Research Snapshots
Stunting in the first year of life:

Pathway analysis of a birth cohortThis is a summary of the following paper: Mwangome M, Ngari M, Brals D et al (2024)
Stunting in the first year of life: Pathway analysis of a birth cohort. PLOS Global Public Health,4, 2, e0002908. https://doi.org/10.1371/journal.pgph.0002908

M

Community-based health worker in
Burkina Faso conducts education
session with mother-to-be© UNICEF/UNI528404/Cisse

alnutrition among infants aged under six months has often been overlooked, leading to gaps in our understanding of the causes of early
infancy stunting. The World Health Organization(WHO) 2013 conceptual framework for childhood stunting divides contributing factors into
three main domains: context (community andsocietal factors), causes (household and family,feeding, and infection-related factors), and short-and long-term consequences of stunted growth(health, developmental, and economic outcomes). The framework itself does not elucidate
potential pathways and relationships between factors that contribute to stunting, limiting application to prioritising and designing interventions.
This study was set up to examine pathways
including parental and household characteristics, birth size and gestation, and illness in infancy with stunting at birth and months three, six,and 12 using an a priori hypothesised framework.
It was a secondary analysis of a birth cohort of
1,017 infants recruited from four health facilities
in Burkina Faso and followed up for one year.
Among the 1,017 infants included in thestudy, after excluding perinatal deaths, 522 (51%)
were male. The median gestational age was 38.9weeks (interquartile range: 38.2 to 40.2). Forty-eight (4.7%) infants were born prematurely,and 189 (19%) had low birth weight. Of the 48
infants born prematurely, 34 (71%) also had lowbirth weight. A total of 454 infants were born ina health facility (45%), while 399 (39%) and 164(16%) were born at home with and without acommunity-based assistant present, respectively.
The prevalence of being stunted at birth andat months three, six, and 12 was 7.4%, 23%,20%, and 18% respectively. The fractions ofIntimate partner violence and childstunting in South Asia
This is a summary of the following paper: Lakhdir MP, Ambreen S, Sameen S et al (2024)
Association between maternal experiences of intimate partner violence and child stunting: Asecondary analysis of the Demographic Health Surveys of four South Asian countries. BMJ Open,14, 1, e071882. https://doi.org/10.1136/bmjopen-2023-071882

Women experiencing intimate
partner violence (IPV) may face
adverse health outcomes and behaviours during pregnancy, leading to unfavourable pregnancy outcomes. Physical abuse during pregnancy can directly result ininjuries, impacting pregnancy outcomes, including miscarriages and maternal and foetal mortality. Women subject to IPV are more likely tomiss prenatal check-ups, potentially resulting inadverse pregnancy outcomes such as low birthweight and preterm births. Maternal IPV is also
linked to poor nutrition and inadequate weightgain during pregnancy, as well as increased
stress and depression. These can indirectly affect maternal and neonatal outcomes such as
foetal death, preterm birth, low birthweight, andsmall for gestational age infants. In turn, these32

outcomes may significantly impact a child’s early growth and physical development, potentiallyleading to wasting and stunting.
Researchers aimed to determine whether
there was an association between maternal exposure to IPV – i.e. sexual violence, physical violence, or both – and child stunting, measured
based on the height-for-age z-score of children
aged 6–59 months. The authors used data fromthe seventh round of the demographic and healthsurveys in four South Asian countries (Pakistan,Nepal, India, and the Maldives). A Cox proportional regression method conducted separately oneach country's data was used to estimate the association between maternal IPV and child stunting.
The prevalence of women who were ever exposed to IPV (since age 15) ranged from 10%

FIELD EXCHANGE ISSUE 73, July 2024 www.ennonline.net/fex

month 12 stunting attributable to being stunted at birth, month three, and month six were11% (95% CI 5.0–16%), 32% (95% CI 22–41%),and 40% (95% CI 31–49%) respectively. Modelling showed male sex and maternal characteristics had direct effects on stunting at birth andthree months, but not subsequently. Prematurebirth, twin birth, and being stunted at a previous
time point were directly associated with stunting
at months three, six, and 12. Both maternal andpaternal characteristics were directly associatedwith preterm birth. Non-exclusive breastfeeding
had a borderline positive direct effect on stunting at month six but not at month 12.
The study's limitations lie in its reliance onan older dataset from an untreated birth cohort,which makes replication challenging. Changes
in healthcare services since 2004 may have influenced associations. Estimating gestational age
using less accurate methods and the lack of variables such as maternal mental health status areamong the limitations. Future studies, throughtreated cohorts, should encompass all factors
in the WHO framework for childhood stunting
and additional items identified here for a comprehensive pathway view.
Through this review, the authors uncover complex connections among child, maternal, paternal, and household characteristics. To
improve birth size, it is crucial to focus on improving women's nutritional status before conception and during the first trimester of pregnancy, improving socioeconomic conditions,and promoting exclusive breastfeeding. By
analysing pathways, we can better understandthe shared and distinct links between wasting,stunting, and underweight, fostering collaboration across communities of practice to develop
more unified strategies.

(Maldives) to 31% (India). The burden of childstunting was the lowest in the Maldives (14%),
followed by Nepal (33%), and then highest in
both India and Pakistan (around 36%).
Although crude data showed a higher prevalence of child stunting in women who experienced
IPV across all four countries, only India and Nepal demonstrated a significant association afteradjusting for maternal age, education, number ofchildren, household wealth ranking, and place ofresidence. In India, children whose mothers wereexposed to IPV showed a 7% increase in the prevalence of moderate and severe child stunting (OR1.07, 95% CI 1.01-1.14). In Nepal, severe stunting was strongly associated with the prevalence ofphysical IPV (OR 1.66, 95% CI 1.01-2.87). There
were no other statistically significant associations that showed a higher prevalence of stunting
among ever-abused women.
The study findings suggest that maternal exposure to IPV could be associated with childstunting. However, further research investigating the relationship between IPV and child outcomes, and using improved and advanced statistical analyses, is required. Further research may
provide substantial evidence to enhance publicawareness and potentially reduce the burden ofchild stunting in South Asian countries.