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Childhood Malnutrition and Postwar Reconstruction in Rural El Salvador
A Community-Based Survey
Paula E. Brentlinger, MD, MPH;
Miguel A. Hernán, MD, MPH;
Sonia Hernández-Díaz, MD, MPH;
Lenore S. Azaroff, ScD;
Maureen McCall, MD, MPH
JAMA. 1999;281:184-190.
Context The 1992 peace settlement that ended the civil war in El Salvador included land redistribution and other provisions designed to improve the socioeconomic status of ex-combatants and vulnerable civilians.
Objective To describe associations between postwar social and economic assistance programs, especially land reform, and current child health status as reflected by nutrition in a population of resettled rural refugees.
Design A population-based cross-sectional survey of child nutritional status and principal elements of the reconstruction process.
Setting A single rural municipality in northern El Salvador.
Participants A representative sample of 761 children younger than 5 years, living in 27 villages.
Main Outcome Measure Prevalence of stunting (low height for age) in children younger than 5 years.
Results Prevalence of stunting was 32.4%. Stunting was significantly more prevalent among children whose families cultivated less land (odds ratio [OR] for stunting per additional hectare of redistributed land cultivated, 0.64; 95% confidence interval [CI], 0.44-0.93). Less than half of newly transferred land was being cultivated by its owners. Most of the children (84.7%) lived in families cultivating 2 hectares or less of redistributed land. Stunting was also more prevalent among children whose households lacked piped water (adjusted OR, 2.72; 95% CI, 1.87-3.96) vs those who had had piped water since before the cease-fire.
Conclusions Malnutrition, particularly stunting, persisted at high levels and was strongly associated with delay in full cultivation of redistributed land and in provision of water.
Author Affiliations: Physicians for Human Rights (Dr Brentlinger), and Department of Epidemiology, Harvard School of Public Health (Drs Hernán and Hernández-Díaz), Boston, Mass; Work Environment Department, University of Massachusetts, Lowell (Dr Azaroff); and Red Deer Regional Hospital, Red Deer, Alberta (Dr McCall).
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