Multidimensional Child Growth

Objectives and scope

The project "Multidimensional Child Growth" aims to: (1) understand child growth beyond anthropometry in low resource settings; and (2) develop a multidimensional tool for the assessment of child growth of children under five years of age.

The project starts with a conceptualisation of healthy child growth that is embedded in the capability approach and the Convention of the Rights of the Child followed by ethnographic research in Tanzania and Bangladesh. Recently, we have developed an index for multidimensional child growth (MICG) and have used this index to identify children who are deprived in the various dimensions of the MICG using the Young Lives database. Those children are being left behind in their development process and would benefit from tailor-made interventions targeted at specific dimensions of child growth, for example economic exploitation, or exposure to domestic violence. The approach is relevant both at the individual, population and health systems level.

The project was initiated in 2012 and received funding from NWO/WOTRO/VIDI (W01.70.300.002) until 2017. The project is embedded in the Task Force "Towards a Multidimensional Approach for Child Growth" of the International Union for Nutrition Sciences (IUNS) that started in 2013 and is currently in its third term.

Problem Statement

"What you measure affects what you do" (Stiglitz, Sen, Fitoussi, 2018).

Over the past decades, Ministries of Health, NGOs and scientists have made substantial progress in reducing child mortality around the globe. However, many children still do not reach the age of five. The double burden of malnutrition creates new challenges particularly in low resource settings. Scientists and policy makers agree on the importance of multisectoral programmes to combat the double burden of malnutrition to improve child morbidity and mortality. Yet, for the assessment of the effectiveness of nutrition-sensitive interventions the focus is on the physical outcomes only.

In our project we build on the inspirational work by Amartya Sen and Martha Nussbaum in the field of human development. Similar to their conviction that human development should be assessed beyond economic growth and include for example indicators of health and education, we argue that child growth should be assessed beyond anthropometry. Following Sen and Nussbaum, we apply a capability approach for child growth and draw from the Convention of the Rights of the Child for identification of dimensions of child growth. The dimensions of child growth include: life and physical health, bodily integrity and safety, love and care, leisure activities, respect, social relations, participation, mental well-being, education, freedom from economic and non-economic exploitation, environment (internal and external risks), religion and identity, time autonomy, and ease of mobility to education or health centers. These dimensions were identified by children through a participatory process (Biggeri et al., 2006). Which dimensions are relevant and how they shape child growth depends on the context. For our research, we focused on two low resource settings: Tanzania and Bangladesh.

Capability Approach

Why do we use the capability approach?

The CA offers the intellectual resources to highlight and respond to persistent inequalities;
Conceptualises health and wellbeing as being multi-dimensional;
Better / more robust causal framework and explanations;
Grounded in concepts such as health equity, human rights, and social justice.

Earlier relevant work

We build on expertise generated from a three earlier projects:

a theory-based ethnographic study on overweight in a low resource setting in the Netherlands using the capability approach and cultural schema theory (Visser et al., 2006); from this study we learned that food practices are multidimensional and go beyond the health domain but are informed for example by the need for harmony at the dinner table;
a comparison of growth monitoring manuals from Tanzania, India, the Netherlands against the WHO manuals (Zadelhoff and Haisma, 2022); this study showed that the manuals for growth monitoring are only partially context-specifica and we suggest that further improvement of child malnutrition could be obtained from improving growth monitoring manuals for training of health professionals;
a qualitative study on mothers' intention to breastfeed and their actual behaviours (Oosterhoff et al., 2014; Oosterhoff et al., 2022).

Societal relevance

How is a multidimensional assessment of child growth relevant?

A multidimensional assessment of child growth will shed new light on inequalities and will thus help develop interventions that are better tailored to the needs of vulnerable children/ populations.
The rights-based multidimensional framework will contribute to priority setting of policy makers and contribute to the SDG agenda of leaving no-one behind.
It could be extended to clinical practice and include contextual indicators into the growth monitoring assessment.

IUNS Task Force

The Task Force "Towards a multidimensional index for child growth" of the International Union for Nutrition Sciences was launched at the International Conference on Nutrition in 2013. Scientists from different disciplines were invited to a workshop to discuss the need and potential of a multidimensional approach. Since then the Task Force has provided a platform for scientists to contribute to the development of the approach. In the first term (2013-2017) the focus was on the theoretical foundations and conceptualisations of the approach. In the second term (2017-2022), the focus was on the operationalisation and contextualisation (empirical research in Tanzania and Bangladesh). And in the third term (from 2022), we have generated a multidimensional index that allowed assessment of interventions and comparisons between countries in a multidimensional way and are developing new research questions and moving towards implementation of the approach. For more information, please see the IUNS website.