Childhood Malnutrition and Postwar Reconstruction in Rural El Salvador

Abstract

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.