Economic crisis and malnutrition: socioeconomic determinants of anthropometric status of preschool children and their mothers in an African urban area.

OBJECTIVE To assess the relative importance of socioeconomic and maternal/prenatal determinants of the nutritional situation of children < 6 years old in an urban African area after several years of economic crisis. DESIGN Cross-sectional cluster sample survey. SETTING Brazzaville, capital city of the Congo. SUBJECTS Information on socioeconomic characteristics was gathered from a random sample of 1368 households by house visits and anthropometric measurements were performed using standardized procedures on preschool children (n = 2373) and their mothers (n = 1512). RESULTS The influence of socioeconomic factors on the nutritional status of children, taking into account adjustment variables such as mother's age and child's age and sex was assessed. For stunting, as well as for the mean height-for-age index among children, the main determinants were economic level of the household (P = 0.048 and P = 0.004, respectively), schooling of the mother (P = 0.004 and P < 10(-3)) and living in the peripheral district (P = 0.005 and P < 10(-3)). The influence of socioeconomic determinants on weight-for-age and wasting was less straightforward. When adjusting, in addition, for maternal and prenatal factors (mother's height and body mass index (BMI) and birth weight), most of the effects of the socioeconomic determinants on the nutritional status of children persisted somewhat, but the effect of the economic level on the stunting became not significant (P = 0.11). The mean BMI of mothers appeared to be related to the economic level of the household (P < 10(-4)), to the marital status (P = 0.01) and to the occupation of the mother (P < 10(-4)). CONCLUSIONS Among the socioeconomic determinants of malnutrition in children, some, such as economic level of the household or schooling of the mother, seem to act mainly through prenatal factors, whereas others, mainly dwelling district characteristics, seem to influence more directly the children's nutritional status.