Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala

Abstract

AbstractObjectiveMeasurements of length at birth, or in the neonatal period, are challenging to obtain and often discounted for lack of validity. Hence, classical ‘under-5’ stunting rates have been derived from surveys on children from 6 to 59 months of age. Guatemala has a high prevalence of stunting (49·8 %), but the age of onset of growth failure is not clearly defined. The objective of the study was to assess length-for-age within the first 1·5 months of life among Guatemalan infants.DesignAs part of a cross-sectional observational study, supine length was measured in young infants. Mothers’ height was measured. Length-for-ageZ-scores (HAZ) were generated and stunting was defined as HAZ <−2 using WHO growth standards.SettingEight rural, indigenous Mam-Mayan villages (n200, 100 % of Mayan indigenous origin) and an urban clinic of Quetzaltenango (n106, 27 % of Mayan indigenous origin), Guatemala.SubjectsThree hundred and six newborns with a median age of 19 d.ResultsThe median rural HAZ was −1·56 and prevalence of stunting was 38 %; the respective urban values were −1·41 and 25 %. Linear regression revealed no relationship between infant age and HAZ (r=0·101,r2=0·010,P=0·077). Maternal height explained 3 % of the variability in HAZ (r=0·171,r2=0·029,P=0·003).ConclusionsStunting must be carried over fromin uterogrowth retardation in short-stature Guatemalan mothers. As linear growth failure in this setting beginsin utero, its prevention must be linked to maternal care strategies during gestation, or even before. A focus on maternal nutrition and health in an intergenerational dimension is needed to reduce its prevalence.