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Tufts University (2021)

Longitudinal growth faltering among young children in Burkina Faso

Cliffer, Ilana

Titre : Longitudinal growth faltering among young children in Burkina Faso

Auteur : Cliffer, Ilana.

Université de soutenance  : Tufts University,

Grade : Doctor of Philosophy (PhD) 2021

Résumé partiel
Growth faltering, when children fail to attain expected height and/or weight for their age in relation to growth of a standard reference population, is associated with increased mortality and morbidity and decreased educational attainment and earning potential. Despite programming and policy efforts to prevent it, growth faltering remains a salient issue in many low- and middle- income countries. Knowledge that growth faltering is concentrated in the first two years of life is largely based on cross-sectional studies that pool data from separate cohorts of children in different age ranges. This limits our understanding of the timing of growth faltering along an individual child’s growth trajectory. Combining a longitudinal anthropometric dataset comprised of 5,039 Burkinabè children aged 6-28 months with remotely sensed climate data, we characterize longitudinal growth faltering among individual children to determine optimal timing and nature of growth interventions.

To determine the timing of onset and continued intensity of growth faltering among individuals, we visualized individual growth curves by quintiles and selected centiles of attained length at 27 months and used two-stage regression models to establish whether growth faltering happens through continuous or distinct episodes of slow growth. First, we regressed each individual child’s length on their age using linear spline regressions and extracted model fit parameters representing the smoothness of the growth curve (R2), initial length at study entry (intercept), and average velocities in each age period (coefficients for each age spline). Next, we regressed these parameters on individual-level attained length at study end. Growth faltering manifests as both lower growth velocity and greater heterogeneity in growth velocity amplitude. The most influential period for growth is 9-11 months. Children who started short stayed on their initial trajectories and ended short, and taller children had smoother, faster growth.


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