Plain English Summary
Background and study aims
Early life growth faltering (slower than expected rate of growth) has increasingly been recognized as a risk factor for children’s long run developmental and economic potential. While several studies have linked adult outcomes to child growth at the individual level, there is a lack of evidence on the long run benefits of reducing stunting rates at the national or subnational (population) levels. The aim of this study is to estimate the associations between early life growth faltering at the subnational (population) level and adult height and education outcomes in a representative sample of low- and middle-income countries.
Who can participate?
Adults born between 1985 and 1995 across 34 Demographic and Health Surveys (DHS) conducted between 2006 and 2014 in 24 low- and middle-income countries
What does the study involve?
Data from the DHS surveys is used to calculated average height-for-age for children under age 5 at the country-region and birth cohort level (a group of people born during a particular period or year). The measures of early life growth are then compared with adult height and educational attainment.
What are the possible benefits and risks of participating?
This study only uses de-identified data from the DHS Program and there is no further data collection.
Where is the study run from?
ICF International (USA)
When is the study starting and how long is it expected to run for?
April 2017 to September 2017
Who is funding the study?
Boston University (USA)
Who is the main contact?
Prof. Mahesh Karra
Prof Mahesh Karra
152 Bay State Road
United States of America
Long run effects of early life growth faltering: a retrospective analysis of 847 birth cohorts in low- and middle-income countries
To estimate the associations between exposure to early life growth faltering at the subnational (population) level and adult height and education outcomes in a representative sample of low- and middle-income countries.
This study obtained a human subjects exemption from the institutional review board at Harvard University, 05/04/2016, protocol number IRB16-0515. Only de-identified data were obtained from the Demographic and Health (DHS) survey program at https://dhsprogram.com/
Observational cross-sectional cohort study
Primary study design
Secondary study design
Cross sectional study
Patient information sheet
Not available in web format, please use the contact details to request a patient information sheet
Early life growth faltering (height and stunting at childhood)
All available anthropometric data collected through the Demographic and Health Surveys (DHS) is combined to construct country-region measures of early childhood exposure to growth faltering, and this dataset is used to quantify the long-term outcomes of cohort-level changes in early life environments. The final analytic sample consists of 211,318 adult records across 34 DHS surveys that were conducted between 2006 and 2014 in 24 low- and middle-income countries.
Data from the Demographic and Health Surveys were used to compute average height-for-age z-scores for children under age 5 at the country-region and birth cohort level. The cohort measures of early life growth were then linked to adult height and educational attainment. The primary exposure of interest was population-level early life growth faltering, with adult height and adult educational attainment as primary outcomes. Multivariable linear regression models were used to estimate the associations between adult outcomes and population-level measures of early life linear growth.
Primary outcome measure
1. Adult height, measured by reported height in adulthood, taken from DHS surveys conducted between 2006 and 2014
2. Educational attainment, measured by the highest educational grade completed, taken from DHS surveys conducted between 2006 and 2014
Secondary outcome measures
No secondary outcome measures
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
211,318 adults who born between 1985 and 1995 across 34 DHS surveys that were conducted between 2006 and 2014 in 24 low- and middle-income countries
Target number of participants
Participant exclusion criteria
Missing income data
Recruitment start date
Recruitment end date
Countries of recruitment
Burkina Faso, Cameroon, Colombia, Cote d'Ivoire, Dominican Republic, Egypt, Ghana, Haiti, Jordan, Kenya, Madagascar, Malawi, Mali, Nepal, Niger, Nigeria, Pakistan, Peru, Rwanda, Senegal, Tanzania, Uganda, Zambia, Zimbabwe
Trial participating centre
530 Gaither Road, Suite 500
United States of America
Funding Body Type
private sector organisation
Funding Body Subtype
Universities (academic only)
United States of America
Results and Publications
Publication and dissemination plan
The trialists intend to submit the results of the study for publication to the American Journal of Clinical Nutrition.
IPD sharing statement
The trialists only used de-identified data from the DHS Program and were in no way involved with any of the data collection or human subjects processes. Further information about participation in a DHS survey can be found here: https://dhsprogram.com/What-We-Do/Protecting-the-Privacy-of-DHS-Survey-Respondents.cfm. The DHS data are publicly available at https://dhsprogram.com/ - the data can be accessed free of charge upon request from ICF International, the organization that manages the DHS data.
Intention to publish date
Participant level data
Available on request
Basic results (scientific)
2019 results in: https://www.ncbi.nlm.nih.gov/pubmed/31272440 (added 08/07/2019)