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Modelling stunting in LiST: the effect of applying smoothing to linear growth data

Overview of attention for article published in BMC Public Health, November 2017
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Title
Modelling stunting in LiST: the effect of applying smoothing to linear growth data
Published in
BMC Public Health, November 2017
DOI 10.1186/s12889-017-4744-3
Pubmed ID
Authors

Simon Cousens, Jamie Perin, Parul Christian, Lee Shu-Fune Wu, Sajid Soofi, Zulfiqar Bhutta, Claudio Lanata, Richard L. Guerrant, Aldo A. M. Lima, Kåre Mølbak, Palle Valentiner-Branth, William Checkley, Robert H. Gilman, R. Bradley Sack, Robert E. Black, Jean Humphrey, Neff Walker

Abstract

The Lives Saved Tool (LiST) is a widely used resource for evidence-based decision-making regarding health program scale-up in low- and middle-income countries. LiST estimates the impact of specified changes in intervention coverage on mortality and stunting among children under 5 years of age. We aimed to improve the estimates of the parameters in LiST that determine the rate at which the effects of interventions to prevent stunting attenuate as children get older. We identified datasets with serial measurements of children's lengths or heights and used random effects models and restricted cubic splines to model the growth trajectories of children with at least six serial length/height measurements. We applied WHO growth standards to both measured and modelled (smoothed) lengths/heights to determine children's stunting status at multiple ages (1, 6, 12, 24 months). We then calculated the odds ratios for the association of stunting at one age point with stunting at the next ("stunting-to-stunting ORs") using both measured and smoothed data points. We ran analyses in LiST to compare the impact on intervention effect attenuation of using smoothed rather than measured stunting-to-stunting ORs. A total of 21,786 children with 178,786 length/height measurements between them contributed to our analysis. The odds of stunting at a given age were strongly related to whether a child is stunted at an earlier age, using both measured and smoothed lengths/heights, although the relationship was stronger for smoothed than measured lengths/heights. Using smoothed lengths/heights, we estimated that children stunted at 1 month have 45 times the odds of being stunted at 6 months, with corresponding odds ratios of 362 for the period 6 to 12 months and 175 for the period 12 to 24 months. Using the odds ratios derived from the smoothed data in LiST resulted in a somewhat slower attenuation of intervention effects over time, but substantial attenuation was still observed in the LiST outputs. For example, in Mali the effect of effectively eliminating SGA births reduced prevalence of stunting at age 59 months from 44.4% to 43.7% when using odds ratios derived from measured lengths/heights and from 44.4% to 41.9% when using odds ratios derived from smoothed lengths/heights. Smoothing of children's measured lengths/heights increased the strength of the association between stunting at a given age and stunting at an earlier age. Using odds ratios based on smoothed lengths/heights in LiST resulted in a small reduction in the attenuation of intervention effects with age and thus some increase in the estimated benefits, and may better reflect the true benefits of early nutritional interventions.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 86 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 86 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 13 15%
Student > Bachelor 12 14%
Researcher 11 13%
Lecturer 10 12%
Student > Ph. D. Student 4 5%
Other 8 9%
Unknown 28 33%
Readers by discipline Count As %
Nursing and Health Professions 20 23%
Medicine and Dentistry 17 20%
Social Sciences 8 9%
Agricultural and Biological Sciences 3 3%
Biochemistry, Genetics and Molecular Biology 2 2%
Other 5 6%
Unknown 31 36%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 26 April 2018.
All research outputs
#11,432,225
of 12,858,386 outputs
Outputs from BMC Public Health
#8,212
of 8,759 outputs
Outputs of similar age
#321,607
of 382,109 outputs
Outputs of similar age from BMC Public Health
#639
of 677 outputs
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