Childhood malnutrition and postwar reconstruction in rural El Salvador - Acommunity-based survey

Context The 1992 peace settlement that ended the civil war in El Salvador i ncluded land redistribution and other provisions designed to improve the so cioeconomic status of ex-combatants and vulnerable civilians. Objective To describe associations between postwar social and economic assi stance programs, especially land reform, and current child health status as reflected by nutrition in a population of resettled rural refugees. Design A population-based cross-sectional survey of child nutritional statu s and principal elements of the reconstruction process. 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 childre n younger than 5 years. Results Prevalence of stunting was 32.4%. Stunting was significantly more p revalent among children whose families cultivated less land (odds ratio [OR ] for stunting per additional hectare of redistributed land cultivated, 0.6 4; 95% confidence interval [CI], 0.44-0.93). Less than half of newly transf erred land was being cultivated by its owners. Most of the children (84.7%) lived in families cultivating 2 hectares or less of redistributed land. St unting 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 wa ter since before the cease-fire. Conclusions Malnutrition, particularly stunting, persisted at high levels a nd was strongly associated with delay in full cultivation of redistributed land and in provision of water.