presents the frequency and the weighted distribution of maternal height and covariates in the population. Approximately one-third of the children had mothers in the middle height category (150–154.9 cm), with 7.6% (4003/48 075) and 12.2% (5382/ 48 075) of children having mothers in the tallest (≥160 cm) and the shortest (<145 cm) categories, respectively, in the mortality data sets. Similar distribution was observed for the anthropometric failure and anemia data sets.
In the population of all live births, 6% (2550/48 075; 95% CI, 5.7%–6.3%) died before reaching age 5 years. Of the children who survived, 42.2% (14791/ 40 089; 95% CI, 41.2%–43.2%) were underweight, 47.8% (17428/40 089; 95% CI, 46.9%–48.7%) had stunting, and 19.7% (7236/40 089; 95% CI, 19.0%–20.4%) had wasting. Severe underweight was prevalent among 15.5% (5189/40 089; 95% CI, 14.9%–16.2%) of the children, while severe stunting and wasting had a prevalence of 23.6% (8205/40 089; 95% CI, 22.8%–24.3%) and 6.4% (2417/40 089; 95% CI, 6.0%–6.7%), respectively (). The weighted prevalence of anemia and severe anemia among children younger than 5 years was 69.1% (22 249/ 36 549; 95% CI, 68.2%–69.9%) and 2.7% (823/36 549; 95% CI, 2.5%–2.9%), respectively ().
Sample Size and Weighted Estimates for Mortality, Anthropometric Failure Measures, and Anemia Among Children Aged 0 to 59 Months
There were differences in maternal height between groups of children who experienced mortality and those who did not. On average, maternal height among children who did not survive the first 5 years of life was 150.5 cm (95% CI, 150.2–150.8 cm), while for those who survived it was 151.6 cm (95% CI, 151.5–151.8 cm) (). Similarly, children who experienced anthropometric failure or anemia had mothers who were consistently shorter than those who did not (). Similar differences were observed for severe anthropometric failure but not for severe anemia ().
Unadjusted, Weighted Mean Maternal Height Among Children Aged 0 to 59 Months Who Experienced vs Did Not Experience Mortality, Anthropometric Failure Measures, and Anemia
presents the distribution of covariates by categories of maternal height in the mortality data set. Samples were observed across all the different levels of covariates and the different categories of maternal height, including in the shortest (<145 cm) and the tallest (≥160 cm) categories. The covariate distribution between the shortest and tallest groups was less balanced, mainly for socioeconomic covariates. The percentage of children whose mothers had no schooling among the group of children whose mothers were in the shortest category was 49.8% (2679/5328), while it was 30.6% (1224/4003) among children with mothers in the tallest category. Similar distributional patterns were observed across other socioeconomic covariates, such as household wealth, paternal education, and, to a lesser extent, maternal occupation. The covariate distribution was relatively balanced across the remaining demographic covariates. The pattern of covariate distribution was similar to those reported in for the anthropometric and anemia data sets, which are shown in eTable 1
and eTable 2
Distribution of Covariates Across Categories of Maternal Height in the Mortality Data Set
The unadjusted association between maternal height and child mortality, anthropometric failure, and anemia, and the association between the outcomes and covariates, respectively, are shown in eTable 3
and eTable 4
. The adjusted association between maternal height and outcomes is presented in detail herein.
In adjusted models, a 1-cm increase in height was associated with a decreased RR for mortality (RR, 0.978; 95% CI, 0.970–0.987; P<.001) (). Compared with children with the tallest mothers (≥160 cm), child mortality among mothers shorter than 145 cm was substantially higher (RR, 1.711; 95% CI, 1.369–2.137) (). The absolute probability of dying among children born to the tallest mothers (≥160 cm) was 0.053 (95% CI, 0.039–0.071), while among those born to the shortest mothers (<145 cm) it was 0.091 (95% CI, 0.071–0.116).
Adjusted Absolute Probabilities and RRs for the Association Between Maternal Height and Mortality, Anthropometric Failure Measures, and Anemia Among Children Aged 0 to 59 Monthsa
In adjusted models, a 1-cm increase in height was associated with a decreased RR for underweight (RR, 0.971; 95% CI, 0.968–0.974; P<.001), stunting (RR, 0.971; 95% CI, 0.968–0.973; P<.001), and wasting (RR, 0.989; 95% CI, 0.984–0.994; P<.001) (). Compared with children with tallest mothers (≥160 cm), anthropometric failure among those with mothers shorter than 145 cm was substantially higher for underweight (RR, 1.869; 95% CI, 1.712–2.041) and stunting (RR, 1.947; 95% CI, 1.792–2.116) (). In terms of absolute probabilities, children whose mothers were 160 cm or taller had an adjusted underweight and stunting probability of 0.249 (95% CI, 0.223–0.278) and 0.273 (95% CI, 0.247–0.302), respectively, while those with mothers shorter than 145 cm had an adjusted underweight and stunting prevalence of 0.466 (95% CI, 0.428–0.507) and 0.532 (95% CI, 0.496–0.571), respectively. An inverse association between maternal height and severe anthropometric failure was also observed; a 1-cm increase in maternal height was associated with a decreased RR for severe underweight (RR, 0.959; 95% CI, 0.954–0.964; P<.001), severe stunting (RR, 0.961; 95% CI, 0.957–0.965; P <.001), and severe wasting (RR, 0.991; 95% CI, 0.982–0.999; P=.03) (). The patterns between categorical measures of maternal height and severe anthropometric failure (especially for severe underweight and severe stunting) were stronger than those observed for moderate anthropometric failure ().
Adjusted Absolute Probabilities and RRs for the Association Between Maternal Height and Severe Anthropometric Failure Measures and Anemia Among Children Aged 0 to 59 Monthsa
In adjusted models, a 1-cm increase in height was associated with a very small decrease in risk of anemia (RR, 0.998; 95% CI, 0.997–0.999; P=.02) (). However, no association between maternal height categories and anemia was observed. Maternal height was also not associated with severe anemia among children ( and ).
Paternal Height and Child Health
We conducted an analysis on a subset of the sample for whom paternal height was also available (n=21 120 for the mortality analysis, n=17 790 for the anthropometric analysis, and n=16 414 for the anemia analysis). Maternal and paternal height were positively associated (r
<.001) and had similar socioeconomic patterning (eTable 5
). In mutually adjusted models, no association was observed between paternal height and child mortality (RR, 1.001; 95% CI, 0.989–1.012; P
=.93), wasting (RR, 0.993; 95% CI, 0.987–1.000;P
=.04), or anemia (RR, 1.000; 95% CI, 0.998–1.002; P
=.97) (). An inverse association was observed between paternal height and underweight (RR, 0.982; 95% CI, 0.978–0.985; P
=<.001), and stunting (RR, 0.982; 95% CI, 0.979–0.985; P
Adjusted and Mutually Adjusted RRs for the Association Between a 1-cm Increase in Maternal/Paternal Height and Mortality, Anthropometric Failure Measures, and Anemia Among Children Aged 0 to 59 Monthsa
We conducted a sensitivity analyses to confirm the robustness of the findings reported in and . First, we tested for nonlinearity in the relationship between maternal health and child mortality, anthropometric failure, and anemia and did not find support for a nonlinear relationship. Second, we specified interactions between maternal height and child’s age, and the interaction effects were neither substantial nor conventionally statistically significant. Finally, we conducted sensitivity analysis by excluding children whose mothers had an HIV-positive diagnosis or had a BMI of less than 18.5, yielding a smaller subset of the data (n=32 345 for the mortality analysis, n=26 918 for the anthropometric analysis, and n=24 295 for the anemia analysis). The results were not substantially different from those reported in (eTable 6