Nonviolent civil insecurity is negatively associated with subsequent height-for-age in children aged <5 y born between 1998 and 2014 in rural areas of Africa

Abstract

Background: Civil wars and wars between states have occurred less frequently since the start of the 21st century, but civil insecurity outside the contexts of official wars continues to plague many parts of the world. The nutritional consequences of civil insecurity may disproportionately affect children, especially if experienced during sensitive developmental periods.

Objectives: This study estimated the associations between localized nonviolent and violent civil insecurity during key child nutritional periods and subsequent height-for-age z scores (HAZs) in 145,948 children born between 1998 and 2014 in Africa and examined the type of place of residence as a mediating factor.

Design: A collection of 61 geo-referenced Demographic and Health Surveys implemented between 1998 and 2014 were merged with data from the high-resolution Armed Conflict Location and Event Data Project to construct a repeat cross-sectional database, which was analyzed by using a difference-in-differences model with maternal fixed-effects.

Results: Exposure to 1 nonviolent localized civil insecurity event (mean ± SD: 0.42 ± 1.87 events) during pregnancy for children living in rural areas was associated with a reduction of 0.01 SD in HAZ (P = 0.024). Exposure to 5 localized civil conflict fatalities (mean ± SD: 1.41 ± 10.21 fatalities) for children living in rural areas during the complementary feeding stage was associated with a 0.002-SD decrease in HAZ (P = 0.030). There were no measurable associations between civil insecurity and child heights in urban areas, even though children in urban areas experience more civil insecurity.

Conclusions: Exposure to both violent and nonviolent civil insecurity had negative associations with subsequent HAZ, but only in rural areas. The associations found were small in magnitude but still meaningful from a child-development perspective, because these events do not necessarily occur in the context of official wars, they are often nonviolent, and they are endemic to the region.

Keywords: Africa; civil insecurity; community and international nutrition; height-for-age; stunting.