title: Early child health in an informal settlement in the Peruvian Amazon.
abstract: Informal settlements are common throughout the developing world. In Peru, land occupations, commonly "invasions" in Spanish, are a means by which the extremely poor attempt to obtain access to land. Here, we examine difference in child health between two communities in the Peruvian Amazon, one well-established and one newly formed by 'invasion', as captured incidentally by a prospective epidemiological cohort study.
  
  
  
  Between 2002 and 2006 a study designed to describe the epidemiology of pediatric enteric infections and child growth in a community-based setting enrolled 442 children in Santa Clara de Nanay, a community adjacent to the city of Iquitos, in Loreto, Peru. In early 2003, a land occupation, commonly called an "invasion" in Spanish, was organized by members of the Santa Clara community, and approximately 20 % of participating study families began occupying privately owned agricultural land adjacent to Santa Clara, thus forming the new community of La Union.
  
  
  
  Parents in families that chose to invade reported less education than parents in families that chose not to. Children in the new community experienced a higher incidence of diarrheal disease and non-specific fevers, although fewer helminth infections, than children who remained in the established community. At the time of the invasion, there were no differences in anthropometric status between the two groups; however children in the new community experienced greater progressive growth faltering over the course of the longitudinal study.
  
  
  
  Growth faltering in early childhood represents an enduring loss of human potential. Therefore, our data suggests the human cost of land invasion may be disproportionately borne by the youngest individuals. Innovative policy strategies may be needed to protect this vulnerable group.
authors.affiliation: Department of Epidemiology, University of Michigan, Ann Arbor, USA.
authors.forename: Gwenyth O
authors.identifier: 0000-0002-7889-3852
authors.initials: GO
authors.lastname: Lee
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.|Biomedical Research, Asociación Benéfica PRISMA, Ramirez Hurtado 622, Iquitos, Peru.
authors.forename: Maribel
authors.initials: M
authors.lastname: Paredes Olortegui
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.|Independent Researcher, Asociación Peruana para la Conservación de la Naturaleza, Lima, Peru.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Salmón-Mulanovich
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.|Biomedical Research, Asociación Benéfica PRISMA, Ramirez Hurtado 622, Iquitos, Peru.
authors.forename: Pablo
authors.initials: P
authors.lastname: Peñataro Yori
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA. mkosek@jhmi.edu.|Biomedical Research, Asociación Benéfica PRISMA, Ramirez Hurtado 622, Iquitos, Peru. mkosek@jhmi.edu.|Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Room E5608, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. mkosek@jhmi.edu.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kosek
mesh_terms: D000328:Adult; D002648:Child; D000067576:Child Health; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D005334:Fever / Q000453:epidemiology; D006130:Growth Disorders / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009349:Nematode Infections / Q000453:epidemiology; D010568:Peru / Q000453:epidemiology; D011203:Poverty; D012111:Residence Characteristics; D014171:Transients and Migrants
keywords: Child health; Height-for-age; Informal settlement; Natural experiment; Peru