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      Misreporting Month of Birth: Diagnosis and Implications for Research on Nutrition and Early Childhood in Developing Countries

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      1 , , 2 , 3
      Demography
      Springer US
      Nutrition, Height-for-age, Stunting, Measurement error, Child age

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          Abstract

          A large literature has used children’s birthdays to identify exposure to shocks and estimate their impacts on later outcomes. Using height-for-age z scores (HAZ) for more than 990,000 children in 62 countries from 163 Demographic and Health Surveys (DHS), we show how random errors in birth dates create artifacts in HAZ that can be used to diagnose the extent of age misreporting. The most important artifact is an upward gradient in HAZ by recorded month of birth (MOB) from start to end of calendar years, resulting in a large HAZ differential between December- and January-born children of –0.32 HAZ points. We observe a second artifact associated with round ages, with a downward gradient in HAZ by recorded age in months, and then an upward step after reaching ages 2, 3, and 4. These artifacts have previously been interpreted as actual health shocks. We show that they are not related to agroclimatic conditions but are instead linked to the type of calendar used and arise mainly when enumerators do not see the child’s birth registration cards. We explain the size of the December–January gap through simulation in which 11 % of children have their birth date replaced by a random month. We find a minor impact on the average stunting rate but a larger impact in specific error-prone surveys. We further show how misreporting MOB causes attenuation bias when MOB is used for identification of shock exposure as well as systematic bias in the impact on HAZ of events that occur early or late in each calendar year.

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          The online version of this article (10.1007/s13524-018-0753-9) contains supplementary material, which is available to authorized users.

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          Long-term consequences of stunting in early life.

          This review summarizes the impact of stunting, highlights recent research findings, discusses policy and programme implications and identifies research priorities. There is growing evidence of the connections between slow growth in height early in life and impaired health and educational and economic performance later in life. Recent research findings, including follow-up of an intervention trial in Guatemala, indicate that stunting can have long-term effects on cognitive development, school achievement, economic productivity in adulthood and maternal reproductive outcomes. This evidence has contributed to the growing scientific consensus that tackling childhood stunting is a high priority for reducing the global burden of disease and for fostering economic development. Follow-up of randomized intervention trials is needed in other regions to add to the findings of the Guatemala trial. Further research is also needed to: understand the pathways by which prevention of stunting can have long-term effects; identify the pathways through which the non-genetic transmission of nutritional effects is mediated in future generations; and determine the impact of interventions focused on linear growth in early life on chronic disease risk in adulthood. © 2011 Blackwell Publishing Ltd.
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            Linear growth deficit continues to accumulate beyond the first 1000 days in low- and middle-income countries: global evidence from 51 national surveys.

            Growth faltering is usually assessed using height-for-age Z-scores (HAZs), which have been used for comparisons of children of different age and sex composition across populations. Because the SD (denominator) for calculating HAZ increases with age, the usefulness of HAZs to assess changes in height over time (across ages) is uncertain. We posited that population-level changes in height as populations age should be assessed using absolute height-for-age differences (HADs) and not HAZs. We used data from 51 nationwide surveys from low- and middle-income countries and graphed mean HAZs and HADs by age. We also calculated annual changes in HAZs and HADs and percentage of total height deficit accumulated annually from birth to age 60 mo using both approaches. Mean HAZ started at -0.4 Z-scores and dropped dramatically up to 24 mo, after which it stabilized and had no additional deterioration. Mean HAD started at -0.8 cm, with the most pronounced faltering occurring between 6 and 18 mo, similar to HAZ. However, in sharp contrast to HAZ, HAD curves had continued increases in the deficit of linear growth from 18 to 60 mo, with no indication of a leveling off. Globally, 70% of the absolute deficit accumulated in height (HAD) at 60 mo was found to be due to faltering during the first "1000 days" (conception to 24 mo), but 30% was due to continued increases in deficit from age 2 to 5 y. The use of HAZ masks these changes because of age-related changes in SD. Therefore, HAD, rather than HAZ, should be used to describe and compare changes in height as children age because detecting any deficit compared with expected changes in height as children grow is important and only HAD does this accurately at all ages. Our findings support the current global programmatic momentum to focus on the first 1000 d. Research is needed to better understand the dynamics and timing of linear growth faltering using indices and indicators that accurately reflect changes over ages and to identify cost-effective ways to prevent growth faltering and its consequences throughout the lifecycle. © 2014 American Society for Nutrition.
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              Early-Life Health and Adult Circumstance in Developing Countries

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                Author and article information

                Contributors
                afl@rfintervention.dk
                d.headey@cgiar.org
                william.masters@tufts.edu
                Journal
                Demography
                Demography
                Demography
                Springer US (New York )
                0070-3370
                1533-7790
                28 January 2019
                28 January 2019
                April 2019
                : 56
                : 2
                : 707-728
                Affiliations
                [1 ]ISNI 0000 0001 0674 042X, GRID grid.5254.6, Department of Economics, , University of Copenhagen, ; Harespringet 3, Copenhagen NV, Denmark
                [2 ]ISNI 0000 0004 0480 4882, GRID grid.419346.d, Poverty, Health, and Nutrition Division, , International Food Policy Research Institute, ; 1201 Eye Street, Washington, DC 20005-3915 USA
                [3 ]ISNI 0000 0004 1936 7531, GRID grid.429997.8, Friedman School of Nutrition and Department of Economics, , Tufts University, ; Boston, MA 02111 USA
                Article
                753
                10.1007/s13524-018-0753-9
                6449488
                30693449
                7af50926-c5d3-4207-87ac-465aafcdffab
                © The Author(s) 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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                © Population Association of America 2019

                Sociology
                nutrition,height-for-age,stunting,measurement error,child age
                Sociology
                nutrition, height-for-age, stunting, measurement error, child age

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