Childhood Malnutrition and Postwar Reconstruction in Rural El Salvador

CONTEXT: The 1992 peace settlement that ended the civil war in El Salvador included land redistribution and other provisions designed to improve the socioeconomic status of ex-combatants and vulnerable civilians. OBJECTIVE: To describe associations between postwar social and economic assistance 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 status 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 children younger than 5 years. RESULTS: Prevalence of stunting was 32.4%. Stunting was significantly more prevalent among children whose families cultivated less land (odds ratio OR for stunting per additional hectare of redistributed land cultivated, 0.64; 95% confidence interval CI, 0.44-0.93). Less than half of newly transferred land was being cultivated by its owners. Most of the children (84.7%) lived in families cultivating 2 hectares or less of redistributed land. Stunting 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 water since before the cease-fire. CONCLUSIONS: Malnutrition, particularly stunting, persisted at high levels and was strongly associated with delay in full cultivation of redistributed land and in provision of water.