Patterns of Protein-Energy Malnutrition Among Preschoolers in Belize

This study is based on a survey to assess nutritional status among children from birth through 5 years old in Belize, Central America. The survey was conducted in 1979 in two districts, one coastal (Stann Creek) and one inland (Cayo). Four major ethnic groups are represented: the Mestizo, Maya, Creole and Garifuna (Black Carib). Previous studies indicated that early childhood malnutrition is a considerable public health problem in Belize. No anthropometric assessment of protein-energy malnutrition among preschoolers had been conducted. In this project 750 children were measured and their mothers interviewed concerning the feeding patterns and health status of their children. Mothers’ reproductive histories were also collected. This information was supplemented with standard ethnographic methods, i.e., key informant interviews and participant-observation. Quantified dietary information, including 24-hour recalls and weekly family dietary patterns, were collected on a selected sample of 50 children from 1 to 6 years old. The unit of analysis is the ethnic group. Survey results are analyzed to assess patterns of severity, duration, and the geographical distribution of malnutrition among preschoolers. Malnourished and non-malnourished children are contrasted to determine the demographic, dietary, and health-related characteristics of each group. Following a literature review on the causes and sequelae of protein-energy malnutrition, information is presented on contemporary socio-economic and nutritional conditions in Belize. Results reveal that ethnicity has a significant effect on the prevalence of protein-energy malnutrition among children. Moreover, the widespread adoption of the infant feeding bottle, high rates of diarrheal disease, low energy intake, and differential access to resources, such as clean water and appropriate medical care, are factors which operate in Belize to predispose certain children to growth retardation. Children exhibiting better-than-average growth often are infants and younger children who are less frequently exposed to the numerous infectious and nutritional stresses to which older preschoolers are subject. The prevalence of acute malnutrition in Belize increases with age, reaching a maximum between the ages of 1 to 2.5 years, while chronic malnutrition continues to increase throughout early childhood. Children living in households with 5 or more children more often experience growth retardation, colds, fevers, reduced appetites, and the death of at least one sibling. This pattern is more frequent among rural than urban residents. Among rural residents the Maya exhibit disproportionately high rates of childhood mortality and growth retardation. In the urban area the Garifuna experience the highest prevalence of severe malnutrition. Hence, the relative nutritional status (from best to worst) of children in the two survey districts may be ordered as follows: Creole, Mestizo, Garifuna, and Maya. This order roughly approximates the socio-economic positions of these ethnic groups in contemporary Belize