Article

Nonlinear effects of altitude on child growth in Peru : a multilevel analysis

02/2006;
Source: RePEc

ABSTRACT Growth at high altitude has been the object of many investigations after experimental studies on animals showed that hypoxia at high altitude slows growth. Many studies have also looked at the Andean populations and found different results. Even though a few studies find that individuals living at high altitudes are smaller than the ones living at low altitudes, a significant group of studies does not reveal such a clear relationship. This study focuses on Peru, a country characterized by a diverse territory, great altitude variations, and a population with a wide socioeconomic gradient. The analysis differs from previous studies in three ways. First, in an attempt to reconcile the main findings of the biological literature with the economic models of child health, it explores the relationship between altitude and child health within a multivariate framework. Second, it benefits from a large spectrum of altitude data and does not concentrate on one or two isolated villages. Third, it takes into account the cluster nature of the data and controls for correlation of variables in the same cluster through multilevel statistical modeling. After controlling for characteristics of the children, families, and communities, the data show a significant nonlinear relationship between altitude and child nutritional status. Peruvian children living at medium/high altitudes appear to be worse off than children living at extremely high altitudes, where the negative effect of hypoxia on growth could be compensated by other favorable health and environmental conditions.

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    ABSTRACT: Despite recent achievement in economic progress in India, the fruit of development has failed to secure a better nutritional status among all children of the country. Growing evidence suggest there exists a socio-economic gradient of childhood malnutrition in India. The present paper is an attempt to measure the extent of socio-economic inequality in chronic childhood malnutrition across major states of India and to realize the role of household socio-economic status (SES) as the contextual determinant of nutritional status of children. Using National Family Health Survey-3 data, an attempt is made to estimate socio-economic inequality in childhood stunting at the state level through Concentration Index (CI). Multi-level models; random-coefficient and random-slope are employed to study the impact of SES on long-term nutritional status among children, keeping in view the hierarchical nature of data. Across the states, a disproportionate burden of stunting is observed among the children from poor SES, more so in urban areas. The state having lower prevalence of chronic childhood malnutrition shows much higher burden among the poor. Though a negative correlation (r = -0.603, p < .001) is established between Net State Domestic Product (NSDP) and CI values for stunting; the development indicator is not always linearly correlated with intra-state inequality in malnutrition prevalence. Results from multi-level models however show children from highest SES quintile posses 50 percent better nutritional status than those from the poorest quintile. In spite of the declining trend of chronic childhood malnutrition in India, the concerns remain for its disproportionate burden on the poor. The socio-economic gradient of long-term nutritional status among children needs special focus, more so in the states where chronic malnutrition among children apparently demonstrates a lower prevalence. The paper calls for state specific policies which are designed and implemented on a priority basis, keeping in view the nature of inequality in childhood malnutrition in the country and its differential characteristics across the states.
    International Journal for Equity in Health 01/2010; 9(1):19. · 1.71 Impact Factor

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