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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. Differences in health determinants within populations have a greater effect on anthropometric status of children than differences in population level health determinants in low- and middle-income countries (LMICs).

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2. Household wealth and maternal education had the greatest impact on anthropometric status variation between populations in LMICs.

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Evidence Rating Level: 4 (Below Average)

Study Rundown:

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Despite ongoing international emphasis on improving nutrition in young children living in LMICs, growth failure continues to be a major cause of life-long morbidity in this population. Developing strategies to combat anthropometric failure requires an understanding of differences in disease patterns and health determinants between populations (Bpop) and between individuals within a population (Wpop). In this study, researchers evaluated measures of maternal and child health and socioeconomic status to determine the relationship between anthropometric failure between differences in Bpop and Wpop health determinants. Results showed that Wpop differences were responsible for more than 80% of anthropometric variation among children, while Bpop differences played a more minor role. Country differences, and differences in household wealth had the greatest contribution to anthropometric variation at the Bpop level. This study was limited by lack of race/ethnicity data which previous studies suggest may independently affect certain health outcomes. Results from this study can be used to develop targeted strategies for reducing growth failure in children n LMICs.

In-depth [cross-sectional study]:

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This study analyzed health and nutrition data collected on mothers (aged 15-49 years) and their children (aged <5 years) as part of the Demographic and Health Surveys program in 57 countries between 2001 and 2015. Researchers defined Bpop using measures related to communities, regions, and countries while Wpop was defined using metrics related to mothers and children. Anthropometric status was defined using z-scores, with failure defined as z-score of < -2 for height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ). Results showed that Wpop differences were responsible for 89%, 83%, and 85% of differences in HAZ, WAZ, and WHZ, respectively. Conversely, 11%, 17%, and 15% of variation in HAZ, WAZ, and WHZ were associated with Bpop differences. Bpop differences in HAZ and WAZ were most heavily affected by household wealth and maternal education (27%-41% and 20-31%, respectively). Most of the Bpop variation in HAZ, WAZ, and WHZ was associated with country level differences (41%, 63%, and 53%), followed by community level differences (37%, 23%, and 32%) and regional level differences (22%, 13%, and 15%).

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