Determinants of stunting reduction in Ethiopia 2000 – 2011

The prevalence of stunting in Ethiopia declined from 57% in 2000 to 44% in 2011, yet the factors producing this change are not fully understood. Data on 23,999 children 0–59 months of age from three Demographic and Health Surveys (DHS) from 2000, 2005, and 2011 were analyzed to assess the trends in stunting prevalence, mean height‐for‐age z‐scores (HAZ) and the associations between potential factors and HAZ. Associations were determined separately using three separate generalized linear models for children age less than 6 months, 6–23 months, and 24–59 months of age. Significant variables were then analyzed to determine if they showed an overall trend between the 2000 and 2011 surveys. In children < 6 months of age, only mother's height was both a significant predictor of HAZ and showed a progressive, albeit non‐significant, increase from 2000 to 2011. In children 6–23 months of age, only mother's use of modern contraception showed substantial changes in a direction consistent with improving HAZ, but improvements in maternal nutrition status were observed from 2000 to 2005. For children 24–59 months of age a consistent and progressive change is seen in child's diarrhea, fever, mother's education, and the occurrence of open defecation. Our analysis demonstrated that factors associated with HAZ vary by child's age and the dominant livelihood practice in the community. Variables that could have contributed to the decline of stunting in Ethiopia in children less than 5 years of age include markers of child health, mother's nutritional status, mother's educational level, and environmental hygiene.     

A review of child stunting determinants in Indonesia

Child stunting reduction is the first of 6 goals in the Global Nutrition Targets for 2025 and a key indicator in the second Sustainable Development Goal of Zero Hunger. The prevalence of child stunting in Indonesia has remained high over the past decade, and at the national level is approximately 37%. It is unclear whether current approaches to reduce child stunting align with the scientific evidence in Indonesia. We use the World Health Organization conceptual framework on child stunting to review the available literature and identify what has been studied and can be concluded about the determinants of child stunting in Indonesia and where data gaps remain. Consistent evidence suggests nonexclusive breastfeeding for the first 6 months, low household socio‐economic status, premature birth, short birth length, and low maternal height and education are particularly important child stunting determinants in Indonesia. Children from households with both unimproved latrines and untreated drinking water are also at increased risk. Community and societal factors—particularly, poor access to health care and living in rural areas—have been repeatedly associated with child stunting. Published studies are lacking on how education; society and culture; agriculture and food systems; and water, sanitation, and the environment contribute to child stunting. This comprehensive synthesis of the available evidence on child stunting determinants in Indonesia outlines who are the most vulnerable to stunting, which interventions have been most successful, and what new research is needed to fill knowledge gaps.     

Age‐appropriate infant and young child feeding practices are associated with child nutrition in India: insights from nationally representative data

Age‐appropriate infant and young child feeding (IYCF) practices are critical to child nutrition. The objective of this paper was to examine the associations between age‐appropriate IYCF practices and child nutrition outcomes in India using data from ～18 463 children of 0–23.9 months old from India's National Family Health Survey, 2005–06‐3. The outcome measures were child height‐for‐age z‐score (HAZ), weight‐for‐age z‐score (WAZ), weight‐for‐height z‐score, stunting, underweight and wasting. Linear and logistic regression analyses were used, accounting for the clustered survey data. Regression models were adjusted for child, maternal, and household characteristics, and state and urban/rural residence. The analyses indicate that in India suboptimal IYCF practices are associated with poor nutrition outcomes in children. Early initiation of breastfeeding and exclusive breastfeeding were not associated with any of the nutrition outcomes considered. Not consuming any solid or semi‐solid foods at 6–8.9 months was associated with being underweight (P < 0.05). The diet diversity score and achieving minimum diet diversity (≥4 food groups) for children 6–23 months of age were most strongly and significantly associated with HAZ, WAZ, stunting and underweight (P < 0.05). Maternal characteristics were also strongly associated with child undernutrition. In summary, poor IYCF practices, particularly poor complementary foods and feeding practices, are associated with poor child nutrition outcomes in India, particularly linear growth.     

Infant and young child feeding practices and stunting in two highland provinces in Ecuador

The first two years of life are critical for growth and development. Little is known about infant and young child feeding (IYCF) practices in the Ecuadorian highlands and how they contribute to stunting. With the objective of understanding nutritional status and the influencing factors to design an intervention, we assessed the nutritional status of 293 infants and children between 0 and 24 months of age, living in 14 communities in the provinces of Tungurahua and Chimborazo using a cross‐sectional study design. We used the WHO IYCF indicators to assess feeding practices; estimated dietary intake with 24‐h recalls; and identified nutritious local foods by food frequency questionnaires. Multiple regression modelling was performed to identify correlates of nutritional status. Stunting was found in 56.2% of children. Mean protein, vitamin A and vitamin C intakes were above recommendations for all ages. Only infants 6.0 to 8.9 months of age and non‐breastfed children 12–23.9 months of age consumed energy intakes below recommendations. Younger age groups had below recommended intakes for iron and calcium. While mean complementary food densities met recommendations for protein, vitamin A, vitamin C and energy, those for zinc, iron and calcium were lower than recommended. Older age, respiratory infections and being male were predictors of lower HAZ, whereas early initiation of breastfeeding, higher socioeconomic status, consumption of iron‐rich foods and higher dietary protein density were protective. Interventions that promote and support optimal breastfeeding practices and enable increased consumption of nutritious local foods have potential to contribute to reducing stunting in this vulnerable population. © 2016 John Wiley & Sons Ltd     

Subsequent pregnancy affects nutritional status of previous child: a study from Bhutan

In a rural area of Bhutan, anthropometric measurements of 113 children and interviews with their mothers were carried out monthly for 32 months. The purpose of the study was to investigate the effect of a mother's subsequent pregnancy on growth in weight of her last–born child. The children whose mothers had a subsequent birth interval of 18–30 months were matched for date of birth with children whose mothers did not become pregnant. Growth of the children during the subsequent pregnancy was compared with growth during the same period of children whose mothers were not pregnant. A statistically significant reduction of 28% was found (p < 0.05), which was most pronounced in early pregnancy. A similar trend was found for change in mid–upper–arm circumference (p < 0.05). The study provides evidence of a causal relationship between a moderate subsequent pregnancy interval and a concurrent reduction in growth rate for the previous child     

Low‐birthweight infants born to short‐stature mothers are at additional risk of stunting and poor growth velocity: Evidence from secondary data analyses

Low‐birthweight (LBW) infants are at an increased risk of stunting and poor linear growth. The risk might be additionally higher in these infants when born to short mothers. However, this hypothesis has been less explored. The objective of this secondary data analysis was to determine the risk of linear growth faltering and difference in linear growth velocity in LBW infants born to short mothers (<150 cm) compared to those born to mothers with height ≥150 cm during the first year of life. This analysis uses data from a community‐based randomized controlled trial of 2,052 hospital‐born term infants with birthweight ≤2,500g from urban low–middle socioeconomic neighbourhoods in Delhi, India. Data on maternal height and infant birth length were available from 1,858 (90.5%) of the infants. Infant anthropometry outcomes were measured at birth, 3, 6, 9, and 12 months of age. We found that infants born to short mothers had around twofold higher odds of stunting and lower attained length‐for‐age Z scores compared to infants of mothers with height ≥150 cm, at all ages of assessment. Linear growth velocity was significantly lower in infants of short mothers particularly in the first 6 months of life. We conclude that LBW infants born to short mothers are at a higher risk of stunting and have slower postnatal growth velocity resulting in lower attained length‐for‐age Z scores in infancy. Evidence‐based strategies need to be tested to optimize growth velocity in LBW infants especially those born to short mothers.     

Determinants of stunting in children under 5 years in Madagascar

Madagascar is among countries where the prevalence of stunting is dramatically high in under 5 years old children. This study investigated the determinants of child stunting based on the UNICEF framework on the causes of malnutrition. A cutoff at 24 months was used to separate the child population into two groups. By using the latest Demographic and Health Survey (2009), logistic regressions were performed to determine the variables associated with stunting. In 2009, 40.1% of the 1,863 children aged 0–23 months and 53.9% of the 2,911 children aged 24–59 months were stunted contributing to the 48.5% overall stunting prevalence in the sample. Girls were less likely to be stunted (adjusted odds ratio with confidence interval [AOR] = 0.69 [0.55–0.88] and 0.84 [0.72–0.97], p < 0.01) than boys; the risk of stunting increased with age. Regarding underlying predictors, increased maternal height was associated with lower odds of stunting in both age groups (AOR = 0.75 [0.68–0.83] and 0.69 [0.61–0.77], p < 0.001). Children living in households using iodized salt (>15 ppm) had lower risk of stunting in the younger group (AOR = 0.76 [0.61–0.94], p < 0.05). Children living in urban areas were less likely to be stunted in both age groups (AOR = 0.67 [0.51–0.88] and 0.73 [0.59–0.90] respectively, p < 0.01]. Region of residence was also a significant basic factor for stunting. This study contributes to the understanding of the determinants of child stunting in Madagascar. The results confirmed the need for specific interventions for each of the two age groups.     

Early childhood development and stunting: Findings from the MAL‐ED birth cohort study in Bangladesh

Information on the association between stunting and child development is limited from low‐income settings including Bangladesh where 36% of children under‐ 5 are stunted. This study aimed to explore differences in early childhood development (ECD) between stunted (length‐for‐age z‐score [LAZ] < ?2) and nonstunted (LAZ ≥ ?2) children in Bangladesh. Children (n = 265) aged 6–24 months who participated in the MAL‐ED birth cohort study were evaluated by trained psychologists at 6, 15, and 24 months of age using the Bayley Scales of Infant and Toddler Development‐III; child length and weight were measured using standard procedures. ECD scores (z‐scores derived from cognitive, motor, language and socio‐emotional skills) were compared between stunted, underweight (weight‐for‐age z‐score < ?2), and wasted (weight‐for‐length z‐score < ?2) children, controlling for child age and sex and maternal age, education, body mass index (BMI), and depressive symptoms. Stunted children had significantly lower ECD scores than their nonstunted peers on cognitive (P = .049), motor (P < .001), language (P < .001) and social–emotional (P = .038) scales where boys had significantly lower fine motor skills compared with girls (P = .027). Mother's schooling and BMI were significant predictors of ECD. Similar to stunting, underweight children had developmental deficits in all domains (cognitive: P = .001; fine motor: P = .039, and P < .001 for both gross motor and total motor; expressive communication: P = .032; total language: P = .013; social–emotional development: P = .017). Wasted children had poor motor skills (P = .006 for the fine motor; P < .001 for both gross motor and total motor development) compared with the nonwasted peers. Early childhood stunting and underweight were associated with poor developmental outcomes in Bangladesh.     

Determinants of stunting at 6, 12, 24 and 60 months and postnatal linear growth in Pakistani children

A "nested" case-control design was used to identify cases from a longitudinally followed cohort of 1236 newborns registered during 1984-1987, living in three socioeconomically different areas. The children had a length <-2SDS (standard deviation scores) at 6, 12, 24 and 60 mo of age using the NCHS reference. The controls were matched for gender, area and month of birth. A logistic regression analysis was used for determining the risk factors for stunting at each age. Postnatal linear growth was also examined in these two groups of children and body size was compared with the NCHS reference and that of upper-middle-class children (n = 240). At 6 mo of age, prematurity and duration of breastfeeding showed a significant association with stunting. At 12 mo, maternal height, birthweight and stunting at 6 mo, while at 24 mo, stunting at 6, 12 and 18 mo were identified as important factors. At 60 mo, no other factors besides previous stunting could be identified. The mean height reached at 60 mo showed a deficit of 6 and 13 cm for the controls and the cases, respectively, compared to the NCHS reference. Twenty-eight percent of the children from the two poor areas who were stunted at 6 mo had improved by 60 mo of age. CONCLUSION: The risk factors for stunting varied at different ages, relating more to feeding at early ages and to previous stunting, predominantly at higher ages. The linear growth showed that faltering increased with age when cases and controls were treated separately. Recovery from stunting could also be demonstrated.     

Individual and contextual factors associated with childhood stunting in Nigeria: a multilevel analysis

Stunting, a form of undernutrition, is the best measure of child health inequalities as it captures multiple dimensions of children's health, development and the environment where they live. The aim of this study was to quantify the predictors of childhood stunting in Nigeria. This study used data obtained from the 2008 Nigeria Demographic and Health Survey (NDHS). A total of 28 647 children aged 0–59 months included in NDHS in 2008 were analysed in this study. We applied multilevel multivariate logistic regression analysis in which individual‐level factors were at the first level and community‐level factors at the second level. The percentage change in variance of the full model accounted for about 46% in odds of stunting across the communities. The present study found that the following predictors increased the odds of childhood stunting: male gender, age above 11 months, multiple birth, low birthweight, low maternal education, low maternal body mass index, poor maternal health‐seeking behaviour, poor household wealth and short birth interval. The community‐level predictors found to have significant association with childhood stunting were: child residing in community with high illiteracy rate and North West and North East regions of the country. In conclusion, this study revealed that both individual‐ and community‐level factors are significant determinants of childhood stunting in Nigeria.     

Infant age at egg introduction and malnutrition‐related child growth in the United States

To evaluate the relationship between infant age of egg introduction and malnutrition‐related growth outcomes in the United States, we analysed secondary data of 1716 mother–child dyads in the Infant Feeding Practices Study II and its Year 6 Follow‐Up Study. Malnutrition‐related growth outcomes included body mass index z‐score (BMIZ), obesity (weight‐for‐height z‐score [WHZ] ≥3 or BMIZ ≥ 2), WHZ, wasting (WHZ < −2), height‐for‐age z‐score (HAZ), and stunting (HAZ < –2). Infant age at egg introduction was analysed as a continuous variable. We used generalised estimating equations to estimate the mean difference in continuous outcomes and relative risk [RR]) for binary outcomes, adjusting for related maternal and child confounders. We also explored interactions with child sex, maternal race/ethnicity, maternal educational level, ever breastfeeding, and formula feeding. In the total sample, a later infant age at egg introduction was associated with a lower mean difference in HAZ (confounder‐adjusted mean difference = −0.08, 95% confidence interval [CI]: −0.12 to −0.03 per month) and a higher risk of stunting (confounder‐adjusted RR = 1.17, 95% CI: 1.03–1.33 per month) at 6 years. The associations between infant age at egg introduction and 12‐month growth outcomes differed by child sex. Among females but not among males, later introduction of eggs was associated with a lower mean WHZ (−0.06 [−0.12 to 0.00] per month) at 12 months. Later egg introduction during infancy was associated with a lower mean HAZ and a higher risk of stunting in 6‐year‐old children. Besides this, it was associated with a lower WHZ among females at 12 months.     

Maternal depression is associated with child undernutrition: A cross‐sectional study in Ethiopia

Child undernutrition is widespread in low‐ and middle‐income countries (LMIC) and is associated with health and economic losses. Undernutrition is estimated to contribute to 3.1 million deaths per year in children less than 5 years of age. A complex causal and contextual factors contributing to child undernutrition have been assessed, but maternal depression, which could contribute to child undernutrition by interfering with the mother's child caring practice and ability, has been received little attention. The objective of this study was to assess the association between maternal postpartum depression symptoms and infant (5–10 months of age) stunting in northern Ethiopia. A community‐based cross‐sectional study was conducted among mother–infant pairs (n = 232) between March and April 2018. Through interviewer‐administrated questionnaire, information on sociodemographic variables were collected, and maternal depression symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS≥13). Infants' length and weight were measured and converted to length and weight for age Z scores using the WHO growth standards. Breastfeeding was a norm, but the adequacy of complementary feeding practice was sub‐optimal. Only 25% of the infants met the minimum meal frequency (MMF), less than 10% met the minimum dietary diversity (MMD; 9%) or minimum acceptable diet (7%). Maternal depression was prevalent (22.8%) and was significantly associated with inappropriate complementary feeding and stunting (P < .05). Improving complementary feeding practices is central to preventing stunting in this and other settings. However, such efforts should integrate interventions that address maternal depression to improve child feeding and caring practices to effectively prevent stunting.     

Recurrence of focal segmental glomerulosclerosis in renal allograft: An in‐depth review

Vinai M, Waber P, Seikaly MG. Recurrence of focal segmental glomerulosclerosis in renal allograft: An in‐depth review.
Pediatr Transplantation 2010: 14: 314–325. © 2010 John Wiley & Sons A/S. Abstract: Focal segmental glomerulosclerosis is a major cause of chronic kidney disease requiring transplantation in children. Recurrence rate in the renal allograft transplantation is as high as 50%. Recurrence of FSGS is associated with renal dysfunction and early graft loss. To date, there is no established therapy for recurrent FSGS after renal transplant. We have reviewed the current English literature in order to summarize current practices with emphasis on graft outcome. We conclude that despite multiple approaches to the post transplant management of recurrent FSGS, none have been shown to be consistently beneficial. Currently, pheresis combined with high dose anti‐calcineurin with or without rituximab seems to be the most promising. Further controlled studies are needed to define the optimal therapeutic regimens to treat recurrent of FSGS.     

The co‐occurrence of anaemia and stunting in young children

Anaemia and stunting are prevalent nutritional problems among children of low‐income countries that have profound effects on development, morbidity, and mortality. Many use a single conceptual framework to identify the basic determinants of these and other forms of malnutrition. One would expect that problems with matching underlying determinants should co‐occur in affected individuals to a greater degree than by chance. In 2 populations of children—ages 6–18 months in Bihar, India, (n = 5,664) and 6–36 months in Lambayeque, Peru (n = 688)—we measured the frequency of the co‐occurrence of anaemia and stunting. We compared this value with the value expected by chance, the product of the prevalence of anaemia and stunting, using a chi‐square test. We also built logistic regression models for each condition. The frequency of co‐occurrence in the Indian population was 21.5%, and in the Peruvian population, it was 30.4%, which are similar to frequencies expected by chance, 21.3% (p = .97) and 31.5% (p = .85). In Peru, anaemia was associated with age and consumption of treated water. Stunting was associated with age, sex, dietary diversity, hand washing, language spoken, and wealth. In India, anaemia was associated with age, sex, caste, dietary diversity, and household hunger. Stunting was associated with age, sex, caste, wealth, and maternal illiteracy. Despite some basic shared factors, anaemia and stunting are more independent than commonly assumed. Interventions that target children based on 1 condition may miss children with the other form of malnutrition.     

Children concurrently wasted and stunted: A meta‐analysis of prevalence data of children 6–59 months from 84 countries

Children can be stunted and wasted at the same time. Having both deficits greatly elevates risk of mortality. The analysis aimed to estimate the prevalence and burden of children aged 6–59 months concurrently wasted and stunted. Data from demographic and health survey and Multi‐indicator Cluster Surveys datasets from 84 countries were analysed. Overall prevalence for being wasted, stunted, and concurrently wasted and stunted among children 6 to 59 months was calculated. A pooled prevalence of concurrence was estimated and reported by gender, age, United Nations regions, and contextual categories. Burden was calculated using population figures from the global joint estimates database. The pooled prevalence of concurrence in the 84 countries was 3.0%, 95% CI [2.97, 3.06], ranging from 0% to 8.0%. Nine countries reported a concurrence prevalence greater than 5%. The estimated burden was 5,963,940 children. Prevalence of concurrence was highest in the 12‐ to 24‐month age group 4.2%, 95% CI [4.1, 4.3], and was significantly higher among boys 3.54%, 95% CI [3.47, 3.61], compared to girls; 2.46%, 95% CI [2.41, 2.52]. Fragile and conflict‐affected states reported significantly higher concurrence 3.6%, 95% CI [3.5, 3.6], than those defined as stable 2.24%, 95% CI [2.18, 2.30]. This analysis represents the first multiple country estimation of the prevalence and burden of children concurrently wasted and stunted. Given the high risk of mortality associated with concurrence, the findings indicate a need to report on this condition as well as investigate whether these children are being reached through existing programmes.     

“A child may be tall but stunted.” Meanings attached to childhood height in Tanzania

Stunting affects large numbers of under‐fives in Tanzania. But do caretakers of under‐fives recognize height as a marker of child growth? What meanings do they attach to linear growth? An ethnographic study using cultural schemas theory was conducted in a rural community in Southeastern Tanzania to investigate caregivers' conceptualizations of child height in relation to growth and the meanings attached to short stature. Data for the study were collected through 19 focus group discussions, 30 in‐depth interviews, and five key informant interviews with caregivers of under‐fives, including mothers, fathers, elderly women, and community health workers. Principles of grounded theory guided the data management and analysis. Although caregivers could recognize height increments in children and were pleased to see improvements, many held that height is not related to nutrition, health, or overall growth. They referred to short stature as a normal condition that caregivers cannot influence; that is, as a function of God's will and/or heredity. While acknowledging short stature as an indicator of stunting, most participants said it is not reliable. Other signs of childhood stunting cited by caregivers include a mature‐looking face, wrinkled skin, weak or copper‐coloured hair, abnormal shortness and thinness, delayed ability to crawl/stand/walk, stunted IQ, and frequent illness. Culturally, a child could be tall but also stunted. Traditional rather than biomedical care was used to remedy growth problems in children. Public health programmers should seek to understand the local knowledge and schemas of child stature employed by people in their own context before designing and implementing interventions.     

Dissimilarities across age groups in the associations between complementary feeding practices and child growth: Evidence from rural Togo

Adequate complementary feeding (CF) practices are essential for achieving optimal growth but challenging to measure comprehensively. This paper describes CF practices in 2,034 children aged 6–23 months and investigates their relationships with length‐for‐age z‐score (LAZ) and stunting, using cross‐sectional data collected from May to July 2014 in rural Northern Togo. The World Health Organization infant and young child feeding indicators were computed, along with ancillary indicators on feeding style and timing of introduction of complementary foods. The associations between those indicators and children's LAZ and stunting were assessed using linear and logistic regressions after stratification by age group and adjustment for children, maternal, and household characteristics. CF practices were suboptimal, and their associations with child's growth varied across indicators and age groups. In children aged 6–11 months, reaching the minimum dietary diversity and the minimum acceptable diet was associated with higher LAZ (p < .05). In 18‐ to 23‐month‐old children, only the consumption of iron‐rich food was associated with both LAZ (p = .02) and stunting (p = .05). The late introduction of family foods was associated with higher odds of being stunted and lower LAZ in children aged 12–17 months (p < .001). The untimely introduction of porridge was associated with higher odds of stunting in children aged 9–23 months (p < .05). Unexpectedly, helping the child to eat was negatively associated with linear growth in all age groups. These findings nurture the ongoing process of review of the World Health Organization infant and young child feeding indicators showing that, in their current version, they hardly capture the links between CF and child's growth at different ages.     

Handwashing,sanitation and family planning practices are the strongest underlying determinants of child stunting in rural indigenous communities of Jharkhand and Odisha,Eastern India: a cross‐sectional study

The World Health Organisation has called for global action to reduce child stunting by 40% by 2025. One third of the world's stunted children live in India, and children belonging to rural indigenous communities are the worst affected. We sought to identify the strongest determinants of stunting among indigenous children in rural Jharkhand and Odisha, India, to highlight key areas for intervention. We analysed data from 1227 children aged 6–23.99 months and their mothers, collected in 2010 from 18 clusters of villages with a high proportion of people from indigenous groups in three districts. We measured height and weight of mothers and children, and captured data on various basic, underlying and immediate determinants of undernutrition. We used Generalised Estimating Equations to identify individual determinants associated with children's height‐for‐age z‐score (HAZ; p < 0.10); we included these in a multivariable model to identify the strongest HAZ determinants using backwards stepwise methods. In the adjusted model, the strongest protective factors for linear growth included cooking outdoors rather than indoors (HAZ +0.66), birth spacing ≥24 months (HAZ +0.40), and handwashing with a cleansing agent (HAZ +0.32). The strongest risk factors were later birth order (HAZ ?0.38) and repeated diarrhoeal infection (HAZ ?0.23). Our results suggest multiple risk factors for linear growth faltering in indigenous communities in Jharkhand and Odisha. Interventions that could improve children's growth include reducing exposure to indoor air pollution, increasing access to family planning, reducing diarrhoeal infections, improving handwashing practices, increasing access to income and strengthening health and sanitation infrastructure.     

World Health Organization infant and young child feeding indicators and their associations with child anthropometry: a synthesis of recent findings

As the World Health Organization (WHO) infant and young child feeding (IYCF) indicators are increasingly adopted, a comparison of country‐specific analyses of the indicators' associations with child growth is needed to examine the consistency of these relationships across contexts and to assess the strengths and potential limitations of the indicators. This study aims to determine cross‐country patterns of associations of each of these indicators with child stunting, wasting, height‐for‐age z‐score (HAZ) and weight‐for‐height z‐score (WHZ). Eight studies using recent Demographic and Health Surveys data from a total of nine countries in sub‐Saharan Africa (nine), Asia (three) and the Caribbean (one) were identified. The WHO indicators showed mixed associations with child anthropometric indicators across countries. Breastfeeding indicators demonstrated negative associations with HAZ, while indicators of diet diversity and overall diet quality were positively associated with HAZ in Bangladesh, Ethiopia, India and Zambia (P < 0.05). These same complementary feeding indicators did not show consistent relationships with child stunting. Exclusive breastfeeding under 6 months of age was associated with greater WHZ in Bangladesh and Zambia (P < 0.05), although CF indicators did not show strong associations with WHZ or wasting. The lack of sensitivity and specificity of many of the IYCF indicators may contribute to the inconsistent associations observed. The WHO indicators are clearly valuable tools for broadly assessing the quality of child diets and for monitoring population trends in IYCF practices over time. However, additional measures of dietary quality and quantity may be necessary to understand how specific IYCF behaviours relate to child growth faltering.