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. 2023 May 26:23:100521.
doi: 10.1016/j.lana.2023.100521. eCollection 2023 Jul.

Small area vulnerability, household food insecurity and child malnutrition in Medellin, Colombia: results from a repeated cross-sectional study

Hugo-Alejandro Santa-Ramírez  1   2 , Gabriel-Jaime Otálvaro-Castro  2 , Stéphane Joost  1   3   4 , Hugo Melgar-Quiñonez  5 , Usama Bilal  6   7 , Silvia Stringhini  1   8   9
Affiliations

Small area vulnerability, household food insecurity and child malnutrition in Medellin, Colombia: results from a repeated cross-sectional study

Hugo-Alejandro Santa-Ramírez et al. Lancet Reg Health Am. .

Abstract

Background: Malnutrition and food insecurity might be driven not only by individual factors but also by contextual conditions, such as area-level deprivation or vulnerability. This study aimed to analyze the association between area-level vulnerability and i) household food insecurity and ii) malnutrition in children in Medellin, Colombia, during the years 2017 and 2018.

Methods: We obtained data from two different sources: the Living Standards Measurement Survey (LSMS) and the nutrition surveillance system of Medellin. The main outcomes were food insecurity in households with children and anthropometric indicators for children under five. The main predictor was area-level vulnerability. Mixed effects Poisson regression with robust standard errors models were conducted to test the association of quintiles of deprivation with each outcome.

Findings: Households with children living in areas with the highest deprivation had 1.9 times the prevalence of food insecurity as compared to those living in areas with the lowest deprivation (PR 1.91, 95% CI 1.42-2.57). Similar results were observed for underweight/risk of underweight (PR 1.26, 95% CI 1.11-1.42), stunting/risk of stunting (PR 1.36, 95% CI 1.22-1.53) and stunting (PR 1.93 95% CI 1.55-2.39) among children under five. We found no consistent associations with wasting/risk of wasting or excess weight/risk of overweight across quintiles of deprivation.

Interpretation: This study sheds light on the role of area-level vulnerability on malnutrition in children in Medellin, Colombia, showing a pattern of increasing prevalence of food insecurity, underweight and stunting by quintile of deprivation.

Funding: Swiss School of Public Health (SSPH+) and Centre for Global Health Inequalities Research (CHAIN).

Keywords: Children; Deprivation; Food insecurity; Malnutrition; Modes of living; Small-area vulnerability.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Prevalence ratios (95% CI) for (a) Any type of food insecurity and (b) Moderate or severe food insecurity, associated with area level quintile of deprivation in households with children, according to the Food Insecurity Experience Scale (FIES). Results obtained from the age and sex-adjusted Poisson regression model. The dashed line represents no association.
Fig. 2
Fig. 2
Prevalence ratios (95% CI) of (a) Underweight and risk of underweight, (b) Wasting and risk of wasting, (c) Excess weight and risk of overweight, (d) Stunting and risk of stunting, and (e) Stunting (without risk), associated with area level quintile of deprivation. Results obtained from the age and sex-adjusted Poisson regression model. The dashed line represents no association. In some cases, the confidence intervals may not be visible because they are too narrow (e.g., Excess weight).
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