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

Local Burden of Disease Child Growth Failure Collaborators

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)231-234
Number of pages4
Issue number7789
StatePublished - 9 Jan 2020

Bibliographical note

Funding Information:
1Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. 2Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA. 3Human Nutrition Department, University of Gondar, Gondar, Ethiopia. 4Department of Global Health, Stellenbosch University, Cape Town, South Africa. 5Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa. 6School of Medicine, Cardiff University, Cardiff, UK. 7Lincoln Medical School, Universities of Nottingham & Lincoln, Lincoln, UK. 8School of Community Health Sciences, University of Nevada, Reno, NV, USA. 9National Malaria Elimination Program, Federal Ministry of Health, Abuja, Nigeria. 10Pediatric Intensive Care Unit, King Saud University, Riyadh, Saudi Arabia. 11Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. 12Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, USA. 13Qazvin University of Medical Sciences, Qazvin, Iran. 14Health Economics Department, Iran University of Medical Sciences, Tehran, Iran. 15Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran. 16King Saud University, Riyadh, Saudi Arabia. 17Health Services Management Department, Arak University of Medical Sciences, Arak, Iran. 18Carol Davila University of Medicine & Pharmacy, Bucharest, Romania. 19Department of Health Policy & Administration, University of the Philippines Manila, Manila, The Philippines. 20Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China. 21School of Health Sciences, Birmingham City University, Birmingham, UK. 22Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran. 23Department of Health Informatics, University of Ha’il, Ha’il, Saudi Arabia. 24School of Business, University of Leicester, Leicester, UK. 25Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania. 26Center for Research in Evaluation and Surveys, National Public Health Institute, Cuernavaca, Mexico. 27Indian Institute of Public Health, Gandhinagar, India. 28Public Health Foundation of India, Gurugram, India. 29The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia. 30General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru. 31Public Health Risk Sciences Division, Public Health Agency of Canada, Toronto, Ontario, Canada. 32Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada. 33Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany. 34T. H. Chan School of Public Health, Harvard University, Boston, MA, USA. 35Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain. 36Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain. 37Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia. 38Department of Community Medicine, Gandhi Medical College Bhopal, Bhopal, India. 39Jazan University, Jazan, Saudi Arabia. 40Institute of Public Health, University of Gondar, Gondar, Ethiopia. 41Public Health Department, Mizan-Tepi University, Teppi, Ethiopia. 42School of Forestry and Environmental Studies, Yale University, New Haven, CT, USA. 43Department of Statistical and Computational Genomics, National Institute of Biomedical Genomics, Kalyani, India. 44Department of Statistics, University of Calcutta, Kolkata, India. 45Department of Global Health, Global Institute for Interdisciplinary Studies, Kathmandu, Nepal. 46Centre for Global Child Health, University of Toronto, Toronto, Ontario, Canada. 47Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan. 48Department of Clinical Chemistry, University of Gondar, Gondar, Ethiopia. 49Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Italy. 50Biomedical Technologies, Bauman Moscow State Technical University, Moscow, Russia. 51Center for Neuroscience, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Panama, Panama. 52School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada. 53Al Shifa School of Public Health, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan. 54Centre for Population Health Sciences, Nanyang Technological University, Singapore, Singapore. 55Global Health Unit, Imperial College London, London, UK. 56Colombian National Health Observatory, National Institute of Health, Bogota, Colombia. 57Epidemiology and Public Health Evaluation Group, National University of Colombia, Bogota, Colombia. 58Gorgas Memorial Institute for Health Studies, Panama, Panama. 59Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia. 60School of Public Health, University of Hong Kong, Hong Kong, China. 61Big Data Institute, University of Oxford, Oxford, UK. 62Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam. 63Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA. 64James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh. 65Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, Queensland, Australia. 66School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia. 67Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK. 68School of Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia. 69Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia. 70Faculty of Veterinary Medicine and Zootechnics, Autonomous University of Sinaloa, Culiacan Rosales, Mexico. 71Center of Complexity Sciences, National Autonomous University of Mexico, Mexico City, Mexico. 72Department of Midwifery, Debre Berhan University, Debre Berhan, Ethiopia. 73Department of Population and Health, University of Cape Coast, Cape Coast, Ghana. 74Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland. 75World Food Programme, New Delhi, India. 76Medical Board, Roberto Santos General Hospital, Salvador, Brazil. 77Department of Internal Medicine, Bahia School of Medicine and Public Health, Salvador, Brazil. 78Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales, Australia. 79Department of Clinical Pathology, Mansoura University, Mansoura, Egypt. 80Pediatric Dentistry and Dental Public Health, Alexandria University, Alexandria, Egypt. 81Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 82World Health Programme, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada. 83School of Public Health, Arak University of Medical Sciences, Arak, Iran. 84Center of Communicable Disease Control, Ministry of Health and Medical

Funding Information:
Acknowledgements This work was primarily supported by grant OPP1132415 from the Bill & Melinda Gates Foundation.

Publisher Copyright:
© 2020, The Author(s).

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