Childhood growth during recovery from acute illness in Africa and South Asia: a secondary analysis of the childhood acute illness and nutrition (CHAIN) prospective cohort

Celine Bourdon, Abdoulaye Hama Diallo, Abu Sadat Mohammad Sayeem Bin Shahid, Md Alfazal Khan, Ali Faisal Saleem, Benson O. Singa, Blaise Siézanga Gnoumou, Caroline Tigoi, Catherine Achieng Otieno, Chrisantus Odhiambo Oduol, Christina L. Lancioni, Christine Manyasi, Christine J. McGrath, Christopher Maronga, Christopher Lwanga, Daniella Brals, Dilruba Ahmed, Dinesh Mondal, Donna M. Denno, Dorothy I. MangaleEmmanuel Chimwezi, Emmie Mbale, Ezekiel Mupere, Gazi Md Salauddin Mamun, Issaka Ouédraogo, James A. Berkley, James M. Njunge, Jenala Njirammadzi, John Mukisa, Johnstone Thitiri, Judd L. Walson, Julie Jemutai, Kirkby D. Tickell, Lubaba Shahrin, Macpherson Mallewa, Md Iqbal Hossain, Mohammod Jobayer Chisti, Molline Timbwa, Moses Mburu, Moses M. Ngari, Narshion Ngao, Peace Aber, Philliness Prisca Harawa, Priya Sukhtankar, Robert H.J. Bandsma, Roseline Maïmouna Bamouni, Sassy Molyneux, Shalton Mwaringa, Shamsun Nahar Shaima, Syed Asad Ali, Syeda Momena Afsana, Sayera Banu, Tahmeed Ahmed, Wieger P. Voskuijl, Zaubina Kazi

Research output: Contribution to journalArticlepeer-review


Background: Growth faltering is well-recognized during acute childhood illness and growth acceleration during convalescence, with or without nutritional therapy, may occur. However, there are limited recent data on growth after hospitalization in low- and middle-income countries. Methods: We evaluated growth following hospitalization among children aged 2–23 months in sub-Saharan Africa and South Asia. Between November 2016 and January 2019, children were recruited at hospital admission and classified as: not-wasted (NW), moderately-wasted (MW), severely-wasted (SW), or having nutritional oedema (NO). We describe earlier (discharge to 45-days) and later (45- to 180-days) changes in length-for-age [LAZ], weight-for-age [WAZ], mid-upper arm circumference [MUACZ], weight-for-length [WLZ] z-scores, and clinical, nutritional, and socioeconomic correlates. Findings: We included 2472 children who survived to 180-days post-discharge: NW, 960 (39%); MW, 572 (23%); SW, 682 (28%); and NO, 258 (10%). During 180-days, LAZ decreased in NW (−0.27 [−0.36, −0.19]) and MW (−0.23 [−0.34, −0.11]). However, all groups increased WAZ (NW, 0.21 [95% CI: 0.11, 0.32]; MW, 0.57 [0.44, 0.71]; SW, 1.0 [0.88, 1.1] and NO, 1.3 [1.1, 1.5]) with greatest gains in the first 45-days. Of children underweight (<−2 WAZ) at discharge, 66% remained underweight at 180-days. Lower WAZ post-discharge was associated with age-inappropriate nutrition, adverse caregiver characteristics, small size at birth, severe or moderate anaemia, and chronic conditions, while lower LAZ was additionally associated with household-level exposures but not with chronic medical conditions. Interpretation: Underweight and poor linear growth mostly persisted after an acute illness. Beyond short-term nutritional supplementation, improving linear growth post-discharge may require broader individual and family support. Funding: Bill & Melinda Gates Foundation OPP1131320; National Institute for Health Research NIHR201813.

Original languageEnglish
Article number102530
Publication statusPublished - Apr 2024


  • Africa
  • Children
  • Growth
  • Hospital
  • Kwashiorkor
  • Length
  • Malnutrition
  • Post-discharge
  • Stunting
  • Vulnerability
  • Wasting
  • Weight
  • “Acute illness”
  • “South asia”


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