Nutrition gap in children, urban-rural: the key education and food. Colombia, 2015

Bermúdez, Jhael N.; Ayala, Daniel; Herrán, Oscar F.

doi:10.11606/s1518-8787.2020054001925

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054001925 copy

Nutrition gap in children, urban-rural: the key education and food. Colombia, 2015

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To analyze the nutritional situation of children under five years old from both urban and rural areas of Colombia.

METHOD:

Analytical study, based on cross-sectional data, collected from ENSIN-2015. The sample consisted of 12,256 children aged between 0 and 4 years old. We calculated the prevalence ratios (PR) with their respective 95% confidence interval (95%CI). PR were assessed by binomial regression models with malnutrition or overweight as the dependent variable and geographic area as the explanatory variable. We used context variables to adjust the estimated PR and control the confounder within.

RESULTS:

Acute malnutrition (weight-for-height) had a prevalence of 1.6%, while overweight had a 5.6% rate. No differences per geographic zone in the weight-for-height indicator were found. Stunted growth – chronic malnutrition – was higher in the rural area (PR = 1.2; 95%CI 1–1.53; p = 0.050). Prevalences adjusted by variables related to structural, social and economic developement showed that both the household chief's educational level and the food insecurity of the area account for malnutrition.

CONCLUSION:

The height-for-age indicator works better to establish development level. Measures against coverage, relevance and quality of education and access to food can harm the nutritional status of the children.

DESCRIPTORS:
Child, Preschool; Nutrition Surveys; Food and Nutrition Security; Health Status Disparities; Rural Areas; Urban Area

Variable		Urban area		Rural area		PR (95%CI)^a a PR: prevalente ratio [urban/rural].	p
Variable		n	Prevalence (95%CI)	n	Prevalence (95%CI)	PR (95%CI)^a a PR: prevalente ratio [urban/rural].	p
Gender
	Male	4,473	51.5 (49.7–53.3)	1,808	51.4 (49.1–53.6)	1.0 (0.97–1.03)	0.928
	Female	4,378	48.5 (46.7–50.3)	1,752	48.6 (46.4–50.9)	1.0 (0.97–1.03)	0.955
Age group (months)
	0–11	1,740	20.1 (18.8–21.4)	657	19.3 (17.7–21.1)	1.0 (0.95–1.08)	0.668
	12–23	1,753	19.9 (18.8–21.2)	675	19.8 (18.2–21.5)	1.0 (0.94–1.06)	0.975
	24–35	1,815	19.8 (18.4–21.2)	733	20.9 (18.7–23.3)	1.0 (0.92–1.04)	0.533
	36–48	1,698	19.5 (18.3–20.8)	754	20.7 (18.9–22.6)	1.0 (0.91–1.05)	0.493
	48–59	1,845	20.7 (19.4–22.1)	741	19.3 (17.8–21.0)	1.0 (0.97–1.09)	0.422
Wealth index
	T₁- Poorest	1,953	9.6 (8.2–11.3)	2,995	76.9 (72.5–80.8)	0.1 (0.09–0.12)	< 0.001
	T₂	3,679	37.9 (35.6–40.3)	542	21.7 (18.0–26.0)	1.1 (1.07–1.12)	< 0.001
	T₅- Wealthiest	3,219	52.5 (50.0–54.9)	23	1.4 (0.9–2.3)	1.0 (1.01–1.02)	< 0.001
Household chief educational level
	Lower than primary school	1,589	15.4 (14.1–16.8)	1,697	46.6 (42.7–50.6)	0.9 (0.82–0.94)	< 0.001
	Lower than secondary school	2,798	33.0 (31.0–35.1)	1,218	33.7 (31.1–36.4)	1.0 (0.95–1.03)	0.673
	Lower than higher education	3,787	43.8 (41.7–45.9)	583	19.2 (16.4–22.3)	1.1 (1.12–1.17)	< 0.001
	Higher education and further	607	7.8 (6.2–9.8)	27	0.5 (0.3–0.8)	1.0 (0.98–1.07)	0.478
Food insecurity^b b Based on ELCSA.
	No	3,194	40.4 (38.3–42.6)	969	31.7 (28.6–34.9)	1.1 (1.05–1.13)	< 0.001
	Mild	3,282	37.6 (35.5–39.6)	1,236	35.7 (32.9–38.7)	1.0 (0.99–1.07)	0.234
	Moderate	1,437	13.4 (12.3–14.6)	690	18.3 (16.1–20.7)	0.9 (0.80–0.97)	0.004
	Severe	936	8.6 (7.5–9.9)	660	14.3 (11.9–17.0)	0.8 (0.65–0.90)	< 0.001
Water availability
	Water supply network	6,171	84.6 (82.3–86.4)	634	22.6 (19.3–26.2)	1.5 (1.42–1.53)	< 0.001
	Well or community supply	353	1.5 (1.04–2.03)	1166	34.0 (29.7–38.7)	0.0 (0.02–0.10)	< 0.001
	Bottled water	1,311	10.0 (8.67–11.6)	161	4.1 (3.05–5.60)	1.1 (1.03–1.12)	0.020
	Others	1,016	3.9 (2.98–5.15)	1,599	39.3 (34.4–44.3)	0.9 (0.84–0.91)	< 0.001
Sewage system
	Yes	6,924	89.9 (88.0–91.5)	378	16.2 (12.5–20.6)	3.1 (2.96–3.35)	< 0.001
	No	1,927	10.1 (8.5–12.0)	3,182	83.8 (79.4–87.5)	0.0 (0.03–0.05)	< 0.001
Diarrhea^c c Within the previous fifteen days, self-reported.
	Yes	1,057	29.0 (26.6–31.6)	428	38.0 (32.6–43.6)	1.2 (1.08–1.27)	< 0.001
	No	2,314	71.0 (68.4–73.4)	703	62.0 (56.4–67.4)	1.1 (1.06–1.16)	< 0.001
Acute respiratory infection^c c Within the previous fifteen days, self-reported.
	Yes	2,634	79.8 (77.6–81.8)	873	77.6 (72.9–81.6)	1.0 (0.99–1.09)	0.155
	No	737	20.2 (18.2–22.4)	258	22.4 (18.4–27.1)	1.0 (0.88–1.06)	0.441

Variable		Urban area (n = 8,735)		Rural area (n = 3,521)		aPR^a a aPR: adjusted prevalence ratio [rural/urban] found in a binomial model, having the wasting prevalence in the weight-for-height indicator, Z < −2, as the independent variable and area as the explanatory variable. Adjustment was applied by the following covariables: gender, age, stunted growth in height-for-age, Z < −2, household chief's educational level, health insurance status, household food insecurity, wealth index, ethnicity and region (95%CI)	p
Variable		Prevalence (95%CI)	p	Prevalence (95%CI)	p		p
Total		1.4 (1.13–1.83)		1.8 (1.29–2.57)	0.282	0.7 (0.44–1.10)	0.120
	Gender		0.753		0.766
	Male	1.5 (1.12–2.00)		1.9 (1.13–3.25)		0.8 (0.40–165)	0.563
	Female	1.4 (0.94–2.04)		1.7 (1.07–2.76)		0.6 (0.31–1.10)	0.093
Age group (months)			0.001		0.004
	0–11	2.4 (1.64–3.47)		2.9 (1.31–6.50)		0.6 (0.25–1.37)	0.211
	12–23	1.7 (1.12–2.61)		2.7 (1.41–4.98)		0.5 (0.25–1.13)	0.099
	24–35	1.5 (0.75–3.19)		1.5 (0.60–3.70)		0.9 (0.33–2.34)	0.790
	36–48	0.5 (0.02–1.02)		1.9 (1.00–3.72)		4.7 (0.65–33.65)	0.124
	48–59	1.1 (0.67–1.86)		0.0 (0.00–0.34)		0.0 (0.00–0.32)	0.004
Stunted growth (height-for-age)			0.272		0.798
	No	1.5 (1.16–1.91)		1.8 (1.21–2.66)		0.7 (0.41–1.36)	0.139
	Yes (Z < −2)	1.0 (0.50–1.98)		2.0 (1.06–3.65)		0.7 (0.28–1.91)	0.511
Household chief's educational level			0.984		0.058
	Lower than primary school	1.5 (0.90–2.54)		2.7 (1.76–4.06)		1.0 (0.44–2.14)	0.944
	Lower than secondary school	1.2 (0.80–1.75)		0.9 (0.37–2.29)		0.3 (0.12–0.77)	0.013
	Lower than higher education	1.8 (1.24–2.61)		1.3 (0.57–3.12)		0.6 (0.22–1.62)	0.303
	Higher education or further	0.6 (0.25–1.24)		NO		NA	NA
Health insurance			0.009		< 0.001
	Uninsured	1.1 (0.64–1.70)		0.2 (0.00–0.73)		0.1 (0.04–0.31)	< 0.001
	Subsidized	1.7 (1.26–2.19)		2.2 (1.51–3.13)		0.8 (0.50–1.40)	0.490
	Contributive/others	4.1 (2.12–5.46)		1.5 (0.47–4.57)		0.2 (0.05–0.84)	0.029
Food insecurity^b b Based on ELCSA.			0.114		0.132
	No	1.2 (0.68–1.99)		1.7 (0.84–3.30)		1.1 (0.45–2.57)	0.872
	Mild	1.5 (1.09–2.10)		1.2 (0.69–2.12)		0.4 (0.19–0.97)	0.043
	Moderate	1.5 (0.84–2.67)		1.5 (0.72–3.08)		0.4 (0.14–0.92)	0.034
	Severe	2.3 (1.34–4.02)		4.1 (1.99–8.34)		0.8 (0.38–1.58)	0.476
Wealth index			0.010		0.077
	T₁- poorest	2.8 (1.76–4.60)		2.2 (1.54–3.19)		0.7 (0.40–1.26)	0.239
	T₂	1.6 (1.16–2.19)		0.6 (0.12–2.58)		0.4 (0.07–1.70)	0.190
	T₅- wealthiest	1.1 (0.67–1.70)		NO		NA	NA
Ethnicity			0.119		0.174
	Mestizo	1.3 (1.01–1.76)		1.6 (1.13–2.31)		0.6 (0.36–1.05)	0.072
	Black/Afro-descendant	2.5 (1.47–4.33)		1.1 (0.41–2.77)		0.3 (0.07–1.58)	0.152
	Indigenous	1.0 (0.32–3.37)		3.6 (1.41–8.92)		1.5 (0.44–5.33)	0.473
Region			0.116		0.068
	Central	1.1 (0.67–1.76)		2.4 (1.45–4.01)		0.7 (0.28–1.55)	0.318
	Atlantic	2.3 (1.69–3.03)		2.2 (1.05–4.59)		0.5 (0.25–1.05)	0.067
	Oriental	1.8 (0.79–3.85)		0.9 (0.50–1.65)		1.5 (0.63–3.34)	0.350
	Pacific	1.2 (0.65–2.26)		1.8 (0.95–3.40)		1.0 (0.23–4.26)	0.994
	Bogotá	0.9 (0.41–1.99)		NO		NA	NA
	Amazon/Orinoquia	0.6 (0.31–1.15)		NO		NA	NA

Variable		Urban area (n = 8,735)		Rural area (n = 3,521)		aPR^a a aPR: adjusted prevalence ratio [rural/urban] found in a binomial model, having the wasting prevalence in the weight-for-height indicator, Z < −2, as the independent variable and area as the explanatory variable. Adjustment was applied by the following covariables: gender, age, stunted growth in height-for-age, Z < −2, household chief's educational level, health insurance, household food insecurity, wealth index, ethnicity and region (95%CI)	p
Variable		Prevalence (95%CI)	p	Prevalence (95%CI)	p		p
Total		5.7 (4.98–6.52)		5.5 (4.20–7.12)	0.672	1.3 (0.83–2.01)	0.244
Gender			0.013		0.093
	Male	6.6 (5.52–7.93)		6.3 (4.64–8.54)		1.3 (0.82–2.11)	0.251
	Female	4.7 (3.90–5.73)		4.6 (3.24–6.48)		1.3 (0.74–2.27)	0.360
Age group (months)			0.182		0.001
	0–11	6.2 (4.63–8.32)		6.7 (4.56–9.80)		1.2 (0.73–1.99)	0.460
	12–23	6.2 (4.76–8.01)		7.9 (4.72–12.9)		2.0 (0.91–4.51)	0.081
	24–35	6.5 (4.75–8.85)		5.3 (3.40–8.14)		0.8 (0.41–1.74)	0.639
	36–48	4.1 (3.07–5.49)		5.4 (3.02–9.47)		2.4 (0.80–7.00)	0.119
	48–59	5.5 (4.09–7.32)		2.0 (1.08–3.81)		0.5 (0.21–1.34)	0.178
Stunted growth (hight-for-age)			0.132		0.239
	No	5.5 (4.77–6.35)		5.2 (4.10–6.53)		1.2 (0.85–1.82)	0.247
	Yes (Z < −2)	7.7 (5.06–11.5)		7.1 (3.86–12.7)		1.8 (0.57–5.78)	0.302
Household chief's educational level			0.351		0.995
	Lower than primary school	5.9 (4.24–8.19)		5.2 (3.13–8.65)		1.4 (0.31–6.32)	0.656
	Lower than secondary school	5.1 (4.03–6.42)		5.8 (4.23–7.90)		1.4 (0.92–2.25)	0.107
	Lower than higher education	5.8 (4.81–7.00)		5.3 (3.49–7.86)		1.1 (0.68–1.89)	0.616
	Higher education or further	7.9 (4.56–13.4)		NO		NA	NA
Health insurance			0.003		0.754
	Uninsured	7.0 (5.81–8.43)		6.3 (3.46–11.1)		0.8 (0.45–1.52)	0.562
	Subsidized	4.3 (3.52–5.17)		5.3 (3.81–7.23)		1.7 (0.85–3.43)	0.133
	Contributive/others	5.5 (3.00–9.78)		6.2 (3.58–10.4)		2.0 (0.46–8.73)	0.342
Food insecurity^b b Based on ELCSA.			0.024		0.641
	No	7.2 (5.86–8.88)		5.0 (3.69–6.81)		0.7 (0.48–1.18)	0.210
	Mild	4.3 (3.46–5.38)		6.2 (4.50–8.56)		1.5 (0.96–2.36)	0.077
	Moderate	6.1 (4.39–8.48)		6.6 (2.54–15.9)		3.8 (1.67–8.80)	0.002
	Severe	4.0 (2.43–6.43)		3.2 (2.01–5.23)		1.2 (0.52–2.82)	0.649
Wealth index			< 0.001		0.677
	T₁- poorest	2.6 (1.69–3.85)		5.2 (4.23–6.33)		2.0 (1.30–3.19)	0.002
	T₂	5.1 (4.17–6.25)		6.8 (3.01–14.6)		1.2 (0.50–3.04)	0.649
	T₅- wealthiest	6.7 (5.57–8.07)		1.5 (0.20–9.97		0.2 (0.03–1.38)	0.102
Ethnicity			0.097		0.359
	Mestizo	5.8 (5.02–6.71)		5.7 (4.12–7.78)		1.3 (0.75–2.15)	0.367
	Black/Afro-descendant	4.9 (3.20–7.48)		5.1 (3.19–8.08)		1.9 (0.75–4.72)	0.162
	Indigenous	2.4 (1.42–4.19)		4.2 (2.41–7.25)		2.3 (0.98–5.40)	0.056
Region			0.704		0.121
	Central	6.5 (5.04–8.39)		7.5 (4.00–13.7)		1.8 (0.54–6.19)	0.306
	Atlantic	5.0 (4.14–6.05)		4.4 (3.09–6.12)		2.4 (1.43–3.95)	0.003
	Oriental	5.8 (3.91–8.64)		6.2 (3.91–9.71)		0.7 (0.28–1.53)	0.305
	Pacific	5.3 (3.63–7.81)		4.8 (3.36–6.69)		1.2 (0.52–2.60)	0.680
	Bogotá	5.7 (3.95–8.27)		NO		NA	NA
	Amazon/Orinoquia	5.9 (4.59–7.48)		0.1 (0.00–1.97)		7.6 (1.29–44.86)	0.011

Variable		Urban area (n = 8,735)		Rural area (n = 3,521)		aPR^a a aPR: adjusted prevalence ratio [rural/urban] found in a binomial model, having the wasting prevalence in the weight-for-height indicator, Z < −2, as the independent variable and area as the explanatory variable. Adjustment was applied by the following covariables: gender, age, stunted growth in height-for-age, Z < −2, household chief's educational level, health insurance, household food insecurity, wealth index, ethnicity and region (95%CI)	p
Variable		Prevalence (95%CI)	p	Prevalence (95%CI)	p		p
Total		9.0 (7.96–10.2)		15.4 (13.7–17.3)	0.004	1.2 (1.00–1.53)	0.050
Gender			0.041		0.033
	Male	10.0 (8.67–11.6)		17.4 (15.1–20.0)		1.2 (0.97–1.59)	0.087
	Female	7.9 (6.52–9.61)		13.3 (10.8–16.3)		1.2 (0.85–1.84)	0.246
Age group (months)			0.102		0.010
	0–11	5.4 (3.14–9.17)		8.1 (5.32–12.1)		2.2 (1.20–3.89)	0.011
	12–23	9.4 (7.31–12.1)		16.2 (12.3–21.2)		1.4 (0.81–2.52)	0.220
	24–35	12.3 (10.0–14.9)		21.2 (17.3–25.7)		0.9 (0.68–1.26)	0.615
	36–48	9.2 (7.43–11.3)		16.7 (13.2–21.0)		0.3 (0.83–2.15)	0.227
	48–59	8.8 (7.04–10.9)		14.2 (11.1–18.1)		1.2 (0.80–1.72)	0.401
Nutrition situation (weight-for-height)			< 0.001		< 0.001
	Acute malnutrition (Z < −2)	6.2 (3.14–12.0)		16.7 (8.76–2.94)		1.6 (0.40–6.20)	0.491
	Normal	8.9 (7.80–10.1)		15.1 (13.3–17.1)		1.2 (0.97–1.51)	0.093
	Oerweight (Z > 2)	12.2 (8.04–18.0)		20.0 (12.5–30.4)		1.7 (1.30–2.33)	< 0.001
Household chief's educational level			< 0.001		0.020
	Lower than primary school	10.5 (8.14–13.4)		18.3 (15.7–21.2)		1.7 (1.21–2.50)	0.003
	Lower than secondary school	11.4 (9.33–13.9)		13.0 (10.4–16.2)		0.8 (0.58–1.20)	0.326
	Lower than higher education	7.3 (6.15–8.72)		12.4 (8.02–18.6)		1.5 (1.03–2.10)	0.034
	Higher education or further	4.8 (2.76–8.09)		11.8 (2.22–44.0)		2.3 (0.87–6.00)	0.089
Health insurance status			0.011		0.639
	Uninsured	7.3 (5.78–9.16)		13.3 (9.04–19.2)		1.8 (1.07–2.94)	0.027
	Subsidized	10.5 (9.17–11.9)		16.0 (14.1–18.1)		1.1 (0.90–1.42)	0.301
	Contributive/others	9.0 (5.97–13.5)		12.9 (8.48–19.2)		NA	NA
Food insecurity^b b Based on ELCSA.			0.081		< 0.001
	No	8.6 (6.76–10.8)		10.2 (7.96–13.0)		0.8 (0.53–1.19)	0.252
	Mild	8.1 (6.72–9.84)		13.1 (10.3–16.5)		1.1 (0.79–1.65)	0.470
	Moderate	11.0 (8.92–13.5)		18.8 (14.7–23.6)		1.7 (1.09–2.59)	0.019
	Severe	11.8 (8.72–15.8)		28.4 (24.3–33.0)		1.5 (1.01–2.26)	0.044
Wealth index			0.001		0.089
	T₁- poorest	13.5 (10.8–16.8)		16.3 (14.5–18.3)		1.2 (0.91–1.52)	0.203
	T₂	10.0 (8.61–11.6)		12.5 (7.99–19.0)		1.3 (0.82–2.03)	0.264
	T₅- wealthiest	7.5 (5.96–9.32)		11.1 (1.58–49.1)		NA	NA
Ethnicity			0.720		< 0.001
	Mestizo	9.0 (7.88–10.3)		12.8 (11.0–14.9)		1.0 (0.79–1.35)	0.796
	Black/Afro-descendant	5.7 (3.78–8.60)		10.7 (7.97–14.3)		1.4 (0.68–3.00)	0.319
	Indigenous	17.8 (11.9–25.8)		34.0 (29.1–39.3)		1.3 (0.75–2.34)	0.312
Region			0.008		0.337
	Central	7.1 (5.53–9.15)		15.5 (12.1–19.5)		2.0 (1.02–3.76)	0.043
	Atlantic	8.7 (7.38–10.3)		19.4 (16.7–22.4)		1.0 (0.73–1.31)	0.863
	Oriental	8.3 (5.96–11.5)		11.6 (8.93–14.8)		0.9 (0.55–1.65)	0.840
	Pacific	7.5 (5.55–10.1)		13.9 (9.77–19.4)		1.4 (0.71–2.70)	0.303
	Bogotá	13.1 (9.43–17.9)		NO		NA	NA
	Amazon/Orinoquia	10.4 (8.93–12.1)		16.2 (6.23–36.1)		NA	NA

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Oscar F. Herrán, Universidad Industrial de Santander, Facultad de Salud, Carrera 32, 29-31, 680002 Bucaramanga, Santander, Colombia. E-mail: herran@uis.edu.co