Whole-population perspective is needed for analyses and actions to address linear growth faltering in low- and middle-income countries

Abstract

AbstractLinear growth faltering (LGF), or slower than normal growth in height, is widely considered an indicator of suboptimal conditions affecting children’s development and health in low- and middle-income countries (LMICs). Recently, Benjamin-Chung and collaborating members of the Healthy Birth, Growth and Development Knowledge integration (HBGDki) consortium described the early onset and low reversal rates of LGF in 32 cohort studies that followed over 52,000 children from birth to 24 months of age in 14 countries. Their adoption and extension of conventionally used growth metrics to describe faltering patterns led to findings that echo a long-standing assumption that LGF in resource-constrained settings occurs mainly during early infancy and is mostly irreversible thereafter. Here, we discuss limitations of their methods and suggest an alternative approach that leads to different conclusions about the rate and timing of LGF in LMICs.