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

Hugo-Alejandro Santa-Ramírez; Gabriel-Jaime Otálvaro-Castro; Stéphane Joost; Hugo Melgar-Quiñonez; Usama Bilal; Silvia Stringhini

doi:10.1016/j.lana.2023.100521

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

Lancet Reg Health Am. 2023 May 26:23:100521. doi: 10.1016/j.lana.2023.100521. eCollection 2023 Jul.

Authors

Hugo-Alejandro Santa-Ramírez^{1

2}, Gabriel-Jaime Otálvaro-Castro², Stéphane Joost^{1

3

4}, Hugo Melgar-Quiñonez⁵, Usama Bilal^{6

7}, Silvia Stringhini^{1

8

9}

Affiliations

¹ Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland.
² Health Policy and Management Research Group, National Faculty of Public Health, University of Antioquia, Medellin, Colombia.
³ Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland.
⁴ Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
⁵ McGill Institute for Global Food Security, School of Human Nutrition, McGill University, Montreal, Canada.
⁶ Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA.
⁷ Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA.
⁸ Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁹ University Centre for General Medicine and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland.

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.