Linear child growth after a natural disaster: a longitudinal study of the effects of the 2004 Indian Ocean tsunami

Abstract Background The 2004 Indian Ocean earthquake, among the largest earthquakes in recorded history, spawned a major tsunami that devastated coastal communities in Aceh, Indonesia. This large-scale, natural disaster resulted in more than 170 000 deaths, displaced half a million people, and devastated large swathes of built infrastructure, arable land, and natural resources along the coast of Aceh. The disaster was followed by one of the largest reconstruction efforts undertaken in any developing country. We aimed to examine the effects of the disaster and subsequent reconstruction on the trajectory of linear child growth in children who were in-utero at the time of the tsunami until 2009–10, when the children were, on average, 5 years of age. Methods The earthquake and tsunami was a completely unanticipated large-scale environmental disaster that resulted in a combination of increased maternal psychosocial stress, reduced access to food, and reduced resources, broadly defined. The disaster was followed by a reconstruction effort that took several years to scale up and eventually resulted in substantial increases in resource availability. Using innovative population-representative longitudinal survey data, the Study of the Tsunami Aftermath and Recovery, which was collected before the tsunami and annually for 5 years after the tsunami, we compare child height after the tsunami of those children who were in utero at the time of the tsunami with cohorts of children not similarly exposed. Findings Using data for 4170 children, in 2006–07, the standardised height of those who were in utero at the time of the tsunami is a third of a standard deviation less than comparison cohorts that were not exposed in utero; the deficit is largest, two-thirds of a standard deviation, for children in the second trimester at the time of the tsunami. By age 5 years, these deficits are eliminated for all children who were in utero at the time of the tsunami except for one group of children. Mothers of 10% of children reported very high levels of post-traumatic stress reactivity; of these children, those exposed during the second trimester of the pregnancy remain about half a standard deviation shorter than the comparison children who were not exposed in utero. Interpretation These new findings provide evidence of substantial scope for catch-up growth in height for most children after a large-scale natural disaster and extremely successful reconstruction effort. However, some children remain vulnerable, particularly those whose mothers reported very high levels of post-traumatic stress reactivity, suggesting maternal stress is a key pathway for persistent deficits in linear growth. The results have important longer-term implications for future health and well-being. Funding National Institute for Child Health and Human Development and National Institutes on Aging.