Use of Relative and Absolute Measures to Evaluate Catch-Up Growth Among Indonesian Children

In recent years, the use of relative metrics like the height-for-age z-score (HAZ) has been demonstrated to yield higher estimates of catch-up growth prevalence compared to absolute measures among children in impoverished settings. The use of height-for-age difference (HAD) may be a complementary tool to estimate rates of catch-up growth. We used data from the Indonesian Family Life Survey waves 4 and 5 to measure changes in linear growth among children aged 2-4 years up to 8-11 years old. Children's height at baseline and follow-up was calculated using HAZ and HAD and catch-up growth measured using change in HAZ and HAD between baseline and follow-up. Absolute magnitude of catch-up growth using HAD was measured and compared to HAZ. The association between catch-up growth and cognitive ability using change in HAZ and HAD was measured with linear regression. Nearly two times more children experienced an increase in HAZ compared to an increase in HAD. The prevalence of stunting among the children dropped from 38.3% to 23.8% at follow-up, mean height deficit increased by 2.11 cm. Only 10% of children recovered 80% or more of their baseline height deficit by follow-up. Both change in HAZ and HAD were associated with cognitive score at follow-up. This study shows that absolute improvements in height deficit have been achieved in Indonesian children; however, the majority continues to increase their height deficit despite increasing HAZ scores.