Correlates of better linear growth among children in sub-Saharan Africa: Cross sectional survey analysis of positive deviants in poor households

Objectives: To examine the sociodemographic correlates associated with better linear growth among children under 5 years living in poor households Design: Cross-sectional Setting: Ghana, Kenya, Democratic Republic of Congo (DRC), Nigeria and Mozambique Participants: Singleton children aged 0 to 59 months, born to mothers aged 15 to 49 years. Information on children was obtained through face-to-face interviews with mothers. Primary outcome measure: Child height-for-age Z-scores (HAZ), categorised into HAZ≥-2 standard deviations (SD) (better growth/not stunted) and HAZ≤-2 SD (stunted/poor growth). Results: A unit change in maternal years of education was associated with increased odds of better growth among children living in poor households in DRC [adjusted odds ratio (aOR)= 1.03, 95% CI=1.01,1.07)], Ghana (aOR=1.06, 95% CI=1.01,1.11), Kenya (aOR=1.03, 95% CI= 1.01, 1.05) and Nigeria (aOR=1.08, 95%=1.06,1.10). Maternal antenatal attendance of at least four visits was associated positively with better child growth in DRC (aOR=1.32, 95% CI=1.05, 1.67) and Ghana (aOR=1.67, 95% CI=1.19, 2.33). The association did not reach statistical significance in the remaining three countries. In Ghana, Mozambique and DRC, breastfeeding was associated significantly with the likelihood of better linear growth when only socio-demographic correlates were included in the models, but disappeared after the inclusion of child level covariates. In Nigeria, maternal normal weight was associated with increased odds (aOR=1.24, 95% CI=1.08, 1.43) of better growth among children living in poor households, so was overweight (aOR=1.51, 95% CI= 1.24, 1.83). In all the countries except Ghana, child biological factors such as sex and age were associated with reduced odds of better linear growth. Conclusions: The socio-demographic factors included in this analysis have the potential to promote linear growth of children under 5 years living in poor households. Interventions aimed at promoting linear growth among children living in poverty should target at enhancing these factors. Keywords: child growth, sub-Saharan Africa, positive deviance, cross sectional survey