Correcting for artifactual correlation between misreported month of birth and attained height-for-age reduces but does not eliminate measured vulnerability to season of birth in poorer countries

Abstract

Background: Height-for-age z-scores (HAZ) are associated with month of birth (MOB) in many nutrition surveys, but that link could be an artifactual result of measurement error in child birthdates. Objective: We corrected estimates of the associations between HAZ and MOB for a common type of age misreporting, to measure the remaining seasonality in HAZ and identify country characteristics associated with vulnerability to seasonal changes in early life. Design: We used nationally representative repeated cross-sections from all available Demographic and Health Surveys (DHS), totaling 1,363,806 children from 218 surveys in 72 countries over 1986-2016, to estimate the seasonal patterns in HAZ by MOB within each survey. Then, we corrected these estimates for each survey's random errors in recorded birth month implied by differences in attained height between children reported as born in December of one year versus January of the next. Indicators of seasonal variation between other months were modeled as functions of national-level incomes using linear regression, and visualizations were constructed using nonparametric local polynomial smoothing regressions. Results: Over all surveys, misreporting MOB accounted for about one-eighth of the gap in attained height between the worst and best months to be born, which averaged 0.41 HAZ in the raw data and 0.34 HAZ after correction for age misreporting. A linear correction reduced apparent seasonality of HAZ by MOB in 49 of 72 countries, and the remaining nonartifactual differences by season of birth were larger in countries with lower average income per capita. Conclusions: Measurement error in child MOB helps to explain the association between attained height and seasonal variation in early life environments, but significant seasonality in HAZ by MOB remains in many poor countries. Higher national income is associated with smoother outcomes across birth months, and birth registration efforts would improve nutrition research.