The family as a determinant of stunting in children living in conditions of extreme poverty: a case-control study.
BACKGROUND
Malnutrition in children can be a consequence of unfavourable socioeconomic conditions. However, some families maintain adequate nutritional status in their children despite living in poverty. The aim of this study was to ascertain whether family-related factors are determinants of stunting in young Mexican children living in extreme poverty, and whether these factors differ between rural or urban contexts.


METHODS
A case-control study was conducted in one rural and one urban extreme poverty level areas in Mexico. Cases comprised stunted children aged between 6 and 23 months. Controls were well-nourished children. Independent variables were defined in five dimensions: family characteristics; family income; household allocation of resources and family organisation; social networks; and child health care. Information was collected from 108 cases and 139 controls in the rural area and from 198 cases and 211 controls in the urban area. Statistical analysis was carried out separately for each area; unconditional multiple logistic regression analyses were performed to obtain the best explanatory model for stunting.


RESULTS
In the rural area, a greater risk of stunting was associated with father's occupation as farmer and the presence of family networks for child care. The greatest protective effect was found in children cared for exclusively by their mothers. In the urban area, risk factors for stunting were father with unstable job, presence of small social networks, low rate of attendance to the Well Child Program activities, breast-feeding longer than six months, and two variables within the family characteristics dimension (longer duration of parents' union and migration from rural to urban area).


CONCLUSIONS
This study suggests the influence of the family on the nutritional status of children under two years of age living in extreme poverty areas. Factors associated with stunting were different in rural and urban communities.Therefore, developing and implementing health programs to tackle malnutrition should take into account such differences that are consequence of the social, economic, and cultural contexts in which the family lives.
Reyes
Hortensia
H
Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México. hortensia.reyes@imss.gob.mx
Pérez-Cuevas
Ricardo
R
Sandoval
Araceli
A
Castillo
Raúl
R
Santos
José Ignacio
JI
Doubova
Svetlana V
SV
Gutiérrez
Gonzalo
G
D000383:Agriculture / Q000191:economics; D000886:Anthropometry; D001942:Breast Feeding / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002657:Child Development / Q000502:physiology*; D002662:Child Health Services / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D006798:Housing; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000150:complications / Q000191:economics / Q000453:epidemiology*; D008297:Male; D008800:Mexico / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011157:Population Dynamics; D011204:Poverty Areas; D012307:Risk Factors; D012423:Rural Health; D012944:Social Support; D014504:Urban Health