Childhood stunting and subsequent educational outcomes: a marginal structural model analysis from a South African longitudinal study

To examine the association between childhood stunting and grade completion (as educational outcome) in South Africa. Longitudinal study. Data were obtained using the National Income Dynamics Study over five waves (2008 to 2017). Children were tracked at wave 1 in 2008 until wave 5 in 2017 to determine their total years of schooling. We controlled for time-variant and time-varying confounding with a marginal structural model to estimate the associations between childhood stunting and subsequent grade completion. Nationally representative study of South African households. A total of 2629 children aged 2 and 3 years in 2008. We observed a substantial decrease in the prevalence of stunting between wave 1 (28·2 %) and wave 4 (8·6 %). Our marginal structural model results suggest that childhood stunting was significantly associated with decreased odds (22 % less likely) of grade completion (OR = 0·78; 95 % CI: 0·40, 0·86; = 0·015), while those who were only stunted during early childhood had a 29 % reduction in the odds of grade completion (OR = 0·71; 95 % CI: 0·51, 0·82; = 0·020). These findings underscore the fact that stunting is a significant predictor of academic achievement, whose effects might be long-lasting.