Author Affiliations: Physicians for Human Rights (Dr Brentlinger), and Department of Epidemiology, Harvard School of Public Health (Drs Hernán and Hernández-Díaz), Boston, Mass; Work Environment Department, University of Massachusetts, Lowell (Dr Azaroff); and Red Deer Regional Hospital, Red Deer, Alberta (Dr McCall).
Edited by Annette Flanagin, RN, MA, Associate Senior
Context The 1992 peace settlement that ended the civil war in
El Salvador included land redistribution and other provisions designed
to improve the socioeconomic status of ex-combatants and vulnerable
Objective To describe associations between postwar social and
economic assistance programs, especially land reform, and current child
health status as reflected by nutrition in a population of resettled
Design A population-based cross-sectional survey of child
nutritional status and principal elements of the reconstruction
Setting A single rural municipality in northern El Salvador.
Participants A representative sample of 761 children younger than
5 years, living in 27 villages.
Main Outcome Measure Prevalence of stunting (low height for age)
in children younger than 5 years.
Results Prevalence of stunting was 32.4%. Stunting was
significantly more prevalent among children whose families cultivated
less land (odds ratio [OR] for stunting per additional hectare of
redistributed land cultivated, 0.64; 95% confidence interval [CI],
0.44-0.93). Less than half of newly transferred land was being
cultivated by its owners. Most of the children (84.7%) lived in
families cultivating 2 hectares or less of redistributed land. Stunting
was also more prevalent among children whose households lacked piped
water (adjusted OR, 2.72; 95% CI, 1.87-3.96) vs those who had had
piped water since before the cease-fire.
Conclusions Malnutrition, particularly stunting, persisted at high
levels and was strongly associated with delay in full cultivation of
redistributed land and in provision of water.
Brentlinger PE, Hernán MA, Hernández-Díaz S, Azaroff LS, McCall M. Childhood Malnutrition and Postwar Reconstruction in Rural El SalvadorA Community-Based Survey. JAMA. 1999;281(2):184-190. doi:10.1001/jama.281.2.184