Epidemiologie de la croissance infantile: Etude de determinants sociaux et biologiques aupres d'enfants ages de 6 a 18 mois en Colombie (Columbia, French and English text)

Introduction. The best indicator of childhood wellbeing is child growth. Infections and inadequate care practices (feeding, preventive and affective practices) significantly affect a child's physical development. These factors are closely associated with socio-economic conditions and the possibility of populations to satisfy their basic needs, which means to guarantee access to food, appropriate housing, and health care. These conditions are known as social determinants of child nutrition. Additionally, some theoretical streams on the subject of child nutrition, which have proposed the concept of positive deviance, have shown that care practices can attenuate the negative effect of living in unfavorable social conditions.; Objectives. In order to achieve a complete, multifactorial comprehension of child nutrition, we pursued the following: (1) To identify the social determinants of child nutritional status, evaluated as growth, in the Colombian Pacific Coast and (2) to identify the care practices and the illness events associated to child growth in the Afro-Colombian population.; Results. Afro-Colombian children 6-18 months of age have lower prevalence of chronic and acute malnutrition than that reported in other populations with similar levels of deprivation. Article 1 shows that among immediate causes, breastfeeding the child, providing a richly diverse diet and having adequate preventive practices are positively related with both nutritional indexes. Article 2 demonstrates that maternal resources for childcare exert a direct effect on the child nutrition status as proposed by the UNICEF's causal model. The study demonstrates that children with good nutritional status belong to families that have access to food (food security), have adequate hygiene conditions (presence of toilet) and have a mother enjoying social support (general and from the partner) and sharing decisions and control of home resources. The main obstacles to reaching adequate weight were related with having a mother in poor nutritional status and absence of toilet. Article 3 reveals that mothers in higher social levels (either by education level, income or social networks) have their children in better nutritional status (length for age). Differences among those in the most favorable social position and those in the lowest social position were explained by access to food and living conditions (neo-material explanation), social support (psychosocial explanation) and preventive and feeding practices. Article 4 confirms that breastfeeding is a practice positively associated with child growth in the study population, as is evident from length growth and weight gain. Respiratory illnesses appear to be the main obstacles for children to reach a good nutritional status.; Conclusion. Our investigation substantiates that child growth is a multicausal process in which social determinants of child nutritional status are related in a hierarchical fashion, as suggested by the UNICEF's causal model and the neo-material and psychosocial models. Breastfeeding appears as a moderating factor of the precarious conditions in the region, confirming the findings of the positive deviance theory. In addition, this study provides an illustration of the use of hierarchical linear models in child growth modeling. This research includes validation and adaptation of instruments to measure maternal resources (food security, general social support and partner support). (Abstract shortened by UMI.)...