Household environment

Urbanization and reduced number of household members are associated with improved access to food and services (including health services) and an improved ability of families to provide adequate nutrition and care for fewer children.

Literature Review

Existing literature suggests that the total number of children a mother has influences child nutritional status and growth through multiple pathways. An increase in the odds of preterm birth (associated with stunting) and neonatal mortality have been observed for mothers having ≥3 children, compared with mothers having 1-2 children. Fewer total children being brought to term and breastfed means maternal nutrient stores are depleted to a lesser extent, and micronutrient passage in breast milk may be increased. Having fewer children (thus fewer total household members) also means less physical crowding, which may reduce the spread of infectious disease such as pneumonia, and diarrhea due to suboptimal hygiene practices and use of sanitation facilities.^{1 2  3}

The number of children in a mother's household can influence the nutrient intake of mothers and children. The more children there are, the more food and resources must be divided between them if household resources are limited. In large households, pregnant mothers may also have less food available for her own needs and that of her growing fetus.⁴

Quantitative Analysis

Based on the linear mixed effects regression, urbanization significantly influenced stunting prevalence in the expected direction across all time periods. For the 2000-2016 period, significance was extremely high (p-value < 0.0001), but the effect size was small (0.04).

According to the decomposition analysis, contribution of urban locality is negligible or not significant across all age groups and time periods.

Number of household members, however, is predictive of HAZ-score across most age groups. While this not one of the top contributors to HAZ increase, it is also not insubstantial.

Qualitative Analysis

Urbanization and improvement of household conditions were mentioned in interviews but not especially emphasized. One participant explicitly noted that improvement of household conditions was a likely contributor to stunting decline.

“Good experiences like Buen Inicio… All share the view that it is not enough to distribute food, that this needs to be accompanied by health interventions, nutrition education, other childhood protection elements… Access to health services, support to families so they can put into practice the whole package, and also by improvement of household conditions and improvement in key child care practices, especially in the nutrition aspect.”

- Pediatrician. Former Technical Officer at UNICEF.

Conclusion

The influence of household conditions, particularly household size, is well supported in the existing global literature. While the modeled effect is small, both urbanization and household size appear to have a significant association with stunting and child height in Peru.

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