A socioeconomic lens on understanding early childhood linear growth faltering
Authors: Shyon Baumann, Hamnah Majeed, Haris Majeed
Journal: The Lancet Global Health (2018)

Past global efforts and research studies have aimed to reduce the prevalence of malnutrition deficiencies among infants and young children, particularly in low-income and middle-income countries.1Grantham-McGregor S Cheung YB Cueto S et al.Developmental potential in the first 5 years for children in developing countries.Lancet. 2007; 369: 60-70Summary Full Text Full Text PDF PubMed Scopus (1953) Google Scholar However, these efforts have taken biological and environmental approaches,1Grantham-McGregor S Cheung YB Cueto S et al.Developmental potential in the first 5 years for children in developing countries.Lancet. 2007; 369: 60-70Summary Full Text Full Text PDF PubMed Scopus (1953) Google Scholar, 2Black RE Allen LH Bhutta ZA et al.Maternal and child undernutrition: global and regional exposures and health consequences.Lancet. 2008; 371: 243-260Summary Full Text Full Text PDF PubMed Scopus (3854) Google Scholar and a sociological perspective is often overlooked or regarded as a minor consideration. At a global level, understanding patterns of childhood linear growth faltering, known as stunting, are crucial indicators of population health and key tools for comparisons across countries and over time. A sociological perspective on the influence of changes in childhood linear growth faltering emphasises a set of factors that are often overlooked by health scholars. In particular, sociological explanations privilege the role of population-level factors, allowing for cultural and material dimensions of social dynamics to play roles in the understanding of childhood linear growth faltering. Additionally, sociological understandings of the consequences of social inequality can provide new ways of understanding biometric trends. Inequality can manifest in a variety of ways, many of which are often unexpected. In The Lancet Global Health, Daniel Roth and colleagues' sophisticated study3Roth DE Krishna A Leung M Shi J Bassani DG Barros AJ Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 demographic and health surveys from 64 countries (1993–2015).Lancet Glob Health. 2017; 5: e1249-e1257Summary Full Text Full Text PDF PubMed Scopus (53) Google Scholar (December, 2017, e1249–57) found declines in mean height-for-age Z scores, with declines in the 5th and 95th percentiles, across 64 low-income and middle-income countries from 1993 to 2015. Additionally, their analyses demonstrated that the results were not plausibly explained by linear growth faltering among a subgroup of children, but rather reflected a downward shift in height-for-age Z scores of the population.3Roth DE Krishna A Leung M Shi J Bassani DG Barros AJ Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 demographic and health surveys from 64 countries (1993–2015).Lancet Glob Health. 2017; 5: e1249-e1257Summary Full Text Full Text PDF PubMed Scopus (53) Google Scholar They also considered potential modifiers, including world region, national income, and year. Roth and colleagues offered caveats regarding the limitations of their data, including the underrepresentation of high-income individuals within the countries they studied.3Roth DE Krishna A Leung M Shi J Bassani DG Barros AJ Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 demographic and health surveys from 64 countries (1993–2015).Lancet Glob Health. 2017; 5: e1249-e1257Summary Full Text Full Text PDF PubMed Scopus (53) Google Scholar Also among the caveats they pointed to was the potential role of community-level determinants of child growth, which remained largely unmeasured in their study, particularly public policies, service provision, or environmental conditions.3Roth DE Krishna A Leung M Shi J Bassani DG Barros AJ Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 demographic and health surveys from 64 countries (1993–2015).Lancet Glob Health. 2017; 5: e1249-e1257Summary Full Text Full Text PDF PubMed Scopus (53) Google ScholarRoth and colleagues'3Roth DE Krishna A Leung M Shi J Bassani DG Barros AJ Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 demographic and health surveys from 64 countries (1993–2015).Lancet Glob Health. 2017; 5: e1249-e1257Summary Full Text Full Text PDF PubMed Scopus (53) Google Scholar population-wide study on linear growth faltering raises the question of which social structural and cultural factors could have such broad impact within countries, across the diversity of countries under study, from 1993 to 2015. These results point to the pressing need to better understand how social dynamics at the population level can be implicated in linear growth faltering. There is potential explanatory utility in a few core sociological concerns. The link between nutrition and linear growth faltering suggests that much could be gained from an examination of changes in food production and distribution practices during the period under study. When commodity chains are globalised, low-income and middle-income countries have incentives to focus production on export and cash crops, which reduce the availability of some foods locally.4Lang T Heasman M Food wars: The global battle for mouths, minds and markets. Earthscan, London2015Crossref Scopus (79) Google Scholar This production focus has the effect of not only increasing national income, but discouraging reliance on a healthy system of local and diverse food production, which tends to be more nutritious. Moreover, Roth and colleagues3Roth DE Krishna A Leung M Shi J Bassani DG Barros AJ Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 demographic and health surveys from 64 countries (1993–2015).Lancet Glob Health. 2017; 5: e1249-e1257Summary Full Text Full Text PDF PubMed Scopus (53) Google Scholar did not find evidence of any subgroup differences, that is, their analysis does not examine differences between boys and girls. In conditions of nutritional shortage, research has shown how norms and values regarding gender differences can create nutritional inequalities between boys and girls.5Jayachandran S Pande R Why are Indian children so short? The role of birth order and son preference.Am Econ Rev. 2017; 107: 2600-2629Crossref PubMed Scopus (119) Google Scholar Gender differences might account for some of their findings, which could serve as more evidence yet of how conditions of economic hardship tend to have greater negative impact on girls and women than on boys and men.6Jayachandran S The roots of gender inequality in developing countries.Annu Rev Econ. 2015; 7: 63-88Crossref Scopus (287) Google Scholar Therefore, we urge that future studies on children linear growth faltering should not overlook sociological factors such as those discussed in this letter. In the consideration of global strategies to prevent linear growth faltering, policies that are sensitive to socioeconomic status, food security, and gender norms need to be included. We declare no competing interests. Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 Demographic and Health Surveys from 64 countries (1993–2015)In low-income and middle-income countries, declines in mean HAZ with age are due to a downward shift in the entire HAZ distribution, revealing that children across the HAZ spectrum experience slower growth compared to the international standard. Efforts to mitigate postnatal linear growth faltering in low-income and middle-income countries should prioritise action on community-level determinants of childhood HAZ trajectories. Full-Text PDF Open Access