Malnutrition in Mesoamerica: The distribution and correlates of stunting, wasting, underweight, and anemia.

Abstract

Background: In 2013, 1.5 million deaths attributable to malnutrition occurred globally to children younger than 5 years. Childhood malnutrition is strongly linked to child mortality, disease, and educational and later-life economic success. Latin America is a highly inequitable region that has seen a slowing rate of decline in undernutrition in the past two decades, while facing a high burden of chronic malnutrition. The aims of this analysis were to measure the prevalence of growth attainment and anemia indicators in the poorest quintile of the population in Mesoamerica, and to identify characteristics associated with those conditions. Methods: Data for this analysis came from the Salud Mesoamérica 2015 Initiative (SM2015) baseline evaluation. Data was collected from 23,005 children age 0-59 months in the poorest quintile of the population in each of El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the State of Chiapas, Mexico. Trained anthropometrists performed height and weight measurements for 20,730 children and finger prick anemia tests on 16,964 children age 0-59 months. Child growth was age-sex standardized to measure the prevalence of stunting, wasting, underweight, overweight, and anemia. Logistic regressions were conducted to determine the individual, maternal, and household characteristics associated with each growth and anemia outcome. Survey weights were used to account for survey design. Findings: Anemia and stunting are the most common undernutrition problems in the region. Anemia ranges from 20.1% (Nicaragua) to 55.0% (Guatemala), and stunting from 16.9% (El Salvador) to 58.5% (Guatemala). There is very low wasting prevalence (0.7% in Honduras to 2.4% in El Salvador), and most countries had more children overweight than underweight. Within countries, there is significant geographic variation in the prevalence of these outcomes by department. Socioeconomic characteristics including household wealth and maternal education are associated with stunting. Children in urban areas are less likely to be stunted (OR=0.70, 95% CI: 0.56-0.87) an anemic (OR=0.75, 95% CI: 0.61-0.94). Children who were born at low birth weight are more likely to be stunted (OR=1.62, 95% CI: 1.28-2.06), severely stunted (OR=1.55, 95% CI: 1.10-2.19), wasted (OR=2.23, 95% CI: 1.24-4.00), and underweight (OR=2.71, 95% CI: 1.94-3.80). Recent illness is associated with higher likelihood of anemia (OR=1.26, 95% CI: 1.13-1.51) and underweight (OR=1.36, 95% CI: 1.07-1.73). Conclusions: Recent improvements in undernutrition in the Mesoamerican region mask the high burden of chronic undernutrition affecting the poorest areas. Despite presence of fortified foods and dietary supplementation programs, children in these areas are still not meeting growth potential. These findings can be used to better target at-risk children, families, and communities.