For example, in the unadjusted models for India, a one-unit increase in the wealth index was associated with a 0. In the adjusted model for comparison, the association between the wealth index and HAZ was 0.
Growing up in poverty findings from young lives (palgrave studies on…
Results from models that included interactions between the wealth index and survey round are presented in Table 4 with some heterogeneity in the magnitude and significance of estimates. For both cohorts in Peru and Vietnam, there were significant differences in the association between baseline wealth index and HAZ by survey round, with greater influences of baseline wealth index in round 2. For the older cohort in Peru, baseline wealth index had a smaller influence in round 3. Models include survey and sentinel site fixed effects and random effects for individuals.
Associations between wealth index at baseline and height-for-age z-score, by survey round a. Table A5 provides the percentage of children experiencing any changes in wealth index tertile between rounds. Approximately a quarter to half of children experienced changes in wealth index tertiles between rounds with variation between rounds, cohorts, and countries. Table A6 contains results from the adjusted models examining associations between the baseline wealth index and HAZ for children who experienced either upward or downward changes in wealth index to children who did not experience any changes over time.
For both cohorts in India, Peru, and Vietnam, there were significant differences in the associations between wealth index tertile and stunting with larger associations for children who experienced no change in wealth index compared to those who did experience changes in wealth index over time. However, despite differences in associations, baseline wealth index affected both groups with higher HAZ for wealthier individuals. This study demonstrates that household wealth in early life influences physical growth.
For example, higher HAZ and lower odds of stunting in later life were predicted among children who lived in wealthier households early on. We observe these associations in all countries, suggesting that living standards matter in a variety of contexts. In addition, the current analysis extends previous work 36 , by assessing the lagged effects of early life experiences on child health measured during late childhood for the younger cohort and the beginning of adolescence for the older cohort. We show that even among children who experienced changes in living standards, the influence of early poverty persisted.
Thus, our study finds that early experiences of deprivation have lasting influences through infancy, childhood, and adolescence in both cohorts in all four countries. Another key finding of the study is that associations between household wealth and HAZ are present for both the younger and older cohorts even though baseline wealth index was measured at different life stages.
For the younger cohort, baseline wealth index was measured at age 6—18 months; in comparison, for the older cohort, baseline wealth index was measured when the children were 7—8 years old, representing an exposure much later in life.
Despite the difference in the timing of measurement, we find that wealth in early life is significantly associated with stunting in both cohorts. Thus, the influences of early poverty on older children, who are beyond the critical period of 1, days [beginning at conception and ending at the second birthday during which most growth faltering occurs 44 ], suggest that growth faltering may occur among older children 45 and that household living standards in later childhood, beyond the critical period, affect physical growth.
One explanation is that the association between baseline wealth index and stunting for the older cohort is confounded by persistent poverty from birth, suggesting that poor living standards at ages seven and eight do not matter. Even for the younger cohort, there is concern that the influence of baseline wealth index is conflated with prolonged experiences of poverty over their life-course. Comparisons of children who did and did not experience changes in wealth, however, showed only slightly larger associations between baseline wealth index and physical growth for children who experienced no change in living standards as compared to children who experience upward or downward mobility in wealth.
Similar associations between baseline wealth index and physical growth for these two groups suggest that the early experience of deprivation may have an independent influence on growth that is not mediated through later life wealth. For the older cohort, we can use persistence in wealth index over the Young Lives follow-up period as a proxy for continuity in living standards before the study's inception.
Similar associations between baseline wealth index and physical growth for the group that did and did not experience change in wealth index further emphasizes the importance of living standards at ages seven and eight, refuting the explanation that the influence of baseline wealth index is entirely attributable to persistent, earlier life poverty for the older cohort. However, inferring causal relationships between wealth and physical growth is complicated by endogeneity problems; there are undoubtedly many unobserved factors that affect both the wealth index and growth even though we included several covariates in order to reduce confounding.
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In addition, for the members of the older cohort, aged 7—8 at the first survey, it is possible that the baseline wealth index may be affected by poor physical growth. For example, children who are stunted are much more likely to contract infectious diseases 3 and may need hospitalization which requires selling material possessions, thereby lowering the household's wealth index. Although, it is impossible to entirely rule out reverse causation and confounding to obtain a truly exogenous measure of wealth in early life and estimate causal relationships, we were able to assess the downstream influences of an early life exposure on later life outcomes by using longitudinal data from Young Lives.
Finally, it should be noted that the wealth index may be a poor measure of income or consumption However, it has been widely used as a measure of living standards in other studies including the Demographic and Health Surveys. This study contributes new insights about the salient and persistent associations between wealth in early life and physical growth.
In particular, it adds to recent work on social determinants of child undernutrition and growth 46 — 49 and builds on the work in the Lancet Series on maternal and child undernutrition 3 by showing that living standards early in life may influence physical growth in early infancy, childhood, and adolescence. Even among older children, who experience poverty beyond the 1, days window, and children living in households with changes in living standards, early experiences of poverty and deprivation have strong and persistent effects later in life.
- Growing Up in Poverty: Findings from Young Lives - CROP.
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More work should focus on the explanations for the lasting effects of early adversity, particular for children living in low- and middle-income countries who experience a disproportionate burden of both poverty and low physical growth. Our findings are important for policymakers, suggesting that improvements in living standards, particularly those experienced in the early years, may improve child nutrition and child health, even beyond the critical window of 1, days.
Source: From Ref. Associations between wealth index at baseline and stunting, by survey round a. Children who experienced changes in wealth index over survey cycles, by country and cohort. Associations between height-for-age z-scores and baseline wealth index, controlling for changes in wealth index over Young Lives surveys a. The authors have not received any funding or benefits from industry or elsewhere to conduct this study. National Center for Biotechnology Information , U. Journal List Glob Health Action v. Glob Health Action. Published online Feb 5. Subramanian 1.
Tracing the consequences of child poverty – evidence from the Young Lives study
Jessica M. Author information Article notes Copyright and License information Disclaimer. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC.
Abstract Background Stunting, a form of anthropometric failure, disproportionately affects children in developing countries with a higher burden on children living in poverty. Objective We investigate the short- and long-run associations between household wealth in early life with physical growth in childhood in four low- and middle-income countries to understand the persistent implications of early life conditions of poverty and resource constraints on physical growth.
Results Baseline wealth index is significantly associated with higher physical growth rates as suggested by higher HAZ and lower odds of stunting. Conclusions Household wealth in early life matters for physical growth with conditions of poverty and deprivation influencing growth faltering even beyond the 1, days window. Keywords: socioeconomic conditions, poverty, child nutrition, life-course epidemiology.
Methods Study population This study uses data from the Young Lives study, a longitudinal study of child health and well-being in four countries — Ethiopia, India, Peru, and Vietnam 24 — Explanatory measure and covariates Filmer and Pritchett developed the wealth index to measure living standards among households in developing countries because of poor availability of income, wealth, or expenditure data Outcome measures The key outcome of interest was physical growth measured as height-for-age with low height-for-age or stunting as a secondary outcome. Statistical models Descriptive statistics were estimated for each country, pooling across rounds and cohorts.
Sensitivity analyses It is possible that the baseline wealth index represents a lifetime of deprivation affecting children over their life-course. Results Table 1 contains sample sizes by country and cohort with some variation due to attrition and missing data on key covariates. Open in a separate window. Younger cohort Older cohort Ethiopia 1, Table 2 Characteristics of the study sample a. Ethiopia India Peru Vietnam Wealth index Table 3 Associations between wealth index at baseline and height-for-age z-scores a. Robust standard errors adjusted for clustered sampling are presented in parentheses.
Table 4 Associations between wealth index at baseline and height-for-age z-score, by survey round a. Younger cohort Older cohort Ethiopia Wealth index 0. Discussion This study demonstrates that household wealth in early life influences physical growth. Conclusion This study contributes new insights about the salient and persistent associations between wealth in early life and physical growth. Appendix Table A1 Constructing the wealth index. Categories Elements Measurement Housing quality 4 items Number of household members per rooms Continuous variable Wall Dummy variable equal to one if household has brick or plaster wall Roof Dummy variable equal to one if house has sturdy roof Floor Dummy variable equal to one if house has a floor made of finished materials, e.
Radio 2. Refrigerator 3. Television 4. Bicycle 6. Motor vehicle 7. Mobile phone 8. Landline phone 9. Modern bed Table or chair Table A2 Prevalence of stunting in Young Lives, by country and cohort. Standard errors are in parentheses. Table A3 Associations between wealth index at baseline and stunting a. Table A4 Associations between wealth index at baseline and stunting, by survey round a. Table A5 Children who experienced changes in wealth index over survey cycles, by country and cohort.
Table A6 Associations between height-for-age z-scores and baseline wealth index, controlling for changes in wealth index over Young Lives surveys a.
Conflict of interest and funding The authors have not received any funding or benefits from industry or elsewhere to conduct this study. References 1. Improving child nutrition: the achievable imperative for global progress. The state of the world's children in numbers: every child counts. Maternal and child undernutrition and overweight in low-income and middle-income countries. Maternal and child undernutrition: global and regional exposures and health consequences.
Strategy for improved nutrition of children and women in developing countries. An analytical framework for the study of child survival in developing countries.
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