Differential effects of dietary diversity and maternal characteristics on linear growth of children aged 6-59 months in sub-Saharan Africa: a multi-country analysis

Objective: To investigate the differential effects of dietary diversity (DD) and maternal characteristics on child linear growth at different points of the conditional distribution of height-for-age Z-score (HAZ) in sub-Saharan Africa. Design: Secondary analysis of data from nationally representative cross-sectional samples of singleton children aged 0-59 months, born to mothers aged 15-49 years. The outcome variable was child HAZ. Quantile regression was used to perform the multivariate analysis. Setting: The most recent Demographic and Health Surveys from Ghana, Nigeria, Kenya, Mozambique and Democratic Republic of Congo (DRC). Subjects: The present analysis was restricted to children aged 6-59 months (n 31 604). Results: DD was associated positively with HAZ in the first four quantiles (5th, 10th, 25th and 50th) and the highest quantile (90th) in Nigeria. The largest effect occurred at the very bottom (5th quantile) and the very top (90th quantile) of the conditional HAZ distribution. In DRC, DD was significantly and positively associated with HAZ in the two lower quantiles (5th, 10th). The largest effects of maternal education occurred at the lower end of the conditional HAZ distribution in Ghana, Nigeria and DRC. Maternal BMI and height also had positive effects on HAZ at different points of the conditional distribution of HAZ. Conclusions: Our analysis shows that the association between DD and maternal factors and HAZ differs along the conditional HAZ distribution. Intervention measures need to take into account the heterogeneous effect of the determinants of child nutritional status along the different percentiles of the HAZ distribution.