Early-Life Exposure to Economic Shocks and Association with Childhood Malnutrition: A Pooled Analysis of 230 Nationwide Surveys from 68 Low- and Middle-Income Countries

Abstract

Background: The relationship between economic growth and nutrition is not yet fully understood in the context of the new nutrition reality where most low- and middle-income countries (LMICs) face an increasing double burden of malnutrition (DBM). We aimed to investigate the association between early-life exposure to economic shocks and multiple forms of childhood malnutrition in LMICs.Methods: We pooled cross-sectional data of children under five from Demographic and Health Surveys and longitudinal income data from the World Inequality Database. An economic shock was defined as any negative income growth and was tested at intensity levels of greater than -1%, -5%, and -10%. Outcomes included stunting, wasting, overweight/obesity, concurrent wasting and stunting (WaSt), and DBM (stunting and overweight). Adjusted associations of economic shocks, at different critical windows (year of the interview, birth, first 1,000 days of life), with malnutrition outcomes were estimated by Poisson regression models with robust errors.Findings: A total of 1,643,898 children across 230 surveys in 68 LMICs were included. Negative income shocks in the year of interview were associated with 5% and 13% increases in the prevalence of wasting (prevalence ratio [PR]: 1.05, 95%CI: 1.03-1.08) and severe wasting (1.13, 1.08-1.18), respectively. Dose-response associations according to the intensity of income shock in the year of birth were found for stunting (-1%: 1.02, 1.01-1.03; -5%: 1.03, 1.02-1.04; -10%: 1.06, 1.05-1.07) and severe stunting (-1%: 1.04, 1.03-1.06; -5%: 1.06, 1.04-1.07; -10%: 1.10, 1.08-1.12). In children aged 2-4 years, income shocks during the first 1,000 days of life strongly increased the prevalence of DBM by 30% (1.30, 1.22-1.39) and overweight by 14% (1.14, 1.09-1.19). We also found a strong dose-response association between the intensity of income shock during the first 1,000 days and DBM (-1%: 1.22, 1.14-1.30; -5%: 1.30, 1.19-1.42; -10%: 1.35, 1.19-1.54).Interpretation: Exposure to negative income shocks can significantly increase the risk of various forms of malnutrition during childhood, with critical windows of vulnerability that vary based on the timing of economic instability and the specific type of malnutrition. Policymakers and public health practitioners must recognize these critical periods and develop targeted interventions to safeguard maternal and child nutrition, particularly during times of economic crises.

Keywords: Economic shocks, Undernutrition, Overnutrition, Double burden of malnutrition, Child, Critical windows, Low income countries, Middle income countries.