Poster Topical Area: Global Nutrition

Location: Hall D

Poster Board Number: 567

P12-056 - Association between stunting and early development among children aged 3-4 years in South Asia: Findings from Multiple Indicator Cluster Surveys

Monday, Jun 11
8:00 AM – 3:00 PM

Objectives: Stunting (height/length-for-age Z-score<-2) before two years of age has shown associations with poor child developmental indicators in some studies, but information at the population level is scarce. We examined associations between undernutrition and early development among children 3-4 years of age in South Asia.


Methods: Data from Multiple Indicator Cluster Surveys (MICS) in Bangladesh (n=8,659), Bhutan (n=2,038), Nepal (n=2,178), and Pakistan (Punjab: n=11,369 and Sindh: n=6,718) were used. Children were considered overall developmentally 'on-track' if they met the criteria of three out of four domains: literacy/numeracy, physical, socio-emotional, and learning. Meta-analysis was conducted to examine the associations at regional level, adjusting for early childhood education and quality of care.


Results: In the five surveys, the prevalence of stunting and underweight (weight-for-age Z-score<-2) ranged from 36.3%-52.9% (stunting) and 13.8%-43.7% (underweight), while the proportion of children who met the criteria for overall "on-track" development ranged from 66.1%-81.1%. Stunted children had significantly lower odds of on-track physical (OR=0.82; 95%CI: 0.71, 0.94) and overall (0.82; 0.76, 0.88) development, but stunting was not associated with social-emotional development (0.99; 0.92, 1.07). Associations of stunting with poor literacy/numeracy (0.66; 0.55, 0.80 in Bangladesh; 0.70; 0.51, 0.96 in Bhutan; 0.60; 0.42, 0.82 in Nepal; 0.54; 0.47, 0.63 in Punjab; 0.41; 0.32, 0.52 in Sindh) and learning domains (0.56; 0.45, 0.69 in Bangladesh; 0.69; 0.57, 0.84 in Punjab; 0. 72; 0. 58, 0.90 in Sindh) existed but were heterogeneous across countries. Underweight status was associated with a lower odds of achieving acceptable learning (0.75; 0.66, 0.85) but not with other development domains. Also, underweight children were less likely to be on-track for overall development (0.88; 0.82, 0.95).


Conclusions: Widespread stunting and underweight in South Asian children is associated with sub-optimal overall development and poorer achievement in some developmental domains. Interventions that prevent stunting and undernutrition are likely to contribute to improved child development and human capital outcomes in South Asia.



Funding Source:

This study was funded by the UNICEF Regional Office for South Asia (ROSA), Kathmandu, Nepal.

CoAuthors: Victor Aguayo – UNICEF; Rebecca Campbell – Johns Hopkins School of Public Health; Keith West – Johns Hopkins School of Public Health

Yunhee Kang

Assistant Scientist
Johns Hopkins School of Public Health
Baltimore, Maryland