REGULAR ARTICLE Height gain during early childhood is an important predictor of schooling and mathematics ability outcomes Mihir Gandhi 1,2 , Per Ashorn 3,4 , Kenneth Maleta 5 , Tiina Teivaanmäki 3 , Xiaolian Duan 3 , Yin Bun Cheung (yinbun.cheung@scri.edu.sg) 1,2,3 1.Biostatistics, Singapore Clinical Research Institute, Singapore 2.Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore 3.Department of International Health, University of Tampere Medical School, Tampere, Finland 4.Department of Paediatrics, Tampere University Hospital, Tampere, Finland 5.College of Medicine, University of Malawi, Malawi Keywords Body height, Cognitive ability, Early childhood, Schooling achievement Correspondence Yin Bun Cheung, Singapore Clinical Research Insti- tute, 31 Biopolis Way, Nanos #02-01, Singapore 138669. Tel: +65 6508 8310 | Fax: +65 6508 8317 | Email: yinbun.cheung@scri.edu.sg Received 21 September 2010; revised 7 February 2011; accepted 28 February 2011. DOI:10.1111/j.1651-2227.2011.02254.x ABSTRACT Aim: To examine the association between height gain at different stages of early childhood and schooling and cognitive outcomes in 12-year-old Malawian children. Methods: A prospective cohort study looking at the growth and development of 325 rural Malawian children. Main outcome measures were highest school grade completed, number of times repeating grades and percentage of correctly answered mathematical questions at 12 years of age. Height-for-age at 1 month and conditional height gain for 6, 18 and 60 months were used as predictors. Ordinal logistic and linear regression analyses were used to estimate the association and adjust for confounder. Results: The conditional height gain during 18–60 months was positively associated with mathematics test results (p = 0.003) and negatively associated with number of times repeating grades (p = 0.011). It was not significantly associated with highest grade com- pleted (p = 0.194) if those who never attended school were included as having com- pleted zero grade, but was positively (p = 0.049) associated with this outcome among those who ever attended school. Conclusion: Height gain during the 18–60 months period of age was related to schooling and mathematics ability at age 12 years. The importance of promoting catch-up growth after the period when stunting is common should receive attention. INTRODUCTION One of the millennium development goals is to achieve uni- versal primary education by 2015 (1). Schooling brings long-term health benefits and income to individuals (2,3). In developing countries, an estimated 99 million children of primary-school age were not enrolled in schools, and of those enrolled only 78% completed primary school (4). Fur- thermore, it is estimated that over 200 million children under 5 years in developing countries failed to reach their developmental potential (4). Stunting in early childhood is associated with diminished adult human capital, including poorer cognitive develop- ment and lower schooling attainment (4–6), even after sta- tistical adjustment for confounding factors such as socioeconomic status. Previous studies have shown that weight gain during the first 2 years of life was strongly asso- ciated with schooling (7). It is also known that children stunted in early life had poor developmental outcomes (5,6). Growth stunting tends to happen shortly after birth and continues until about 18–24 months of age (8,9). Inter- ventions thus often focus on the first 2 years (9). However, the role of catch-up growth in height or recovery from stun- ting is not well understood. Owing to limited data on height / length, Martorell et al. (7) did not examine catch-up linear growth. Studies of Romanian children adopted by British (10) and Canadian (11) families showed that catch-up linear growth was accompanied by improvement in all domains of development. They suggested the potential value of interventions even after the first 1 or 2 years of life. This study aims to assess the importance of height gain at different stages of childhood in relation to schooling and cognitive outcomes during adolescence. We used data from the Lungwena Child Survival Study (LCSS), Malawi, Africa, to assess the associations between height-for-age at 1 month, height gains between 1–6, 6–18 and 18–60 month, and outcome measures at age 12 years including highest Key notes • Height gain during early childhood is likely to be related to cognitive ability at 12 years of age. Acta Pædiatrica ISSN 0803–5253 ª2011 The Author(s)/Acta Pædiatrica ª2011 Foundation Acta Pædiatrica 2011 100, pp. 1113–1118 1113