A Novel Development Indicator Based On Population-Average Height Trajectories Of Children Aged 0-5 Years Modelled Using 145 Surveys In 64 Countries, 2000-2018

IntroductionChildren's growth status is an important measure commonly used as a proxy indicator of advancements in a country's health, human capital and economic development. We aimed to assess the feasibility of using Super-Imposition by Translation And Rotation (SITAR) models for summarising population-based cross-sectional height-by-age data of children under 5 years across 64 countries.MethodsUsing 145 publicly available Demographic and Health Surveys of children under 5 years across 64 low-income and middle-income countries from 2000 to 2018, we created a multicountry pseudo-longitudinal dataset of children's heights.ResultsSITAR models including two parameters (size and intensity) explained 81% of the between-survey variation in mean boys' height and 80% in mean girls' height. Size parameters for boys and girls (relative to the WHO child growth standards) were distributed non-normally around a mean of -5.2 cm for boys (range: -7.9 cm to -1.6 cm) and -4.9 cm for girls (range: -7.7 cm to -1.2 cm). Boys exhibited 10% slower linear growth compared with the WHO (range: 19.7% slower to 1.6% faster) and girls 11% slower linear growth compared with the WHO (range: 21.4% slower to 1.0% faster). Variation in the SITAR size parameter was >= 90% explained by the combination of average length within the first 60 days of birth (as a proxy for fetal growth) and intensity, regardless of sex, with much greater contribution by postnatal intensity (r >= 0.89 between size and intensity).ConclusionsSITAR models with two random effects can be used to model child linear growth using multicountry pseudo-longitudinal data, and thereby provide a feasible alternative approach to summarising early childhood height trajectories based on survey data. The SITAR intensity parameter may be a novel indicator for specifically tracking progress in the determinants of postnatal growth in low-income and middle-income countries.