[Child malnutrition in children under 5 years of age in Peru: trends and determinants].
OBJECTIVE
Analyze malnutrition and anemia trends in Peruvian children under 5 years of age and their association with determinants in the 2000-2011 period.


METHODS
Nutritional indicators for children under 5 years of age from the 2011 Demographic and Family Health Survey (ENDES), and their evolution based on data from the 2000, 2005, and 2008 ENDES, were analyzed. Chronic malnutrition (CM) (height/age ≤ 2 SD), acute malnutrition (AM), (height/weight ≤ 2 SD), and anemia trends were estimated. Associations were found with factors such as sex, age, area of residence (urban or rural), region of residence, mother's education, wealth quintile, availability of public water system, sewer availability, altitude, presence of other children in household, birth order, presence of diarrhea in previous 15 days, and presence of cough in previous 15 days.


RESULTS
AM, CM, and anemia in Peruvian children under 5 years of age decreased from 2000-2011. This reduction was not uniform for the three conditions, with decreases of 1.1% to 0.4% recorded for AM, 31.6% to 19.6% for CM, and 50.4% to 30.7% for anemia. Although the factors analyzed were related to the prevalence of these three illnesses, calculation of the adjusted odds ratios showed significant differences for CM (mother's education, Sierra region, altitude greater than 2 500 m above sea level, presence of two or more children in household, and being the third or successive child) and anemia (child sex [higher in males], children under 2 years of age, Resto de costa region and Selva region, altitude greater than 2 500 m above sea level, availability of public water system, sewer availability, presence of two or more children in household, and presence of diarrhea within 15 days prior to the survey). For AM, differences were observed according to some factors but they were not significant in the adjusted model.


CONCLUSIONS
In the 2000-2011 period, Peru achieved reduction of its CM, AM, and anemia rates. AM rates decreased to almost one-third, with overall figures remaining fairly low, and affecting to a greater extent highly localized areas and groups of the country. However, the current rates of chronic malnutrition and anemia continue to be very high, which represents a true challenge for public policy, as occurs in other countries of the region. In order to overcome this challenge it will be necessary to change the approach, no longer conceiving of child malnutrition exclusively as a nutritional problem and instead placing greater emphasis on the related determinants. Finally, comprehensive and integrated initiatives should be encouraged and strengthened in the poorest communities.
Facultad de Medicina, Universidad de Sevilla, Sevilla, España, drsobrinotoro@gmail.com.
Manuel
M
Sobrino
Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
César
C
Gutiérrez
Facultad de Medicina, Universidad Federal de Río de Janeiro, Río de Janeiro, Brasil.
Antonio J
AJ
Cunha
Organización Panamericana de la Salud, Lima, Perú
Miguel
M
Dávila
Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
Jorge
J
Alarcón
D015362:Child Nutrition Disorders / Q000453:epidemiology*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010568:Peru / Q000453:epidemiology