretation of data, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.