| Overall impact: |  Medium |
|---|---|
|
Impact: |
|
|
Strength: |
|
This includes reduced child disease burden, improved child dietary intake, and lower risk of low birth weight.
Literature Review
|
Impact: |
|
|
Strength: |
|
A substantial amount of literature exists supporting the relationship between diarrheal disease and stunting.1 2
Checkley, et al. found that diarrhea in the first six months of a child’s life retarded growth permanently in Peruvian children. 3 Jaganath, et al. extended this period to the first two years of a child’s life. 4 Lechtig, et al. found that acute respiratory infection is also an immediate cause of stunting.5
However, one study found that diarrhea did not have an impact on HAZ in Peru.6 A Lee, et al. study suggested that while diarrhea was a significant risk factor for stunting, recent incidence of diarrhea was not necessarily correlated with stunting.
Finally, low birth weight has been identified in other literature as a risk factor for stunting.7
Quantitative Analysis
|
Impact: |
|
|
Strength: |
|
Based on the linear mixed effects regression, for the 2000-2016 period, ARI infection was significantly associated with stunting prevalence at the 10 percent level, albeit with a small effect size. Diarrhea and low birthweight were not significantly associated. From a maternal perspective, maternal age was significant, with a small effect size of 0.02; however, prevalence of anemia was not significant.
According to the decomposition analysis, incidence of diarrhea was a significant predictor of change in HAZ-score; however, its contribution was negligible (<1 percent). Older age pregnancy was significant for children under five during the 2000-2016 period, but not across other age groups or time periods. Anemia, maternal age, and ARI were not significant.
Peru Victoria curves flatten out considerable between 2000 and 2016 for the 6-23-month period. This suggests dramatic improvements during this part of Peruvian children’s lifespans; reductions in disease burden likely contributed to these improvements.
Qualitative Analysis
|
Impact: |
|
|
Strength: |
|
Childhood disease prevention was mentioned as an important part of stunting reduction.
Conclusion
The quantitative analyses suggest that reductions in ARI and diarrheal disease made at least some contribution to Peru’s decline in stunting prevalence. Moreover, the global literature and evidence-based programs specifically addressed these immediate determinants of child growth. It is therefore likely that improvements across these criteria contributed to reduction in stunting.
-
1
Lee G, Yori P, Olortegui MP, Pan W, Caulfield L, Gilman RH, Sanders JW, Delgado HS, Kosek M. Comparative effects of vivax malaria, fever and diarrhoea on child growth. Int J Epidemiol [Internet]. 2012;41:531-9.
-
2
Lee G, Paredes Olortegui M, Salmón-Mulanovich G, Peñataro Yori P, Kosek M. Early child health in an informal settlement in the Peruvian Amazon. BMC Int Health Hum Rights [Internet]. 2016;16:1-9.
-
3
Checkley W, Epstein LD, Gilman RH, Cabrera L, Black RE. Effects of acute diarrhea on linear growth in Peruvian children. Am J Epidemiol [Internet]. 2003;157:166-75.
-
4
Jaganath D, Saito M, Gilman RH, Queiroz DMM, Rocha GA, Cama V, Cabrera L, Kelleher D, Windle HJ, Crabtree JE, et al. First Detected Helicobacter pylori Infection in Infancy Modifies the Association Between Diarrheal Disease and Childhood Growth in Peru. Helicobacter [Internet]. 2014;19:272-9.
-
5
Lechtig A, Cornale G, Ugaz ME, Arias L. Decreasing stunting, anemia, and vitamin A deficiency in Peru: results of the Good Start in Life Program. Food Nutr Bull [Internet]. 2009;30:37-48.
-
6
Iannotti LL, Zavaleta N, Leon Z, Caulfield EL. Growth and body composition of Peruvian infants in a peri urban setting. Food Nutr Bull [Internet]. 2009;30:245-53.
-
7
Mariños-Anticona C, Chaña-Toledo R, Medina-Osis J, Vidal-Anzardo M, Valdez-Huarcaya W. Determinantes sociales de la desnutrición crónica infantil en el Perú. Rev peru epidemiol. 2014;18:1-7.