Imperial College London


Faculty of MedicineSchool of Public Health

Chair in Global Environmental Health



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BibTex format

author = {Smith, Fawzi MC and Andrews, KG and Fink, G and Danaei, G and McCoy, DC and Sudfeld, CR and Peet, ED and Cho, J and Liu, Y and Finlay, JE and Ezzati, M and Kaaya, SF and Fawzi, WW},
doi = {10.1136/bmjgh-2018-001144},
journal = {BMJ Global Health},
title = {Lifetime economic impact of the burden of childhood stunting attributable to maternal psychosocial risk factors in 137 low/middle-income countries},
url = {},
volume = {4},
year = {2019}

RIS format (EndNote, RefMan)

AB - Introduction: The first 1000 days of life is a period of great potential and vulnerability. In particular, physical growth of children can be affected by the lack of access to basic needs as well as psychosocial factors, such as maternal depression. The objectives of the present study are to: (1) quantify the burden of childhood stunting in low/middle-income countries attributable to psychosocial risk factors; and (2) estimate the related lifetime economic costs. Methods: A comparative risk assessment analysis was performed with data from 137 low/middle-income countries throughout Asia, Latin America and the Caribbean, North Africa and the Middle East, and sub-Saharan Africa. The proportion of stunting prevalence, defined as <-2 SDs from the median height for age according to the WHO Child Growth Standards, and the number of cases attributable to low maternal education, intimate partner violence (IPV), maternal depression and orphanhood were calculated. The joint effect of psychosocial risk factors on stunting was estimated. The economic impact, as reflected in the total future income losses per birth cohort, was examined. Results: Approximately 7.2 million cases of stunting in low/middle-income countries were attributable to psychosocial factors. The leading risk factor was maternal depression with 3.2 million cases attributable. Maternal depression also demonstrated the greatest economic cost at $14.5 billion, followed by low maternal education ($10.0 billion) and IPV ($8.5 billion). The joint cost of these risk factors was $29.3 billion per birth cohort. Conclusion: The cost of neglecting these psychosocial risk factors is significant. Improving access to formal secondary school education for girls may offset the risk of maternal depression, IPV and orphanhood. Focusing on maternal depression may play a key role in reducing the burden of stunting. Overall, addressing psychosocial factors among perinatal women can have a signi
AU - Smith,Fawzi MC
AU - Andrews,KG
AU - Fink,G
AU - Danaei,G
AU - McCoy,DC
AU - Sudfeld,CR
AU - Peet,ED
AU - Cho,J
AU - Liu,Y
AU - Finlay,JE
AU - Ezzati,M
AU - Kaaya,SF
AU - Fawzi,WW
DO - 10.1136/bmjgh-2018-001144
PY - 2019///
SN - 2059-7908
TI - Lifetime economic impact of the burden of childhood stunting attributable to maternal psychosocial risk factors in 137 low/middle-income countries
T2 - BMJ Global Health
UR -
UR -
UR -
VL - 4
ER -