Socioeconomic context of the community and chronic child malnutrition in Colombia

Osorio, Ana María; Romero, Gustavo Alfonso; Bonilla, Harold; Aguado, Luis Fernando

doi:10.11606/S1518-8787.2018052000394

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Sumário

Original Article • Rev. Saúde Pública 52 • 2018 • https://doi.org/10.11606/S1518-8787.2018052000394 copy

Socioeconomic context of the community and chronic child malnutrition in Colombia

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze the influence of the socioeconomic context of the community on chronic child malnutrition in Colombia.

METHODS

We estimated multilevel logistic models using data from the National Demographic and Health Survey in Colombia in 2010. The final sample included 11,448 children under the age of five gathered in 3,528 communities. In addition, we used the Principal Component Analysis with polychoric correlations for the construction of composed indicators of wealth, autonomy of the woman, and the use and access to the health system.

RESULTS

The average level of community wealth was significantly and independently associated with chronic malnutrition in early childhood, more than the socioeconomic status of the household itself. At the individual and household level, the probability of chronic malnutrition was higher for children from mothers with low levels of autonomy and use and access to the health system, mothers who had their first child in adolescence, and mothers who live in homes in the lowest wealth quintiles. In contrast, children from mothers with a body mass index > 25 and with at least secondary education (versus no education) were less likely to suffer from chronic malnutrition.

CONCLUSIONS

Research, programs, and interventions need to take into account the physical, economic, and social context of communities to contribute with the improvement of the nutritional status of early childhood in Colombia.

Child, Preschool; Child Nutrition; Malnutrition, Epidemiology; Risk Factors; Socioeconomic Factors; Health Inequalities

Variable	Percentage	95%CI	p
Characteristics of the child

Sex			0.016
Male	51.2	49.96–52.44
Female	48.8
Age (months) (mean = 26.9 - SD = 16.5)			< 0.001
0–11	22.9	21.91–23.96
12–23	23.6	22.55–24.61
24–35	20.9	19.94–21.94
36–47	17.5	16.58–18.4
48–59	15.1	14.28–16
Breastfeeding duration (months) (mean = 12.6 - SD = 9.14)			< 0.001
Never breastfed	2.3	1.98–2.68
≤ 6	30.3	29.18–31.49
≥ 7	67.4	66.16–68.55
Interval from previous birth (months)			< 0.001
First birth	36.2	36.92–39.42
< 24	9.5	8.79–10.16
≥ 24	52.4	51.14–53.63

Characteristics of the mother

Education level			< 0.001
No education	1.7	1.44–2.06
Primary	24.4	23.18–25.68
Secondary	54.9	53.5–56.21
Higher	19.0	17.9–20.17
Age at birth (years) (mean = 20.4 - SD = 4.6)			< 0.001
≤ 19	51.9	50.5–53.25
20–29	42.9	41.58–44.21
30–49	5.2	4.69–5839
Body Mass Index (kg/m²) (mean = 25.06 - SD = 4.6)			0.045
< 18.5	4.3	3.85–4.81
18.5 to 24.9	51.0	49.78–52.19
≥ 25	44.7	43.5–45.92
Level of autonomy in decision making			0.015
Low	39.3	38.06–40.54
Average	25.3	24.27–26.41
High	35.4	34.16–36.63
Level of use and access to the health system			0.001
Low	14.0	13.09–14.9
Average	26.3	25.21–27.5
High	59.7	58.39–60.98

Characteristics of the household

Number of children < 5 years (mean = 1.4 - SD = 0.67)
Wealth indicator (quintiles)			< 0.001
Very poor (q1)	12.2	11.27–13.08
Poor (q2)	19.1	18.08–20.21
Middle (q3)	26.1	24.89–27.27
Rich (q4)	28.1	26.89–29.41
Very rich (q5)	14.5	13.57–15.55

Characteristics of the community

Average level of wealth^a (mean = 0.046 - SD = 0.84)
Education of the women (years) (mean = 8.9 - SD = 3.92)
Average level of autonomy^a (mean = 0.023 - SD = 0.56)
% of households with access to drinking water	85.2	84.13–86.29
% of households with access to basic sanitation^b	79.7	77.89–80.95
Place of residence			< 0.001
Rural	27.67	25.85–29.57
Urban	72.33	70.43–74.15

Variable	Model 1		Model 2		Model 3

	OR	95%CI	OR	95%CI	OR	95%CI
Characteristics of the child

Sex (Ref.: Female)
Male			1.227^a	1.09–1.37	1.228^a a UNICEF; WHO; World Bank. Joint child malnutrition estimates: levels and trends. Geneva; 2016 [cited 2018 Jan 14]. Available from: http://data.unicef.org/nutrition/malnutrition.html	1.10–1.38
Age (months) (Ref.: 0–11)
12–23			1.820^a	1.52–2.18	1.820^a	1.52–2.18
24–35			1.749^a	1.45–2.11	1.754^a	1.45–2.12
36–47			1.443^a	1.18–1.77	1.453^a	1.18–1.78
48–59			1.258^b	1.01–1.57	1.269^b	1.01–1.59
Breastfeeding duration (months) (Ref.: ≤ 6)
Never breastfed			1.516^b	1.03–2.23	1.488^b	1.01–2.18
≥ 7			1.266^b	1.09–1.47	1.235^b	1.07–1.43
Interval from previous birth (months) (Ref.: First birth)
< 24			1.268^b	1.03–1.56	1.283^b	1.05–1.57
≥ 24			0.984	0.86–1.13	0.982	0.85–1.13

Characteristics of the mother

Education level (Ref.: No education)
Primary			0.734^b	0.54–0.99	0.777	0.57–1.05
Secondary			0.508^a	0.37–0.69	0.553^a	0.40–0.76
Higher			0.533^a	0.37–0.76	0.584^b	0.40–0.84
Age at birth (years) (Ref.: 20–29)
≤ 19			1.146^b	1.01–1.30	1.141^b	1.01–1.30
30–49			0.855	0.60–1.23	0.866	0.60–1.24
Body Mass Index (kg/m²) (Ref.: < 18.5)
18.5–24.9			0.928	0.70–1.23	0.924	0.70–1.22
≥ 25			0.782^c	0.59–1.04	0.785^c	0.59–1.04
Level of autonomy in decision making (Ref.: High)
Average			1.052	0.90–1.23	1.046	0.89–1.23
Low			1.174^b	1.02–1.35	1.156^b	1.01–1.33
Level of use and access to the health system (Ref.: High)
Average			1.101	0.95–1.28	1.097	0.95–1.27
Low			1.474^a	1.27–1.72	1.385^a	1.19–1.62

Characteristics of the household

Number of children < 5 years			1.211^a	1.12–1.31	1.195^a	1.10–1.30
Wealth indicator (Ref.: Very rich q5)
Very poor (q1)			2.973^a	2.26–3.90	2.217^a	1.64–3.00
Poor (q2)			2.170^a	1.66–2.83	1.886^a	1.43–2.48
Middle (q3)			1.643^a	1.26–2.14	1.502^b	1.15–1.96
Rich (q4)			1.492^b	1.14–1.95	1.448^b	1.11–1.89

Characteristics of the community

Level of wealth					0.806^a	0.72–0.90
Education of the women					1.003	0.96–1.05
Autonomy of the women					0.94	0.84–1.05
Access to drinking water					1.086	0.88–1.34
Place of residence (Ref.: Rural)
Urban					1.108	0.94–1.31

Random effects

Community-level variation (Standard Error)	0.662^a	0.499–0.825	0.285^a	0.179–0.453	0.251^a	0.15–0.42
Variance Partition Coefficient (VPC)^d	0.167		0.079		0.071

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[1] Correspondence: Ana María OsorioCa. lle 18 No118-250. Pontificia Universidad Javeriana Seccional Cali Cali, Colombia. E-mail: anao@javerianacali.edu.co