The determinants of growth failure in children under five in 25 low- and middle-income countries

Thumbnail Image
File version
Version of Record (VoR)
Jiang, Stephen
Sung, Jerry
Sawhney, Rakshat
Cai, Jinxuan
Xu, Huaying
Ng, Shu Kay
Sun, Jing
Griffith University Author(s)
Primary Supervisor
Other Supervisors
File type(s)

Background: Past studies have identified determinants of growth failure (GF) such as socio-economic, nutritional, parenting, and inequality factors. However, few studies investigate the numerous causes of GF across multiple countries. By analysing the data of children under five in 25 low and middle-income countries, this study aims to examine the correlations of determinants with GF to identify the strongest modifiable risk factors. Methods: Cross-sectional study design was used, and data were collected across 25 LMICs by the United Nations Children’s Fund in 2019. Regions and households were randomly selected in participating LMICs. The four outcome measures were stunting, wasting, underweight and low body mass index (BMI). Results: Multilevel analysis was performed to identify the impact of country, suburb, and household levels on the variance of outcome variables. GF measures were significantly correlated with low gross domestic product (GDP) per capita (odds ratio (OR) = 2.482), rural areas (OR = 1.223), lack of health insurance (OR = 1.474), low maternal education (OR = 2.260), lack of plain water (OR = 1.402), poor maternal physical caregiving ability (OR = 1.112), low carbohydrate consumption (OR = 1.470), and continued breastfeeding in children >12 months old (OR = 0.802). Conclusions: By identifying key GF risk factors, this study may provide valuable insights for policymaking and interventions. This may allow the prioritisation of resources within countries for preventative measures to be developed.

Journal Title
Journal of Global Health
Conference Title
Book Title
Thesis Type
Degree Program
Publisher link
Patent number
Grant identifier(s)
Rights Statement
Rights Statement
© The Author(s) 2023. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Item Access Status
Access the data
Related item(s)
Major global burdens of disease
Public health
Persistent link to this record
Jiang, S; Sung, J; Sawhney, R; Cai, J; Xu, H; Ng, SK; Sun, J, The determinants of growth failure in children under five in 25 low- and middle-income countries, Journal of Global Health, 2023, 13, pp. 04077