Child stunting from birth to age two years: The Birhan Cohort in Ethiopia.

Objective: Although there has been a reduction in stunting (low height/length for age), the prevalence of malnutrition in Ethiopia is still high. Child growth patterns and estimates of stunting are needed to determine vulnerabilities and potential for recovery. We collected longitudinal data to determine the prevalence, incidence and reversal of stunting among children aged 0-24 months. Methods: We conducted a cohort study of 4,354 children between December 2018 and November 2020 in the Birhan maternal and child health cohort in North Shewa Zone, Amhara Ethiopia. Children who had their length measured at least once were included in this study. Results: Among the 4,354 children enrolled, 3,674 (84.4%) were included. Our findings indicate that median population-level length is consistently below global standards from birth to age two. Growth velocity was slowest compared to global standards during the neonatal period and after children reached six months of age. The observed prevalence of stunting was highest at age two (57.9%). Incidence of stunting increased over time and reversal was highest between the ages of birth to six months. We found substantial heterogeneity in anthropometric measurements, which we addressed by fitting modeled growth trajectories for each child. Conclusion: Overall, the evidence from this study highlights a chronically malnourished population with much of the burden driven by growth faltering during the neonatal periods as well as after 6 months of age. To end all forms of malnutrition, growth faltering in populations such as that in young children in Amhara, Ethiopia needs to be addressed. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This study has been supported by the Bill & Melinda Gates Foundation (Grant number INV-010382 and INV-003612). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical clearance was obtained from the Ethics Review Board (IRB) of Saint Pauls Hospital Millennium Medical college, Boston Childrens Hospital, and Harvard T.H. Chan School of Public Health. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data are available upon reasonable request.