DOI: 10.7910/dvn/68zppw
title: Early Childhood Feeding Practices and Chronic Malnutrition: A Case-Control Study in an Urban District of Bogotá, Colombia

description: Background: Child malnutrition is a public health problem comprising millions of children, especially in early stages of development. In Latin America, its primary manifestation is chronic undernutrition, impacting the physical and cognitive potential of children and the productive development of a country. This multi-causal phenomenon is associated with structural and intermediate Social Determinants of Health (SDH) that lead to poor nutrition. In Bogota, Colombia's capital city, vulnerable communities with migrants and families displaced by violence coexist in poverty. This work aimed to determine the relationship between SDHs within chronic malnutrition within a group of children in early childhood and their caregivers in the locality of Los Mátires, where chronic child malnutrition is among the highest in the city. 
Methods: Case-control design to identify the structural and intermediate SDH that constitute a risk of chronic child malnutrition. Formal 1:1 sample of 54 caregiver-child pairs in the Los Mártires in Bogotá.
Cases were couples with children diagnosed with chronic malnutrition, and controls were couples with children with normal nutritional status measured with a KAP survey and a questionnaire designed and validated by the FAO, and applied to both groups. Analysis with descriptive statistics and ORs to determine associations. P-values less than 0.05 were considered statistically significant. 
Results: We found a high proportion of migrant population, displaced by violence, with informal jobs, low income, and limited access to health services. The principal caregivers were young females with an incomplete education. Risk factors for malnutrition in children were the caregiver´s perceptions about the quantity and quality of food (OR 13.656, 95% CI (3.557-52.429), the perception that dairy products were unhealthy (OR 12.250, 95% CI (3.395-44.196), and living in shared housing, with several families using the same kitchen (OR 4.08, 95% CI (1.194-13.978). The only protective factor was the perception that excess cereals were unhealthy, preferring to replace them with more nutritious foods (OR 0.168, 95% CI (0.051-0.556). 
Conclusions: Approaching SDH is fundamental to better understanding the processes of chronic child undernutrition in vulnerable populations. It is not only the availability of food and the elements of the surrounding social structure that influence this phenomenon; there is also a complex network of knowledge and attitudes towards food and diet established by those responsible for feeding these children that must be taken into account when addressing nutritional programs and policies. The approach must be holistic and integrated interventions designed to create caring, supportive environments that lead to healthy behaviors, improving the quality of food intake and life of these populations. The perception of dairy product intake, quantity of nutritious foods, and distribution of housing play essential roles in the risk of developing malnutrition; conversely,the perception of reducing cereal intake is a protective factor against malnutrition.
A comprehensive approach is crucial to identify and address the social factors that influence health to interrupt the cycle of child malnutrition observed in the population, promote long-term well-being, and cultivate a healthier future generation.