Trends and patterns of the double burden of malnutrition (DBM) in Peru: a pooled analysis of 129,159 mother-child dyads.

BACKGROUND: This study aims to evaluate trends of DBM in Peru over the last 20 years. METHODS: Using individual-level data collected in nationally representative household surveys from Peru between 1996 and 2017, we analysed trends in the prevalence and patterning of the DBM. We classified the nutritional status of children and their mothers as undernourished (either underweight, stunted or wasted for children), normal, overweight or obese. Children classified as experiencing the DBM were those undernourished and living with an overweight or obese mother. We also fitted logistic regression models to evaluate the probability of children having an overweight/obese mother across subgroups of socioeconomic status, place of residence and education. RESULTS: The overall percentage of children experiencing the DBM in 2016 was 7%, and constitutes ~203,600 children (90% of whom were stunted). Between 1996 and 2016, undernourished children have seen the largest relative increase in the risk of having an overweight mother (31% vs. 37%) or obese mother (6% vs. 17%); however, due to the substantial decrease in the absolute number of undernourished children, the DBM has not grown. Moreover, all children, irrespective of their own nutritional status, are now more likely to live with an overweight or obese mother, a consistent pattern across wealth, location and education subgroups, and all regions of Peru. CONCLUSIONS: DBM prevalence in Peru has decreased, although the number of DBM cases is estimated to be above 200,000. In addition, all children are now more likely to live with overweight or obese mothers. The basic pattern has shifted from one of undernourished children whose mothers have a 'normal' BMI, to one where now most children have a 'normal' or healthy anthropometric status, but whose mothers are overweight or obese. This suggest that Peru is on the cusp of a major public health challenge requiring significant action.

Severe Housing Deprivation in the European Union: a Joint Analysis of Measurement and Theory.

Concerns about the quality of housing feature prominently in academic and policy discussion on housing, yet there is little agreement about how housing deprivation should be measured or monitored. In empirical studies, measures of housing deprivation are typically examined for one of two purposes-either to compare incidences of housing quality problems for different groups, which typically leads to an examination of performance of different measures of housing deprivation, or as dependent variables to examine competing theories about what explains cross-national variation in such problems, which typically ignores these measurement considerations. Our paper seeks to analyse measurement and theory jointly, focussing in particular on the EU's severe housing deprivation measure, and its subcomponents-overcrowding and housing conditions problems. In descriptive analysis, we show that the two components of the severe housing deprivation measure are weakly related and pattern differently across nations and that the aggregation rule of the main measure has a substantial influence on observed incidences of this problem. We subsequently construct multi-level regression-based models and demonstrate that the two components have quite different determinants. Our paper has implications for the measurement of severe housing deprivation in Europe, for theories that seek to account for differences in housing outcomes, and for policy that seeks to tackle housing deprivation problems.

Urbanization in Peru is inversely associated with double burden of malnutrition: Pooled analysis of 92,841 mother-child pairs.

OBJECTIVE: This study assessed the relationship between urbanization and the double burden of malnutrition (DBM) in Peru. METHODS: A cross-sectional analysis of the Demographic and Health Survey (2009 to 2016) was conducted. A DBM "case" comprised a child with undernutrition and a mother with overweight/obesity. For urbanization, three indicators were used: an eight-category variable based on district-level population density (inhabitants/km2 ), a dichotomous urban/rural variable, and place of residence (countryside, towns, small cities, or capital/large cities). RESULTS: The prevalence of DBM was lower in urban than in rural areas (prevalence ratio [PR] 0.70; 95% CI: 0.65-0.75), and compared with the countryside, DBM was less prevalent in towns (PR 0.75; 95% CI: 0.69-0.82), small cities (PR 0.73; 95% CI: 0.67-0.79), and capital/large cities (PR 0.53; 95% CI: 0.46-0.61). Using population density, the adjusted prevalence of DBM was 9.7% (95% CI: 9.4%-10.1%) in low-density settings (1 to 500 inhabitants/km2 ), 5.9% (95% CI: 4.9%-6.8%) in mid-urbanized settings (1,001 to 2,500 inhabitants/km2 ), 5.8% (95% CI: 4.5%-7.1%) in more densely populated settings (7,501 to 10,000 inhabitants/km2 ), and 5.5% (95% CI: 4.1%-7.0%) in high-density settings (>15,000 inhabitants/km2 ). CONCLUSIONS: The prevalence of DBM is higher in the least-urbanized settings such as rural and peri-urban areas, particularly those under 2,500 inhabitants/km2 .

Towards an EU measure of child deprivation.

This paper proposes a new measure of child material and social deprivation (MSD) in the European Union (EU) which includes age appropriate child-specific information available from the thematic deprivation modules included in the 2009 and 2014 waves of the "EU Statistics on Income and Living Conditions" (EU-SILC). It summarises the main results of the in-depth analysis of these two datasets, identifies an optimal set of robust children MSD items and recommends a child-specific MSD indicator for use by EU countries and the European Commission in their regular social monitoring. In doing this, the paper replicates and expands on the methodological framework outlined in Guio et al. (2012, 2016), particularly by including additional advanced reliability tests.

Applying the Consensual Method of Estimating Poverty in a Low Income African Setting.

We present the first study of multidimensional poverty in Benin using the consensual or socially perceived necessities approach. There is a remarkable level consensus about what constitutes the necessities of life and an adequate standard of living. Following Townsend's concept of relative deprivation, we show how social consensus provides the basis for a reliable and valid index of multiple deprivation, which can be used to reflect multidimensional poverty. We discuss the issue of adaptive preferences, which has previously been used to criticise the consensual approach, and provide evidence to contest the claim that the poor adjust their aspirations downwards.