Caretakers, child care practices, and growth failure in highland Ecuador.

Problems for child health have been attributed to child and sibling caretaking. Nevertheless, our data from highland Ecuador suggest an ambiguous relationship between growth failure and the practice of peer care. In a region where levels of chronic undernutrition as measured by stunting exceed 75 percent and fully one-quarter of children under five are underweight, analysis of structured observations of a sample of 28 children reveals no statistical association between growth indices and the practice of older children caring for younger children. Qualitative data, however, indicate that the practice can be a complication in specific cases where children already suffer compromised health. While the advantages or disadvantages associated with particular caretakers appear secondary to the risks attending inadequate diets or the broader environment of rural poverty, the potential for difficulties to emerge from peer care suggests that community day care provides a valuable alternative in this context.

Influence of dietary quality on the growth of highland and coastal Ecuadorian children.

This study examines variation in dietary patterns and its influence on physical growth among children under 60 months of age from rural households of highland and coastal Ecuador. Differences in subsistence ecology between the regions appear to influence infant and early childhood feeding patterns. Coastal children are weaned significantly earlier than their highland counterparts (median +/- SE = 15.9 +/- 1.7 vs. 24.7 +/- 3.4 months) and have a weaning/supplemental diet that contains significantly more animal foods. In both regions, growth retardation is most severe among infants (<12 months), with growth rates being poorer in the highlands than on the coast. Linear growth rates among coastal infants are positively correlated with intakes of animal energy and animal protein, whereas among highland children energy intake from supplemental/weaning foods is negatively correlated with linear growth. These divergent patterns appear to be a consequence of the differences in nutrient density of the weaning/supplemental diets. Among the coastal infants, higher quality, nutrient dense foods augment breast milk and contribute to better growth rates. In contrast, among the highland infants the more filling, less nutrient dense foods appear to be replacing breast milk, and thus compromising growth status. In the older cohorts (i.e., "weaning age" children: 12.0-35.9 months, and completely weaned children: 36.0-59.9 months), linear growth rates stabilize with little evidence of "catch up" growth in either region. Improved weight gain, however, is seen among the highland children, and is correlated with the nutritional intake (i.e., energy, total protein, and animal protein) from weaning foods. Overall, marked growth stunting is seen in both regions, but is more pronounced in the highland children. These high levels of stunting are largely established in the first 12 months of life. Greater growth retardation among the highland children appears to reflect the influence of hypoxia as well as the lower nutrient density of weaning foods in that region. Am. J. Hum. Biol. 12:825-837, 2000. Copyright 2000 Wiley-Liss Inc.

Growth differences between children of highland and coastal Ecuador.

This study examines patterns of growth in height and weight among children (< 60 months) of highland and coastal agricultural communities of Ecuador. Highland children are significantly shorter, but not significantly lighter than their coastal peers. Linear growth rates (cm/6 months) are comparable between the two samples. Growth rates for body weight (kg/6 m) are similar in highland and coastal boys, whereas highland girls display larger weight gains than their coastal counterparts. In both regions, linear growth is compromised to a much greater extent than growth in body weight, and growth faltering for both height and weight is most pronounced between birth and 24 months of age. The similarity in growth rates between the highland and coastal samples suggests that high altitude hypoxia plays a relatively small role in shaping growth during the first five years after birth. Rather, it appears that most of the disparity in height between the two samples can be attributed to differences established by 6 months of age. The pattern of growth retardation seen in both regions during the first 24 postnatal months is similar to that observed among impoverished populations throughout the world and is likely associated with the influence of nutritional and disease stressors. After 2 years of age, little or no "catch up" growth is seen in height, whereas improvements in weight gain are more pronounced, especially among highland girls. Ongoing research is investigating the nutritional and socio-economic correlates of growth within each region.

Nutrition and the commercialization of agriculture: ten years later.

This paper reviews the results of studies examining the impacts of agricultural commercialization on food consumption and nutritional status carried out over the last 10 years. Several conclusions can be drawn. First, the income effects of shifts to cash cropping are highly dependent on pricing policy for cash crops. Short term gains seen in some schemes are often highly dependent on the maintenance of high prices for commercial crops. Second, those schemes in which subsistence production is protected or stabilized are more likely to show positive results with an increase in income generated from cash cropping. Third, increased income does not translate directly into increased food consumption at either the household or individual (child) level. Shifts in control of income from women to men are important. Fourth, morbidity, especially from diarrheal disease is an important predictor of child growth. A failure to improve morbidity of children may offset gains in food consumption and in some instances a decrease in the time women have to care for their children as a result of commercialization has resulted in greater morbidity among children. Finally, the question "Who benefits and who loses?" is rarely addressed in these studies. The impacts of commercialization are mixed. They are highly dependent on the nature of the crop, the control of production and income, the allocation of household labor, the maintenance of subsistence production, land tenure, and pricing policies for both cash crops and food stuffs. It is these 'intervening' factors, not crop choice, that appear to be the most crucial in the nutritional status of rural people. Economic, food and agricultural policies and programs that advantage the most vulnerable population groups are the most likely to provide positive benefits in terms of food security and nutritional status. To place the emphasis on commercialization per se is to misplace it.

The use of itemized register tapes for analysis of household food acquisition patterns prompted by children.

This article describes a method of collecting and analyzing itemized grocery receipts for use in epidemiological studies. As part of a larger study of children's food acquisition and exercise habits related to cardiovascular disease, a sample of 50 families was asked to keep itemized grocery receipts for a 2-week period. To control for bias as a result of differences in food consumption and food acquisition, mothers were asked to log meals eaten away from home, food used from home production, and gifts of foods. Items on the receipts were coded according to food groups and whether they represented child-prompted purchases. The items were expressed in terms of the percentage of the food dollar each category represented. Data from the survey were compared with data collected in national surveys. The method was found to be relatively non-intrusive, easily carried out, and eliminated many of the problems associated with non-response, respondent burden, and recall characteristic of other food account methods. It is suggested as a feasible way of characterizing the family food environment in epidemiological studies.

Income and dietary adequacy in an agricultural community.

Although many studies as well as conventional wisdom suggest that increases in income result in improved diet and nutritional status in rural areas of developing countries, several recent studies have failed to demonstrate such a relationship. In this paper the relationships between material wealth and income and dietary strategies are examined for an agricultural community in rural Mexico. A superficial examination focusing on summary indices of dietary adequacy frequently cited in the literature and indices of wealth and income demonstrates a positive relationship between them in this community. However, an examination of the same data emphasizing alternative dietary strategies to achieve nutritional adequacy shows a more complex picture. Increasing income is associated with consumption of purchased foods especially foods of animal origin, and is not associated with the consumption of staple foods produced within the household. Diets dependent on purchased foods do not necessarily meet nutritional needs more adequately than diets which rely on agricultural products and gathered foods. Among the implications of this research are a need for a method of analysis which focuses on alternative nutritional strategies available in particular settings, and a need to reassess the relative importance of income generating activities and subsistence agriculture in areas undergoing agricultural change.

Diet as adaptation: the search for nutritional strategies.

This paper addresses two important methodological problems in the study of diet and nutrition. These are 1) the problems of looking at individual variations in diet within a system of shared dietary norms, and 2) the difficulties in organizing the collection and analysis of data on the circumstances that account for individual differences in diet. It is suggested that an environment provides several alternatives for meeting nutrient requirements, corresponding to alternative methods of food getting. These alternatives are called "nutritional strategies." The environment, including both its physical and social aspects, also imposes constraints on the ability of families to follow particular nutritional strategies. a family's strategy depends on its ability and desire to exploit particular methods of food getting. Data from a small agricultural community in Mexico are used to illustrate this approach. Several alternative strategies are outlined and are seen to be based on differential use of food potentially available to families from 1) subsistence agriculture; 2) purchase; and 3) gathering of wild foods. A focus on alternative nutritional strategies emphasizes the importance of dietary variation, which, at the same time, allows for an understanding of the effects of different variables on food choice.