Volume 86, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Chronic infection over a 16-month period and stunting of preschool children were compared between more spatially dense versus dispersed households in rural Panamá. Chronic protozoan infection was associated with higher household density, lower household wealth index, poor household water quality, yard defecation, and the practice of not washing hands with soap before eating. Models for chronic diarrhea confirmed the importance of household wealth, water quality, sanitation, and hygiene practices. Furthermore, chronic protozoan infection was an important predictor for low height-for-age, along with low household wealth index scores, but not household density. Thus, despite better access to health related infrastructure in the more densely populated households, chronic protozoan infection was more common, and was associated with higher rates of child stunting, compared with more dispersed households.


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  1. Nations United, , 2009. Rethinking Poverty: Report on the World Social Situation 2010. Geneva: United Nations.
  2. Fiszbein A, Schady N, , 2009. Conditional Cash Transfers: Reducing Present and Future Poverty. Washington, DC: World Bank.
  3. Khandker SR, Bakht Z, Koolwal GB, , 2009. The poverty impact of rural roads: evidence from Bangladesh. Econ Dev Cult Change 57: 685722.[Crossref]
  4. Reardon T, Berdegué J, Escobar G, , 2001. Rural nonfarm employment and incomes in Latin America: overview and policy implications. World Dev 29: 395409.[Crossref]
  5. Escobal J, Ponce C, , 2004. The Benefits of Rural Roads: Enhancing Income Opportunities for the Rural Poor. Lima, Peru: Grupo de Análisis para el Desarrollo (GRADE).
  6. Brenneman A, Kerf M, , 2002. Infrastructure and Poverty Linkages: A Literature Review. Washington, DC: The World Bank.
  7. Ombok M, Adazu K, Odhiambo F, Bayoh N, Kiriinya R, Slutsker L, Hamel MJ, Williamson J, Hightower A, Laserson KF, Feikin DR, , 2010. Geospatial distribution and determinants of child mortality in rural western Kenya 2002–2005. Trop Med Int Health 15: 423433.[Crossref]
  8. Denno D, , 2011. Global child health. Pediatr Rev 32: e25e38.[Crossref]
  9. Agee MD, , 2010. Reducing child malnutrition in Nigeria: combined effects of income growth and provision of information about mothers' access to health care services. Soc Sci Med 71: 19731980.[Crossref]
  10. Bartram J, Cairncross S, , 2010. Hygiene, sanitation, and water: forgotten foundations of health. PLoS Med 7: e1000367.[Crossref]
  11. Jenkins MW, Curtis V, , 2005. Achieving the ‘good life’: why some people want latrines in rural Benin. Soc Sci Med 61: 24462459.[Crossref]
  12. Jenkins MW, Cairncross S, , 2010. Modelling latrine diffusion in Benin: towards a community typology of demand for improved sanitation in developing countries. J Water Health 8: 166183.[Crossref]
  13. Hunter PR, MacDonald AM, Carter RC, , 2010. Water supply and health. PLoS Med 7: e1000361.[Crossref]
  14. Luque Fernández MA, Mason PR, Gray H, Bauernfeind A, Fesselet JF, Maes P, , 2010. Descriptive spatial analysis of the cholera epidemic 2008–2009 in Harare, Zimbabwe: a secondary data analysis. Trans R Soc Trop Med Hyg 105: 3845.
  15. Ferrari MJ, Djibo A, Grais RF, Bharti N, Grenfell BT, Bjornstad ON, , 2010. Rural-urban gradient in seasonal forcing of measles transmission in Niger. Proc Biol Sci 277: 27752782.[Crossref]
  16. Younas M, Shah S, Talaat A, , 2008. Frequency of Giardia lamblia infection in children with recurrent abdominal pain. J Pak Med Assoc 58: 171174.
  17. Chacín-Bonilla L, Barrios F, Sanchez Y, , 2008. Environmental risk factors for Cryptosporidium infection in an island from western Venezuela. Mem Inst Oswaldo Cruz 103: 4549.[Crossref]
  18. Bates SJ, Trostle J, Cevallos WT, Hubbard A, Eisenberg JNS, , 2007. Relating diarrheal disease to social networks and the geographic configuration of communities in rural Ecuador. Am J Epidemiol 166: 10881095.[Crossref]
  19. Milroy CA, Borja PC, Barros FR, Barreto ML, , 2001. Evaluating sanitary quality and classifying urban sectors according to environmental conditions. Environ Urban 13: 235255.[Crossref]
  20. Garenne M, , 2010. Urbanisation and child health in resource poor settings with special reference to under-five mortality in Africa. Arch Child Dis 95: 464468.[Crossref]
  21. Lutter CK, Chaparro CM, , 2008. Malnutrition in Infants and Young Children in Latin America and the Caribbean: Achieving the Millenium Development Goals. Washington, DC: Pan American Health Organization.
  22. Golden MH, , 1996. Specific deficiencies versus growth failure: type I and type II. J Nutr Environ Med 6: 301.[Crossref]
  23. Falkingham J, Namazie C, , 2002. Measuring Health and Poverty: A Review of Approaches to Identifying the Poor. London: United Kingdom Department for International Development.
  24. Filmer D, Pritchett LH, , 2001. Estimating wealth effects without expenditure data - or tears: an application to educational enrollments in states of India. Demography 38: 115132.
  25. Rutstein S, Johnson K, , 2004. The DHS Wealth Index. Calverton, MD: ORC Macro, MEASURE DHS+.
  26. Ministerio de Economía y Finanzas, 2003. Encuesta de Niveles de Vida 2003. Panama City, Panama: Ministerio de Economía y Finanzas.
  27. Payne L, Koski KG, Ortega-Barria E, Scott ME, , 2007. Benefit of vitamin A supplementation on Ascaris re-infection is less evident in stunted children. J Nutr 137: 14551459.
  28. Ministerio de Economía y Finanzas, 2010. La Distribución del Ingreso en Los Hogares de Panamá: Encuesta de Niveles de Vida 2008. Panama City, Panama: Ministerio de Economía y Finanzas.
  29. World Health Organization (WHO), 2006. WHO Child Growth Standards: Methods and Development: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age. Geneva: WHO Multicentre Growth Reference Study Group, World Health Organization.
  30. Hamilton WP, Kim M, Thackston EL, , 2005. Comparison of commercially available Escherichia coli enumeration tests: implications for attaining water quality standards. Water Res 39: 48694878.[Crossref]
  31. World Bank, 1999. Panama Poverty Assessment: Priorities and Strategies for Poverty Reduction. Washington, DC: Human Development Department, World Bank.
  32. UNICEF, 2008. The State of the World's Children 2009: Maternal and Newborn Health. New York: UNICEF.
  33. Victora CG, , 1992. The association between wasting and stunting: an international perspective. J Nutr 122: 11051110.
  34. Fotso JC, Kuate-Defo B, , 2005. Socioeconomic inequalities in early childhood malnutrition and morbidity: modification of the household-level effects by the community SES. Health Place 11: 205225.[Crossref]
  35. World Health Organization (WHO), 2008. Guidelines for Drinking Water Quality. Geneva: World Health Organization.
  36. Bateman OM, Smith S, , 1991. A Comparison of the Health Effects of Water Supply and Sanitation in Urban and Rural Guatemala. Washington, DC: U.S. Agency for International Development.
  37. Van De Poel E, Hosseinpoor AR, Speybroeck N, Van Ourti T, Vega J, , 2008. Socioeconomic inequality in malnutrition in developing countries. Bull World Health Organ 86 282291.[Crossref]
  38. Hong R, Mishra V, , 2006. Effect of wealth inequality on chronic under-nutrition in Cambodian children. J Health Popul Nutr 24: 8999.
  39. Raso G, Utzinger J, Silué KD, Ouattara M, Yapi A, Toty A, Matthys B, Vounatsou P, Tanner M, N’Goran EK, , 2005. Disparities in parasitic infections, perceived ill health and access to health care among poorer and less poor schoolchildren of rural Côte d’Ivoire. Trop Med Int Health 10: 4257.[Crossref]
  40. Nundy S, Gilman RH, Xiao L, Cabrera L, Cama R, Ortega YR, Kahn G, Cama VA, , 2011. Wealth and its associations with enteric parasitic infections in a low-income community in Peru: use of principal component analysis. Am J Trop Med Hyg 84: 3842.[Crossref]
  41. Gwatkin D, Wagstaff A, Yazbeck A, , 2005. Reaching the Poor with Health Nutrition and Population Services: What Works, What Doesn't and Why. Washington, DC: World Bank.
  42. Adekanmbi VT, Kayode GA, Uthman OA, , 2011. Individual and contextual factors associated with childhood stunting in Nigeria: a multilevel analysis. Matern Child Nutr doi: 10.1111/j.1740-8709.2011.00361.x.
  43. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J, Maternal and Child Undernutrition Study Group, 2008. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371: 243260.[Crossref]
  44. Sackey ME, Weigel MM, Armijos RX, , 2003. Predictors and nutritional consequences of intestinal parasitic infections in rural Ecuadorian children. J Trop Pediatr 49: 1723.[Crossref]
  45. Boeke CE, Mora-Plazas M, Forero Y, Villamor E, , 2010. Intestinal protozoan infections in relation to nutritional status and gastrointestinal morbidity in Colombian school children. J Trop Pediatr 56: 299306.[Crossref]
  46. Simsek Z, Zeyrek FY, Kurcer MA, , 2004. Effect of Giardia infection on growth and psychomotor development of children aged 0–5 years. J Trop Pediatr 50: 9093.[Crossref]
  47. Thapar N, Sanderson IR, , 2004. Diarrhoea in children: an interface between developing and developed countries. Lancet 363: 641653.[Crossref]
  48. LeVine RA, Rowe ML, , 2009. Maternal literacy and child health in less-developed countries: evidence, processes, and limitations. J Dev Behav Pediatr 30: 340349.[Crossref]
  49. Boyle MH, Racine Y, Georgiades K, Snelling D, Hong S, Omariba W, Hurley P, Rao-Melacini P, , 2006. The influence of economic development level, household wealth and maternal education on child health in the developing world. Soc Sci Med 63: 22422254.[Crossref]
  50. Haidar J, Kogi-Makau W, , 2009. Gender differences in the household-headship and nutritional status of pre-school children. East Afr Med J 86 6973.
  51. McIntyre L, Rondeau K, Kirkpatrick S, Hatfield J, Islam KS, Huda SN, , 2011. Food provisioning experiences of ultra poor female heads of household living in Bangladesh. Soc Sci Med 72: 969976.[Crossref]
  52. Genser B, Strina A, Teles CA, Prado MS, Barreto ML, , 2006. Risk factors for childhood diarrhea incidence: dynamic analysis of a longitudinal study. Epidemiology 17: 658667.[Crossref]
  53. Silva RR, da Silva CAM, de Jesus Pereira CA, de Carvalho Nicolato RL, Negrão-Corrêa D, Lamounier JA, Carneiro M, , 2009. Association between nutritional status, environmental and socio-economic factors and Giardia lamblia infections among children aged 6–71 months in Brazil. Trans R Soc Trop Med Hyg 103: 512519.[Crossref]
  54. Teixeira JC, Heller L, Barreto ML, , 2007. Giardia duodenalis infection: risk factors for children living in sub-standard settlements in Brazil. Cad Saude Publica 23: 14891493.[Crossref]
  55. Lanata C, Huttly SRA, Yeager BAC, , 1998. Diarrhea: whose feces matter? Reflections from studies in a Peruvian shanty town. Pediatr Infect Dis J 17: 79.[Crossref]
  56. Quihui L, Valencia ME, Crompton DW, Phillips S, Hagan P, Morales G, Diaz-Camacho SP, , 2006. Role of the employment status and education of mothers in the prevalence of intestinal parasitic infections in Mexican rural schoolchildren. BMC Public Health 6: 225.[Crossref]
  57. Mara D, Lane J, Scott B, Trouba D, , 2010. Sanitation and health. PLoS Med 7: e1000363.[Crossref]
  58. Rinne S, Rodas EJ, Galer-Unti R, Glickman N, Glickman LT, , 2005. Prevalence and risk factors for protozoan and nematode infections among children in an Ecuadorian highland community. Trans R Soc Trop Med Hyg 99: 585592.[Crossref]
  59. Hussein AS, , 2011. Prevalence of intestinal parasites among school children in northern districts of West Bank-Palestine. Trop Med Int Health 16: 240244.[Crossref]
  60. Curtis V, Cairncross S, , 2003. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis 3: 275281.[Crossref]
  61. Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM, Jr, 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5: 4252.[Crossref]

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  • Received : 04 May 2011
  • Accepted : 03 Oct 2011

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