# Factors associated with childhood chronic malnutrition during the first 12 months of life in children from a peruvian cohort

## TL;DR

This study identifies factors linked to chronic malnutrition in Peruvian children under one year old, highlighting the role of prenatal care, feeding practices, and household decision-making.

## Contribution

The study provides novel insights into the social and behavioral factors influencing early childhood malnutrition in two distinct Peruvian regions.

## Key findings

- Male sex, bottle feeding, and use of polluting fuels were associated with higher risk of chronic malnutrition.
- Six or more prenatal check-ups and JUNTOS program benefits acted as protective factors against malnutrition.
- Food insecurity unexpectedly showed a protective association, suggesting potential biases or confounding effects.

## Abstract

To determine the factors associated with chronic child malnutrition (CCM) in two Peruvian regions: Huancavelica and Loreto.

We analyzed four repeated cross-sectional evaluations nested in a prospective cohort of children treated in primary healthcare facilities. Data was collected on the characteristics of the child, the mother and the household, including anthropometric information, breastfeeding, complementary feeding, and socioeconomic conditions. A generalized linear model was used to calculate the prevalence ratios (PR) for each of the four quarterly evaluations of the cohort (3rd, 6th, 9th and 12th months).

Factors such as male sex, bottle feeding and the use of polluting fuels were associated with a higher risk of CCM, on the other hand, having six or more prenatal check-ups and being a beneficiary of the JUNTOS program acted as protective factors. Mothers who did not speak Spanish as their native language, who worked or studied, or who had limited participation in family decisions, were also at higher risk of CCM. In addition, we identified unexpected associations, such as food insecurity acting as a protective factor, reflecting possible biases or confounding effects.

Our findings highlight the importance of addressing inequalities in prenatal care, dietary practices, and mothers’ participation in household decision-making to prevent CCM in vulnerable contexts.

Determinar los factores asociados a la desnutrición crónica infantil (DCI) en dos regiones peruanas: Huancavelica y Loreto.

. Se realizó un análisis a cuatro evaluaciones transversales repetidas anidadas en una cohorte prospectiva de niños atendidos en establecimientos de salud de primer nivel de atención. Se recopilaron datos sobre características del niño, la madre y el hogar, incluyendo información antropométrica, lactancia, alimentación complementaria, y condiciones socioeconómicas. A través de un modelo lineal generalizado se calculó las razones de prevalencias (RP) por cada una de las cuatro evaluaciones trimestrales de la cohorte (3°, 6°, 9° y 12° meses).

Factores como sexo masculino, uso de biberón y empleo de combustibles contaminantes se asociaron con mayor riesgo de DCI, mientras que recibir seis o más controles prenatales y ser beneficiario del programa JUNTOS actuaron como factores protectores. Las madres con lengua materna distinta al castellano, que trabajaban o estudiaban, o con limitada participación en las decisiones familiares, también presentaron mayor riesgo de DCI. Además, se identificaron asociaciones inesperadas, como la inseguridad alimentaria actuando como factor protector, reflejando posibles sesgos o efectos confusores.

Los hallazgos resaltan la importancia de abordar las desigualdades en la atención prenatal, prácticas alimentarias y participación de las madres en la toma de decisiones del hogar para prevenir la DCI en contextos vulnerables.