Socioeconomic context of the community and chronic child malnutrition in Colombia.

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.

Socioeconomic context of the community and chronic child malnutrition in Colombia / Contexto socioeconómico de la comunidad y desnutrición crónica infantil en Colombia

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.

RESUMEN OBJETIVO Analizar la influencia del contexto socioeconómico de la comunidad sobre la desnutrición infantil crónica en Colombia. MÉTODOS Utilizando datos de la Encuesta Nacional de Demografía y Salud en Colombia en 2010, se estimaron modelos logísticos multinivel. La muestra final incluyó 11.448 niños menores de cinco años anidados en 3.528 comunidades. Además, se utilizó el Análisis de Componentes Principales usando correlaciones policóricas para la construcción de indicadores compuestos de riqueza, autonomía de la mujer y el uso y acceso al sistema de salud. RESULTADOS El nivel de riqueza promedio de la comunidad resultó significativa e independientemente asociado con la desnutrición crónica en la primera infancia, por encima y más allá del propio estatus socioeconómico del hogar. A nivel individual y del hogar, la probabilidad de desnutrición crónica fue mayor para niños de madres con bajos niveles de autonomía y uso y acceso al sistema de salud, que han tenido su primer hijo en la adolescencia y que viven en hogares en los quintiles más bajos de riqueza. En contraste, niños de madres con un índice de masa corporal > 25 y con al menos educación secundaria (versus sin educación) tuvieron menor probabilidad de padecer desnutrición crónica. CONCLUSIONES Investigaciones, programas e intervenciones que tengan en cuenta el contexto físico, económico y social de las comunidades son necesarias para contribuir a mejorar el estado nutricional de la primera infancia en Colombia.

Una mirada a la situación de laniñez en el Valle del Cauca / Uma olhada à situação da infância no Valle del Cauca / A look at the childhood situation in the Province of Valle del Cauca

En este documento identificamos un conjunto de indicadores a nivel departamental y municipal (en la medida en que la información lo permite) con perspectiva de niñez, indicadores que facilitan analizar el bienestar y cumplimiento de los derechos de los niños y niñas en distintas áreas: salud, educación, alimentación, vivienda digna, y la exposición a riesgos tempranos como el trabajo y la maternidad. La construcción de indicadores a nivel municipal que reflejan el bienestar y/o el cumplimiento de los derechos, ofrece una oportunidad para obtener una imagen completa de la situación de la niñez en un departamento, y constituye una herramienta sumamente importante en el diseño de la política pública y la focalización del gasto. Los indicadores del Valle del Cauca aquí presentados reflejan inequidades geográficas en la provisión y acceso de servicios sociales básicos; en ellos se evidencian grandes brechas entre municipios frente al promedio departamental y la ciudad de Cali. Los mayores rezagos se concentran en algunos municipios del norte del Valle y el municipio de Buenaventura. Todo esto plantea importantes retos de política pública, e invitan al debate, al análisis y a la visualización delas condiciones de vida de la niñez en el Valle del Cauca.

Identificamos neste documento um conjunto de indicadores a nível departamental e municipal (na medida em que a informação nos permite) com relação à perspectiva infantil, indicadores que facilitam analisar o bem-estar e cumprimento dos direitos das crianças em distintas áreas: saúde, educação, alimentação, moradia digna, e a exposição a riscos precoces como o trabalho e a maternidade. A construção de indicadores em âmbito municipal que refletem o bem-estar e/ou o cumprimento dos direitos, oferece uma oportunidade para obter uma imagem completa da situação da infância em um departamento, e se constitui uma ferramenta sumamente importante no desenho da política pública e na focalização do gasto. Os indicadores de Valle Del Cauca aqui apresentados refletem iniqüidades geográficas na provisão e acesso dos serviços sociais básicos; neles se evidenciam grandes brechas entre municípios frente à média departamental e a cidade de Cali. Os maiores retrocessos se concentram em alguns municípios do norte do Valle e no município de Buenaventura. Tudo isso suscita importantes desafios para a política pública, e convidam ao debate, a análise e a visualização das condições de vida das crianças du Valle Del Cauca.

In this document we identify a set of indicators at departmental and municipal level (as far as available information permits) with a perspective on childhood. These indicators permit the analysis of the well-being of children and the compliance with their rights in different areas: health, education, nutrition, decent dwelling, and the exposure to early risks such as child labor and maternity. The construction of indicators at municipal level which reflect well-being and/or compliance with children’s rights offers an opportunity to obtain a complete picture of the situation regarding childhood in one department, and constitutes an extremely important tool in the design of public policy and the focus on spending. The indicators for Valle del Cauca presented here reflect geographical inequalities in the provision of, and access to, basic social facilities; here there is evidence of great disparity among towns compared with the departmental average and the city of Cali. The greatest differences are concentrated in some towns in the north of Valle and Buenaventura. All of this lays down important challenges in public policy, and invites debate, analysis and of the visualization of the living conditions of children in Valle del Cauca.