The evolution of the nutritional status of children under five years between the DHS surveys 1991-92 and 1996 is characterized, at the national level, by a decrease in stunting from 31.8% to 25.8%. This reduction has been of greater magnitude in the rural area, in the regions of the mountain range and the forest when compared to Metropolitan urban area and Lima (Figure 7a). Nevertheless, in 1996 the highest prevalence of stunting were in the rural areas (40.4%), in the region of the mountain range (37.8%), the forest (33.0%) and in the departments of Huancavelica (50.3%), Pasco (47.2%), Apurímac (46.9%), Ayacucho (43.2%) and Cusco (40.9%) (Map 2). The national monitoring of indicators (MONIN), initiated in 1996, shows a tendency of a decreased incidence of stunting between 1996 and 1998 at the national level and also in four of its five geographic levels, although not to a statistically significantly extent (Table 4a). MONIN consists of a semester survey on health and nutrition in a representative sample of homes with at least one child under five years and/or one woman between 15 and 49 years, at five geographic levels and at the national level.
The prevalence of underweight diminished from 10,7% en 1991-92 to 7.8% in 1996 (Figure 7b). Wasting does not represent a problem at the national level since it has remained below 2%. Nevertheless, in 1996 a higher percentage in some areas was registered, such as the Amazon department (8.2%).
The results of a 1984 survey show that overweight in smaller children of six years is a problem of limited magnitude (3.8%). The highest prevalence were in Lima Metropolitan (6.6%), the rest of the Coast (4%) and heterogeneous areas.
The National Census of Stature in school age children between 6 and 9 years of age, conducted in 1993, confirms a problem with a 47% stunting prevalence. There are ample differences between urban areas (35%) and rural areas (64%) and between departments with 18% in Tacna and more than 60% in Huancavelica, Apurímac, Ayacucho, Huánuco, Cajamarca and Amazon (Map 4).
The nutritional status of the adult population was measured in 1996 according to Body Mass Index (BMI) of women between 15-49 years with a child of under five years. It was demonstrated that at the national level nutrient deficiencies do not represent a problem (1.1%). Overweight and obesity reach 35% and 9% respectively, on the basis of the same indicators (Table 4b).
A national survey from 1986-87, carried out by the National Program to Fight Against the Goiter Endemic, revealed a 48% prevalence of goiter at the national level and even higher levels in some regions of the country. In 1996, after several years of actions by the mentioned program, an external evaluation demonstrated a urinary iodine excretion medium of over 100 µg/L in all the regions. In 1998, the criteria proposed by the ICCIDD were fulfilled and the evaluation considered iodine deficiency virtually eradicated (Table 5a).
In relation to anemia as a result of iron deficiency, the situation in 1996 indicated that at the national level 4 of every 10 women suffer some degree of anemia. The prevalence is higher in the rural areas (41%), in the Mountain range (42%) and among women who have not attended school. Among children, the situation is even more serious, since 57% had anemia. Differences marked by age exist with some 77% from 6 to 23 months and 33% from 48 to 59 months. However, differences are not noted by sex, residency or region. From 1996 to 1997, MONIN national level data shows a decrease in anemia for children of five. These levels were maintained in 1998 (Table 5b).
Vitamin A deficiency, a public health problem in children under five years, demonstrated a tendency to decrease from 1996 and 1998 in the proportion of retinol deficient children and women (Table 5b).
The important and constant migration of the rural population towards the cities contributed to a population increase and unstable homes, plus a lack of basic services with limited access. These conditions of instability and insecurity are slowly improving however zones exist with high levels of poverty and malnutrition. The highest levels are found in the urban areas and among individuals in the peripheral urban areas.
The improvement of the nutrition situation, mainly from the early nineties, is due to diverse factors: among them are the economic and social policy in general, the health policy and programs, the support programs for the population at need and the increase of food availability. These improvements also include the rural areas and the mountain range region, where poverty and severe malnutrition still persist (Map 1).