RESUMO
Household expenditure surveys, routinely conducted in low-and middle-income countries (LMICs), usually include questions pertaining to recent household expenditures on key food groups. When child anthropometrics are also available, such expenditure data can provide insights into household food purchasing patterns that are associated with subsequent child growth measures. We used data from 6993 children, born around 2001, from Ethiopia, India, Peru, and Vietnam, from the Young Lives younger cohort. We compared associations between two weeks of household food expenditures (in PPP-Purchasing Power Parity adjusted dollars) on food groups and child height-for-age-Z score (HAZ) at subsequent time points to assess longitudinal associations. Total food expenditures, rural/urban residence, maternal and paternal schooling, and child sex were included in our adjusted models because they may affect the relations between household food group expenditures and future child HAZ. In Ethiopia, India, and Peru every extra PPP$ spent on fats was associated with 0.02-0.07 higher future HAZ. In Vietnam every extra PPP$ spent on starches, was significantly associated with a 0.01 lower future HAZ. Across countries, different patterns of food expenditure and procurement may be differentially critical for predicting child HAZ. Our results demonstrate how expenditures on specific food groups can be associated with children's linear growth. This study provides additional evidence of the utility of longitudinal household food expenditure data in understanding child nutritional status.
Assuntos
Desenvolvimento Infantil , Gastos em Saúde , Criança , Etiópia , Feminino , Humanos , Índia , Lactente , Peru , VietnãRESUMO
Academic and policy literatures on intergenerational transmissions of poverty and inequality suggest that improving schooling attainment and income for parents in poor households will lessen poverty and inequality in their children's generation through increased human capital accumulated by their children. However, magnitudes of such effects are unknown. We use data on children born in the 21st century in four developing countries to simulate how changes in parents' schooling attainment and consumption would affect poverty and inequality in both the parent's and their children's generations. We find that increasing minimum schooling or income substantially reduces poverty and inequality in the parent's generation, but does not carry over to reducing poverty and inequality substantially in the children's generation. Therefore, while reductions in poverty and inequality in the parents' generation are desirable in themselves to improve welfare among current adults, they are not likely to have large impacts in reducing poverty and particularly in reducing inequality in human capital in the next generation.
RESUMO
OBJECTIVE: Test associations between household water and sanitation (W&S) and children's concurrent and subsequent Peabody Picture Vocabulary Test (PPVT) scores. DESIGN: Prospective cohort study. SETTING: Ethiopia, India, Peru, Vietnam. PARTICIPANTS: 7269 children. PRIMARY OUTCOME MEASURES: PPVT scores at 5 and 8â years. Key exposure variables were related to W&S, and collected at 1, 5 and 8â years, including 'improved' water (eg, piped, public tap or standpipe) and 'improved' toilets (eg, collection, storage, treatment and recycling of human excreta). RESULTS: Access to improved water at 1â year was associated with higher language scores at 5â years (3/4 unadjusted associations) and 8â years (4/4 unadjusted associations). Ethiopian children with access to improved water at 1â year had test scores that were 0.26 SD (95% CI 0.17 to 0.36) higher at 5â years than children without access. Access to improved water at 5â years was associated with higher concurrent PPVT scores (in 3/4 unadjusted associations), but not later scores (in 1/4 unadjusted associations). 5-year-old Peruvian children with access to improved water had better concurrent performance on the PPVT (0.44 SD, 95% CI 0.30 to 0.59) than children without access to improved water. Toilet access at 1â year was also associated with better PPVT scores at 5â years (3/4 unadjusted associations) and sometimes associated with test results at 8â years (2/4 unadjusted associations). Toilet access at 5â years was associated with concurrent PPVT scores (3/4 unadjusted associations). More than half of all associations in unadjusted models (water and toilets) persisted in adjusted models, particularly for toilets in India, Peru and Vietnam. CONCLUSIONS: Access to 'improved' water and toilets had independent associations with children's PPVT scores that often persisted with adjustment for covariates. Our findings suggest that effects of W&S may go beyond subacute and acute infections and physical growth to include children's language performance, a critical component of cognitive development.
Assuntos
Desenvolvimento Infantil , Testes de Linguagem/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Vocabulário , Qualidade da Água , Criança , Pré-Escolar , Estudos de Coortes , Etiópia , Feminino , Humanos , Índia , Lactente , Masculino , Peru , Estudos Prospectivos , VietnãRESUMO
Population-level analysis of dietary influences on nutritional status is challenging in part due to limitations in dietary intake data. Household expenditure surveys, covering recent household expenditures and including key food groups, are routinely conducted in low- and middle-income countries. These data may help identify patterns of food expenditure that relate to child growth. OBJECTIVES: We investigated the relationship between household food expenditures and child growth using factor analysis. METHODS: We used data on 6993 children from Ethiopia, India, Peru and Vietnam at ages 5, 8 and 12y from the Young Lives cohort. We compared associations between household food expenditures and child growth (height-for-age z scores, HAZ; body mass index-for-age z scores, BMI-Z) using total household food expenditures and the "household food group expenditure index" (HFGEI) extracted from household expenditures with factor analysis on the seven food groups in the child dietary diversity scale, controlling for total food expenditures, child dietary diversity, data collection round, rural/urban residence and child sex. We used the HFGEI to capture households' allocations of their finances across food groups in the context of local food pricing, availability and pReferences RESULTS: The HFGEI was associated with significant increases in child HAZ in Ethiopia (0.07), India (0.14), and Vietnam (0.07) after adjusting for all control variables. Total food expenditures remained significantly associated with increases in BMI-Z for India (0.15), Peru (0.11) and Vietnam (0.06) after adjusting for study round, HFGEI, dietary diversity, rural residence, and whether the child was female. Dietary diversity was inversely associated with BMI-Z in India and Peru. Mean dietary diversity increased from age 5y to 8y and decreased from age 8y to 12y in all countries. CONCLUSION: Household food expenditure data provide insights into household food purchasing patterns that significantly predict HAZ and BMI-Z. Including food expenditure patterns data in analyses may yield important information about child nutritional status and linear growth.
Assuntos
Antropometria , Desenvolvimento Infantil/fisiologia , Preferências Alimentares/classificação , População Rural , Criança , Pré-Escolar , Etiópia , Humanos , Índia , Peru , VietnãRESUMO
BACKGROUND: This study's purpose was to understand associations between water, sanitation, and child growth. METHODS: We estimated stunting (height-for-age Z score <-2 SD) and thinness (BMI-Z <-2 SD) risk ratios using data from 7,715 Ethiopian, Indian, Peruvian, and Vietnamese children from the Young Lives study. RESULTS: In unadjusted models, household access to improved water and toilets was often associated with reduced stunting risk. After adjusting for child, household, parent, and community variables, access to improved water was usually not associated with stunting nor thinness except in Ethiopia where access to improved water was associated with reduced stunting and thinness at 1y and 5y. In contrast, in both unadjusted and adjusted models, stunting at 1y was less common among children with good toilet access than among those without access and this difference persisted when children were 5y and 8y. For example, in adjusted estimates, Vietnamese 5y olds with access to improved toilets had relative stunting risk at 8y 0.62-0.68 that of 5y olds with no access to improved toilets. Water and toilets were rarely associated with thinness. CONCLUSIONS: Results from our study indicate that access to improved sanitation is more frequently associated with reduced stunting risk than access to improved water. However, additional studies are needed before drawing definitive conclusions about the impact of toilets relative to water. This study is the first to our knowledge to demonstrate the robust and persistent importance of access to improved toilets in infancy, not only during the first year but continuing into childhood. Additional longitudinal investigations are needed to determine concurrent and long-term associations of WASH with stunting and thinness.
Assuntos
Transtornos do Crescimento/etiologia , Saneamento/estatística & dados numéricos , Abastecimento de Água/estatística & dados numéricos , Criança , Pré-Escolar , Estudos de Coortes , Etiópia/epidemiologia , Características da Família , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Índia/epidemiologia , Lactente , Masculino , Razão de Chances , Peru/epidemiologia , Risco , Magreza/epidemiologia , Magreza/etiologia , Vietnã/epidemiologiaRESUMO
Several studies in developing countries have found that children who experience growth faltering in the first years of life show lower cognitive abilities than their peers. In this study, we use the Young Lives longitudinal dataset in Peru to analyze if attending pre-school affects cognitive abilities at age five years, and if there is an interaction with HAZ at age one year. Using instrumental variables we found, for receptive vocabulary, a positive effect of attending Jardines (formal) pre-schools; the effect of attending PRONOEI (community-based) pre-schools was not significant. More years attending Jardines was more beneficial for children who were better nourished. We suggest working to improve the quality of PRONOEIs, and with teachers on targeting children of lower nutritional status.
RESUMO
BACKGROUND: It is unclear what effects a conditional cash transfer (CCT) program would have on child anthropometry, language development, or school achievement in the context of the nutrition transition experienced by many low- and middle-income countries. OBJECTIVE: We estimated the association of participation in Peru's Juntos CCT with anthropometry, language development, and school achievement among children aged 7-8 y. METHODS: We used data from the Young Lives Study of a cohort born between 2001 and 2002. We estimated associations of the Juntos program with height-for-age z score (HAZ), body mass index-for-age z score (BAZ), stunting, and overweight at age 7-8 y separately for children participating in the program for ≥2 y (n = 169) and children participating for <2 y (n = 188). We then estimated associations with receptive vocabulary and grade achievement among children who had been assessed at age 4-6 y before enrollment in Juntos (n = 243). We identified control subjects using propensity score matching and conducted difference-in-differences comparisons. RESULTS: Juntos participation was associated with increases in HAZ among boys participating for ≥2 y [average effect of treatment among the treated (ATT): 0.43; 95% CI: 0.09, 0.77; P = 0.01] and for boys participating for <2 y (ATT: 0.52; 95% CI: 0.23, 0.80; P < 0.01). Among girls participating in the program for ≥2 y, BAZ declined (ATT: -0.60; 95% CI: -1.00, -0.21; P < 0.01) as did the prevalence of overweight (ATT: -22.0 percentage points; 95% CI: -42.5, -2.7 percentage points; P = 0.03). We observed no significant associations of Juntos participation with receptive vocabulary or grade attainment. CONCLUSIONS: CCT program participation in Peru was associated with better linear growth among boys and decreased BAZ among girls, highlighting that a large-scale poverty-alleviation intervention may influence anthropometric outcomes in the context of the nutrition transition.
Assuntos
Desenvolvimento Infantil , Fenômenos Fisiológicos da Nutrição Infantil , Dieta , Sobrepeso/prevenção & controle , Pobreza/prevenção & controle , Assistência Pública , Índice de Massa Corporal , Criança , Estudos de Coortes , Dieta/efeitos adversos , Dieta/economia , Escolaridade , Feminino , Seguimentos , Implementação de Plano de Saúde , Humanos , Desenvolvimento da Linguagem , Masculino , Sobrepeso/economia , Sobrepeso/epidemiologia , Sobrepeso/etiologia , Peru/epidemiologia , Prevalência , Fatores SexuaisRESUMO
BACKGROUND: Poor childhood nutritional status has lifetime effects and food insecurity is associated with dietary practices that can impair nutritional status. OBJECTIVES: We assessed concurrent and subsequent associations between food insecurity and height-for-age z scores (HAZs) and body mass index-for-age z scores (BMI-Zs); evaluated associations with transitory and chronic food insecurity; and tested whether dietary diversity mediates associations between food insecurity and nutritional status. METHODS: We used data from the Young Lives younger cohort composed of children in Ethiopia (n = 1757), India (n = 1825), Peru (n = 1844), and Vietnam (n = 1828) recruited in 2002 (round 1) at â¼1 y old, with subsequent data collection at 5 y in 2006 (round 2) and 8 y in 2009 (round 3). RESULTS: Children from food-insecure households had significantly lower HAZs in all countries at 5 y (Ethiopia, -0.33; India, -0.53; Peru, -0.31; and Vietnam, -0.68 HAZ; all P < 0.001), although results were attenuated after controlling for potential confounders (Ethiopia, -0.21; India, -0.32; Peru, -0.14; and Vietnam, -0.27 HAZ; P < 0.01). Age 5 y food insecurity predicted the age 8 y HAZ, but did not add predictive power beyond HAZ at age 5 y in Ethiopia, India, or Peru. Age 5 y food insecurity predicted the age 8 y BMI-Z even after controlling for the 5 y BMI-Z, although associations were not significant after the inclusion of additional confounding variables (Ethiopia, P = 0.12; India, P = 0.29; Peru, P = 0.16; and Vietnam, P = 0.51). Chronically food-insecure households had significantly lower HAZs than households that were consistently food-secure, although BMI-Zs did not differ by chronic food-insecurity status. Dietary diversity mediated 18.8-30.5% of the association between food security and anthropometry in Vietnam, but mediated to a lesser degree (8.4-19.3%) in other countries. CONCLUSIONS: In 4 countries, food insecurity at 5 y of age was associated with both HAZ and BMI-Z at age 8 y, although the association was attenuated after adjusting for other household factors and anthropometry at age 5 y, and remained significant only for the HAZ in Vietnam.
Assuntos
Antropometria , Desenvolvimento Infantil , Características da Família , Abastecimento de Alimentos/normas , Criança , Pré-Escolar , Estudos Transversais , Etiópia , Feminino , Humanos , Índia , Estudos Longitudinais , Masculino , Peru , VietnãRESUMO
BACKGROUND: Bully-victimization is a widespread public health issue with significant negative effects on both social function and psychological well-being. Existing research in Peru shows high prevalence of bullying. However, researchers have yet to fully understand the phenomenon of victimization in developing regions. OBJECTIVES: The purpose of this study was to characterize victimization patterns over time, along with the predictors of victimization from a cohort of Peruvian adolescents enrolled in the young lives (YL) study. MATERIALS AND METHODS: This study examined data from YL, a longitudinal study of poverty, health, and development, which examined data from the older cohort of children in Peru across three rounds (ages 8, 12, and 15 years). The sample consisted of 714 children from 74 communities that represent 20 districts in Peru. RESULTS: After adjusting for urban/rural setting, there remained a significantly lower wealth index for children who were bullied at ages 8 and 12 years. Exploratory analysis showed that although those in the lowest quartile of body mass index (BMI) were significantly more likely to be bullied at age 8 years, this association waned over time. A worse caregiver assessment of child's health compared with others was associated with a significantly greater risk of bully-victimization. At age 8 years, caregiver education was significantly lower among those bullied compared with those who were not bullied. CONCLUSION: This study showed several factors as the predictors of victimization in the early years, including being male and having low BMI, low socioeconomic status, and low parental/caregiver education. Further longitudinal studies should be conducted to determine the extent to which these predictors vary in significance over time.
Assuntos
Comportamento do Adolescente/psicologia , Bullying/estatística & dados numéricos , Vítimas de Crime/psicologia , Vítimas de Crime/estatística & dados numéricos , Adolescente , Distribuição por Idade , Índice de Massa Corporal , Cuidadores , Criança , Estudos de Coortes , Feminino , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Grupo Associado , Peru , Pobreza , Fatores de Risco , População Rural , Distribuição por Sexo , Fatores Socioeconômicos , População UrbanaRESUMO
BACKGROUND: Relative to plant-based foods, animal source foods (ASFs) are richer in accessible protein, iron, zinc, calcium, vitamin B-12 and other nutrients. Because of their nutritional value, particularly for childhood growth and nutrition, it is important to identify factors influencing ASF consumption, especially for poorer households that generally consume less ASFs. OBJECTIVE: To estimate differential responsiveness of ASF consumption to changes in total household expenditures for households with different expenditures in a middle-income country with substantial recent income increases. METHODS: The Peruvian Young Lives household panel (n = 1750) from 2002, 2006 and 2009 was used to characterize patterns of ASF expenditures. Multivariate models with controls for unobserved household fixed effects and common secular trends were used to examine nonlinear relationships between changes in household expenditures and in ASF expenditures. RESULTS: Households with lower total expenditures dedicated greater percentages of expenditures to food (58.4% vs.17.9% in 2002 and 24.2% vs. 21.5% in 2009 for lowest and highest quintiles respectively) and lower percentages of food expenditures to ASF (22.8% vs. 33.9% in 2002 and 30.3% vs. 37.6% in 2009 for lowest and highest quintiles respectively). Average percentages of overall expenditures spent on food dropped from 47% to 23.2% between 2002 and 2009. Households in the lowest quintiles of expenditures showed greater increases in ASF expenditures relative to total consumption than households in the highest quintiles. Among ASF components, meat and poultry expenditures increased more than proportionately for households in the lowest quintiles, and eggs and fish expenditures increased less than proportionately for all households. CONCLUSIONS: Increases in household expenditures were associated with substantial increases in consumption of ASFs for households, particularly households with lower total expenditures. Increases in ASF expenditures for all but the top quintile of households were proportionately greater than increases in total food expenditures, and proportionately less than overall expenditures.