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Factors behind the success story of under-five stunting in Peru: a district ecological multilevel analysis

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dc.contributor.author Huicho, Luis
dc.contributor.author Huayanay-Espinoza, Carlos A.
dc.contributor.author Herrera-Perez, Eder
dc.contributor.author Segura, Eddy R.
dc.contributor.author Nino de Guzman, Jessica
dc.contributor.author Rivera-Ch, Maria
dc.contributor.author Barros, Aluisio J. D.
dc.date.accessioned 2019-01-25T15:18:35Z
dc.date.available 2019-01-25T15:18:35Z
dc.date.issued 2017
dc.identifier.uri http://doi.org/10.1186/s12887-017-0790-3
dc.identifier.uri http://repositorio.upch.edu.pe/handle/upch/4654
dc.description.abstract BACKGROUND: Stunting prevalence in children less than 5 years has remained stagnated in Peru from 1992 to 2007, with a rapid reduction thereafter. We aimed to assess the role of different predictors on stunting reduction over time and across departments, from 2000 to 2012. METHODS: We used various secondary data sources to describe time trends of stunting and of possible predictors that included distal to proximal determinants. We determined a ranking of departments by annual change of stunting and of different predictors. To account for variation over time and across departments, we used an ecological hierarchical approach based on a multilevel mixed-effects regression model, considering stunting as the outcome. Our unit of analysis was one department-year. RESULTS: Stunting followed a decreasing trend in all departments, with differing slopes. The reduction pace was higher from 2007-2008 onwards. The departments with the highest annual stunting reduction were Cusco (-2.31%), Amazonas (-1.57%), Puno (-1.54%), Huanuco (-1.52%), and Ancash (-1.44). Those with the lowest reduction were Ica (-0.67%), Ucayali (-0.64%), Tumbes (-0.45%), Lima (-0.37%), and Tacna (-0.31%). Amazon and Andean departments, with the highest baseline poverty rates and concentrating the highest rural populations, showed the highest stunting reduction. In the multilevel analysis, when accounting for confounding, social determinants seemed to be the most important factors influencing annual stunting reduction, with significant variation between departments. CONCLUSIONS: Stunting reduction may be explained by the adoption of anti-poverty policies and sustained implementation of equitable crosscutting interventions, with focus on poorest areas. Inclusion of quality indicators for reproductive, maternal, neonatal and child health interventions may enable further analyses to show the influence of these factors. After a long stagnation period, Peru reduced dramatically its national and departmental stunting prevalence, thanks to a combination of social determinants and crosscutting factors. This experience offers useful lessons to other countries trying to improve their children's nutrition.
dc.language.iso eng
dc.publisher BMC
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Female
dc.subject Humans
dc.subject Male
dc.subject Poverty
dc.subject Children
dc.subject Infant
dc.subject Child, Preschool
dc.subject Health Status Disparities
dc.subject Prevalence
dc.subject Infant, Newborn
dc.subject Childhood interventions
dc.subject Ecologic study
dc.subject Economic growth
dc.subject Models, Statistical
dc.subject Multilevel mixed-effects analysis
dc.subject Protective Factors
dc.subject Social determinants
dc.subject Stunting
dc.subject Peru/epidemiology
dc.subject Economic Development
dc.subject Health Policy
dc.subject Rural Health
dc.subject Social Determinants of Health
dc.subject Growth Disorders/economics/epidemiology/prevention & control
dc.subject Poverty/prevention & control
dc.title Factors behind the success story of under-five stunting in Peru: a district ecological multilevel analysis
dc.type info:eu-repo/semantics/article
dc.identifier.journal BMC Pediatrics

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