Causes and consequences of child growth failure in low- and middle-income countries

Child growth failure is associated with a higher risk of illness and mortality, which contributed to the United Nations Sustainable Development Goal 2.2 to end malnutrition by 2030. Current prenatal and postnatal interventions, such as nutritional supplementation, have been insufficient to eliminate growth failure in low resource settings -motivating a search for key age windows and population subgroups in which to focus future preventive efforts. Quantifying the effect of early growth failure on severe outcomes is important to assess burden and longer-term impacts on the child. Here we show through an analysis of 35 longitudinal cohorts (108,336 children) that maternal and child characteristics at birth accounted for the largest attributable differences in growth. Yet, postnatal growth failure was larger than differences at birth, and characteristics of the child's household environment were additional determinants of growth failure after age 6 months. Children who experienced early ponderal or linear growth failure were at much higher risk of persistent growth failure and were 2.0 to 4.8 times more likely to die by age 24 months. High attributable risk from prenatal causes, and severe consequences for children who experienced early growth failure, support a focus on pre-conception and pregnancy as key opportunities for new preventive interventions. Our results suggest that broad improvements in wellbeing will be necessary to eliminate growth failure in low resource settings, but that screening based on weight could help identify children at highest risk of death before age 24 months.