Decreased attendance at routine health activities mediates deterioration in nutritional status of young African children under worsening socioeconomic conditions

Background Economic crisis and sociopolitical instability are generally ass ociated with worsening health and nutrition in developing countries. This s tudy examines the role played by the attendance rate of young children at r outine health activities in the deterioration of their nutritional status u nder adverse social and economic conditions. Methods Two nutritional cross-sectional surveys were carried out in two dis tricts of Brazzaville, capital city of The Congo, in 1993 and 1996. They in cluded respectively 2807 and 1695 randomly selected children 4-23 months ol d. The children's nutritional status was assessed by height-for-age in z-sc ores. Using embedded general linear regression models, explanatory variable s (routine health activities index, socio-demographic context, household ec onomic level, prenatal factors) were tested as potential mediators for the effect of the year of survey on child mean height-for-age. Results The routine health activities index declined sharply from 1993 to 1 996. Its introduction in the regression model including all other explanato ry variables led to a sharp decrease in the effect of the year on children' s nutritional status, showing the important mediating effect of routine hea lth activities. This result was encountered across all economic categories of households. Other explanatory variables showed more limited mediating ef fect. Conclusion Attendance at preventive health activities should be fostered in African urban communities facing harsh socioeconomic situations to prevent further deterioration in the nutritional status of children.