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Stunting risk of orphans by caregiver and living arrangement in low-income and middle-income countries
  1. Jocelyn E Finlay1,
  2. Günther Fink2,
  3. Dana Charles McCoy3,
  4. L Carolina Tavárez4,
  5. Jeanne Chai2,
  6. Goodarz Danaei2,
  7. Majid Ezzati5,
  8. Wafaie Fawzi2,
  9. Mary C Smith Fawzi4
  1. 1Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
  2. 2Department of Global Health and Population, Harvard University, Cambridge, Massachusetts, USA
  3. 3Graduate School of Education, Harvard University, Cambridge, Massachusetts, USA
  4. 4Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  5. 5MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London UK
  1. Correspondence to Dr Jocelyn E Finlay, Research Scientist, Harvard University, 9 Bow St, Cambridge, MA 01238, USA; jfinlay{at}


Background An estimated 151 million children worldwide have lost one or both parents (UNICEF). Although a considerable literature has documented the impact of parental loss on children's emotional development, to date there are mixed findings regarding the potential effect of orphanhood on children's physical growth. The aim of the study is to examine the association between orphanhood (maternal, paternal or both) on childhood stunting status, accounting for living arrangement.

Methods We combine nationally representative data from 84 Demographic Health Surveys for 49 low-income and middle-income countries (LMICs). Data from 222 690 children aged 0–23 months were included in the analytical sample. We show pooled estimates from multiple analysis models, as well as models examining the role of the surviving parent's residence and household structure.

Results In fully adjusted models, maternal orphans were found to have an increased risk of stunting (RR 1.3, 95% CI 1.2 to 1.4) compared to children with two living parents. The stratified models demonstrated that the greatest risk was observed for maternal orphans whose surviving fathers did not live with the child (RR 1.4, 95% CI 1.3 to 1.6).

Conclusions Early orphanhood constitutes a major risk for children's physical development in LMICs. However, the results suggest that the adverse effects of a parental loss can be mitigated if appropriate support is provided, indicating the potential benefits of the surviving parents staying with their children. The benefits of targeted social policies aimed at single fathers and grandparents supporting orphans may be significant.

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