Determinants of Catch-up Growth in Early Childhood: A Longitudinal Study

Abstract

Background. Growth failure in the first 1000 days of life can have a major impact on a child's health. Therefore, catching up on growth in early childhood is essential to prevent nutritional problems, especially stunting, as indicated by the height for age z-score (HAZ). Catch-up growth after a period of malnutrition in the first 1000 days of life can be measured as an improvement in linear growth using HAZ parameters.

Objective. This study aimed to determine the factors that influence catch-up growth in early childhood based on the HAZ.

Methods. This three-year cohort study used two waves of secondary data from the Indonesian Family Life Survey (IFLS). Baseline data of the study were taken in 1997 when the children were 0 to 23 months old, then followed up in 2000 (at 3 to 5 years old). The study included 537 children aged 0 to 23 months in 1997. The dependent variable was catch-up growth. The independent variables were: children-related, parent-related, and household factors. We collected secondary data from the IFLS annual report book. Bivariate data analysis was performed using the Chisquared test, while multivariate analysis was performed using multinomial logistic regression.

Results. There were four groups in this study: not stunted (reference group), stunted catch-up, stunted non-catchup, and late incident stunted. Bivariate analysis showed that catch-up growth, based on HAZ, was significantly influenced by birth weight (normal birth weight), head circumference (normal head circumference), maternal nutritional status (normal), and maternal height (p <0.05). After controlling for potentially confounding factors, sex (p = 0.003; 95% CI:1.43-5.93) and maternal nutritional status (p = 0.011; 95% CI:0.19-0.81) were the most influential factors on catch-up growth in early childhood.

Conclusion. Children with stunting and catch-up growth are more common among males, and poor maternal nutritional status was associated with stunting and failure to achieve catch-up growth. The determining factors for the late incident and stunted non-catchup groups include head circumference, breastfeeding status, maternal height, and maternal nutritional status. The stunted non-catch-up group is also influenced by small gestational age (SGA). Therefore, it is important to regularly monitor the growth and development of children in early childhood.