Determinantes del retraso del crecimiento infantil en Bolivia: análisis transversal nacional
Determinants of childhood stunting in Bolivia: a national cross-sectional analysisBarra lateral del artículo
Contenido principal del artículo
Objetivo: Analizar los determinantes multifactoriales del retraso del crecimiento en niños bolivianos menores de cinco años. Métodos: Estudio transversal analítico utilizando datos de la Encuesta de Demografía y Salud de Bolivia. Muestra nacionalmente representativa de 3.650 niños de 0-59 meses. El retraso del crecimiento se definió como talla para la edad <-2 desviaciones estándar (OMS). Se aplicó regresión logística múltiple para identificar determinantes independientes. Resultados: La prevalencia de retraso del crecimiento fue 21,4%. Los principales determinantes asociados incluyeron: residencia rural (ORa=1,85), bajo nivel educativo materno (ORa=3,10), pobreza extrema (ORa=4,50), acceso deficiente a agua potable (ORa=1,60) y saneamiento (ORa=1,45), baja talla materna (ORa=2,05), controles prenatales insuficientes (ORa=1,30) y no lactancia materna exclusiva (ORa=1,25). Conclusiones: El retraso del crecimiento en Bolivia resulta de factores socioeconómicos, materno-infantiles y ambientales complejos, requiriendo intervenciones multisectoriales focalizadas.
Objective: To analyze multifactorial determinants of stunting in Bolivian children under five years. Methods: Analytical cross-sectional study using Bolivia’s Demographic and Health Survey data. Nationally representative sample of 3,650 children aged 0-59 months. Stunting was defined as height-for-age <-2 standard deviations (WHO). Multiple logistic regression identified independent determinants. Results: Stunting prevalence was 21,4%. Main associated determinants included: rural residence (aOR=1,85), low maternal education (aOR=3,10), extreme poverty (aOR=4,50), poor access to safe water (aOR=1,60) and sanitation (aOR=1,45), short maternal stature (aOR=2,05), insufficient prenatal care (aOR=1,30), and non-exclusive breastfeeding (aOR=1,25). Conclusions: Stunting in Bolivia results from complex socioeconomic, maternal-child, and environmental factors, requiring targeted multisectoral interventions. These findings provide robust empirical evidence for implementing comprehensive strategies addressing structural vulnerabilities and promoting optimal child care practices in Bolivia’s public health context.
Descargas
Detalles del artículo
Black R, Victora C, Walker S, Bhutta Z, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427-451. https://repositorio.unprg.edu.pe/handle/20.500.12893/10253
World Health Organization. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: WHO; 2006. https://link.springer.com/article/10.1186/s12939-020-01197-1
Grantham-McGregor S, Fernald CH, Kagawa M, Walker S. Effects of integrated child development and nutrition interventions on child development and nutritional status. Ann N Y Acad Sci. 2014; 1308:11-32. https://www.scielo.br/j/rbsmi/a/kNYc4fNMvYwPF4BW6GBxHHk/?lang=en
Temponi H, Velasquez-Melendez G. Prevalence of double burden on malnutrition at household level in four Latin America countries. Rev Bras Saude Mater Infant. 2020;20(4):1017-1026. https://repositorio.unprg.edu.pe/handle/20.500.12893/11623
Montenegro C, Gomez G, Hincapie O, Agudelo-López S. The pediatric global burden of stunting: Focus on Latin America. Lifestyle Med. 2022;3(2): e67. https://www.cambridge.org/core/journals/public-health-nutrition/article/malnutrition-in-all-its-forms-and-socioeconomic-status-in-bolivia/8DEDB97047B15304FB24FD22617F0578
Batis C, Mazariegos M, Martorell R, Gil A, Rivera J. Malnutrition in all its forms by wealth, education and ethnicity in Latin America: ¿who are more affected? Public Health Nutr. 2020;23(15):2747-2763. https://www.cambridge.org/core/journals/public-health-nutrition/article/malnutrition-in-all-its-forms-by-wealth-education-and-ethnicity-in-latin-america-who-are-more-affected/1C0AC7F5A68D3587661E1A7495E6E990
Celhay P, Martinez S, Vidal C. Measuring socioeconomic gaps in nutrition and early child development in Bolivia. Int J Equity Health. 2020;19(1):97. https://onlinelibrary.wiley.com/doi/abs/10.1002/lim2.67
Miranda M, Bento A, Aguilar A. Malnutrition in all its forms and socioeconomic status in Bolivia. Public Health Nutr. 2020;23(15):2764-2775. https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0009519
Aguilar A. ¿Un índice para comprender la desnutrición infantil en Bolivia? Rev Cient Cienc Méd. 2022;25(2):45-58. https://eprints.soton.ac.uk/455793
Ruel M, Alderman H; Maternal and Child Nutrition Study Group. Nutrition-sensitive interventions and programmes: ¿how can they help to accelerate progress in improving maternal and child nutrition? Lancet. 2013;382(9891):536-551. https://www.chaireunesco-adm.com/IMG/pdf/01-sowhat-21_2022-en_29sept.pdf
Pérez-Escamilla R, Bermúdez O, Buccini GS, Kumanyika S, Lutter C, Monsivais P, et al. Nutrition disparities and the global burden of malnutrition. BMJ. 2018;361: k2252. http://dspace.utb.edu.ec/handle/49000/14301
Instituto Nacional de Estadística Bolivia. Encuesta de Demografía y Salud EDSA-2016. La Paz: INE; 2017. https://tzibalnaah.unah.edu.hn/handle/123456789/13161
Webb C, Morales M, Lopez M, Chernet A, Llanque M, Cusicanqui J, et al. Stunting in pre-school and school-age children in the Peruvian highlands and its association with Fasciola infection and demographic factors. PLoS Negl Trop Dis. 2021;15(6): e0009519. https://journals.sagepub.com/doi/abs/10.1177/02601060251337117
World Health Organization. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: WHO; 2006. https://link.springer.com/article/10.1007/s12187-021-09880-7
Wamani H, Åstrøm A, Peterson S, Tumwine J, Tylleskär T. Predictors of poor anthropometric status among children under 2 years of age in rural Uganda. Public Health Nutr. 2006;9(3):320-326. https://www.mdpi.com/1660-4601/17/21/7806
UNICEF, OMS, Banco Mundial. Joint child malnutrition estimates: Levels and trends in child malnutrition. Nueva York: UNICEF; 2021. https://www.unicef.org/reports/joint-child-malnutrition-estimates-levels-and-trends-child-malnutrition-2021
Montenegro C, Gomez G, Hincapie O, Agudelo-López S. The pediatric global burden of stunting: Focus on Latin America. Lifestyle Med. 2022;3(2): e67. https://www.scielosp.org/article/rpsp/2021.v45/e47/
Pacheco-Santos L, Hernández-Cordero S, Rodríguez-Ramírez S, García-Guerra A. Quantifying overlapping forms of malnutrition across Latin America. Adv Nutr. 2024;15(4):100184. https://www.intechopen.com/chapters/81572
Albuja W, Lara Jácome A. Determinantes socioeconómicos de la desnutrición crónica infantil en Ecuador. Región Científica. 2022;1(3):1-24. https://books.google.com/books?hl=en&lr=&id=QlN_EQAAQBAJ&oi=fnd&pg=PP1&dq=stunting+Latin+America+epidemiology&ots=yns9mvFKfh&sig=_9OrepmWVi05lojBDsKP0OT2ftA
Sania A, Spiegelman D, Rich-Edwards J, Okuma J, Kisenge R, Mwiru R, et al. The contribution of preterm birth and intrauterine growth restriction to childhood undernutrition in Tanzania. Matern Child Nutr. 2015;11(4):618-630. https://policycommons.net/artifacts/18067904/research-insights/18967315/
Hoddinott J, Behrman J, Maluccio J, Melgar P, Quisumbing A, Ramirez-Zea M, et al. Adult consequences of growth failure in early childhood. Am J Clin Nutr. 2013;98(5):1170-1178. https://www.sciencedirect.com/science/article/pii/S1757780224003408
Stewart C, Iannotti L, Dewey K, Michaelsen K, Onyango A. Contextualising complementary feeding in a broader framework for stunting prevention. Matern Child Nutr. 2013;9 Suppl 2:27-40. https://www.ghspjournal.org/content/10/2/e2100411.abstract
Hernández-Ruiz Á, Perales-Torres A, Nava-González E, Medina-Morales J. Challenges and perspectives of the double burden of malnutrition in Latin America. Rev Chil Nutr. 2021;48(5):773-783. https://link.springer.com/article/10.1186/s12939-020-01165-9
De Sanctis V, Soliman A, Alaaraj N, Ahmed S, Alyafei F, Hamed N. Early and long-term consequences of nutritional stunting: from childhood to adulthood. Acta Biomed. 2021;92(1): e2021168. https://pmc.ncbi.nlm.nih.gov/articles/PMC7678557/
Escher N, Cumbana A, Crispin Del Rio V, Santos L. The effect of nutrition-specific and nutrition-sensitive interventions on undernutrition and overnutrition in LMICs. Lancet Glob Health. 2024;12(3): e395-e406. http://www.scielo.org.bo/scielo.php?pid=S1652-67762021000200003&script=sci_arttext
Kauchali S, Puoane T, Aguilar A, Rollins N. Scaling up improved management of severe acute malnutrition for inpatients: Key factors and experiences from South Africa, Bolivia, Malawi, and Ghana. Glob Health Sci Pract. 2022;10(2): e2100632. https://pmc.ncbi.nlm.nih.gov/articles/PMC9813618/
Bleiweiss-Sande R, Bailey C, Chui K, Sacheck J. Interventions to prevent obesity in Latinx children globally: a systematic review. Syst Rev. 2021;10(1):124. https://pmc.ncbi.nlm.nih.gov/articles/PMC11312709/