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Malnutrition, food insecurity and poverty in older
persons from Mexico City

Jose Alberto Rivera-Marquez

Thesis submitted to the University of London for the
Degree of Doctor of Philosophy

Nutrition and Public Health Intervention
Research Unit

Department of Epidemiology and Population Health

London School of Hygiene and Tropical Medicine

2005

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Abstract

The relationship between malnutrition, food insecurity, and poverty in older

persons from urban Latin America has, to date, received relatively little attention.

This thesis aims to address this important issue in the setting of Mexico City and

its Metropolitan Zone. A theoretical framework has been developed to understand

the causal linkages between the determinants of malnutrition, food insecurity and

poverty, and current data are then used to describe how this public health concern

manifests itself in urban Latin American contexts. This is followed by a

discussion of recent social policy interventions aimed at improving nutrition,

access to food and well-being in older people in Latin America.

The quantitative part of the thesis presents a study which assessed indicators of

nutritional status, food security, health, quality of life and living conditions

among 1,263 households with residents aged 70 and over from socio-

geographically-defined poor areas of Mexico City and its Metropolitan Zone. The

literature suggests that a regular source of economic resources is important to

ensure food security during old age; thus the impact of an ongoing old-age

monetary-transfer programme on nutrition-related indicators, food security and

poverty was assessed at the levels of both older persons and households. This was

carried out through a quasi-experimental study using an ex-post comparison of

intervention and control groups with no baseline measures.

Overall, results suggest differential access to food, quality of life and living

conditions according to socioeconomic stratum among older persons and their

household contexts. Differences in dietary diversity and food insecurity among

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constructed as an indicator of consumption poverty in sampled households with

older persons from Mexico City and the ZMCM. Consumption was divided into

three major categories: 1) food expenditure, 2) non-food expenditure and, 3)

actual or estimated value of rent. Questions on expenditure were addressed to the

member or members of the household in charge of the food shopping and/or in

charge of preparing the meals, provided that they were 18 years of age and older.

a) Food expenditure

Interviewees were asked to remember all the foods consumed, bought, produced,

given as a gift, received as in-kind payment, or obtained through a social

programme in the last 15 days, from a 58-food item list, corresponding to the most

consumed food items by households with older persons reported in the 2000

version of the ENIGH (see Table 4.3). Other food items not included in this list

were also included within food expenditures. Commonly, households in major

urban areas of Mexico do the food shopping every fortnight, which is also the

periodicity with which workers from the formal sector are paid. However, there

was full awareness of purchases made on a weekly or on daily basis (such as

tortillas, bread rolls or sweet bread rolls). The amount and the estimated or actual

value of each food item was obtained. Data on the foods consumed outside the

household were also collected. The sum of all the estimated or actual values for

each food item from the list corresponded to the overall food expenditures in the

household.

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b) Non-food expenditure

Non-food expenditure included in this study are shown in Table 4.4. It is worth

noting that not all goods or services included in this list are consumed, bought,

given as a gift, received as an in-kind payment, or obtained through a social

programme in the same period. The 34-item list was divided into five major

groups, according to the most usual periods of consumption reported by the

ENIGH: a) last 15 days, 2) last month, 3) last two months, 4) last three months

and, 5) last five years. The actual or estimated value of each non-food item was

obtained exactly in the same way as food expenditures were obtained. The sum of

each value corresponded to the overall non-food expenditures in the household.

c) Value of the rent

The value of the rent is an important component of the consumption conditions of

households. Information from people paying rent or from those knowing how

much the rental value of their house was, was used to obtain the real value of rent.

The value of the rent was predicted when people did not know this information or

when they were not willing to respond to this question. There is a systematic

relationship between the value of the rent and the characteristics of both the

dwelling and the residents. In this study, log-linear regression adjusted for

clustering was used to predict the value of the rent." The maximum educational

level and the number of hours worked per week at the household level, as well as

the number of residents in the household, the materials for floors and the

availability of telephones were included in the model for predicting rent.

18 Log-linear regression models to predict the value of the rent were performed by Dr. Saul S.
Morris from the UK Department for International Development (DFID), Honorary Senior Lecturer
of the London School of Hygiene and Tropical Medicine, and co-supervisor of this thesis.

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Appendix 3. Information sheet and consent forms

The World Bank Group

Project: "Malnutrition, food insecurity and poverty in older persons from Mexico City"
Main investigator: Jose Alberto Rivera-Marquez

Information sheet

Date: 2002

Dear Madam or Sir:

We are going to conduct a study aiming at analysing the relationships between food
assistance, food security, nutritional status and self-esteem in a sample of elderly persons aged 70
and over living in the Metropolitan Zone of Mexico City. For this reason, we are kindly requesting
your co-operation. We would also appreciate your primary caregiver and/or some members of
your household aged 16 and over to co-operate with this study by answering some questions.

A survey including various aspects of both the elderly person aged 70 and over and herlhis
household will be conducted. This aspects are: a) socioeconomic characteristics of the members of
the household, b) characteristics of the dwelling and the household, c) use of food assistance-
related programmes at the household level, d) selected household expenses, e) food security at the
household level, and f) health, self-esteem, nutrition and food in the elderly person. We will also
be measuring height, weight and arm-span in elderly persons aged 70 and over only. None of these
measures will cause discomfort or imply distressful physical efforts.

Both the interview and the measures altogether will not take more than one hour and thirty
minutes. However, if you feel tired and want to stop, we could come any other time during this
week. We could also meet you up in a place of your preference in case that you do not want to be
interviewed at home. In addition, you can withdraw from the study at any time without giving us a
reason and you have our promise that none of the food-related assistance that you or your
household is currently being benefited from will change by any reason regarding your
participation in this study.

Should the elderly person have a problem related to hislher nutritional status, she/he will be
advised to seek treatment at local surgeries from the Secretary of Health of Mexico City, the
Health Institute of the State of Mexico, the local premises of the National Institute for Old Age
and/or the local office of the System for the Integral Development of Family. This service will
also be given even though the elderly person decides to withdraw from the study.

It is important to note that all the information you give us will be handled confidentially. No
names, addresses or other data will be given to any health or other governmental authority. Data
will be coded, computerised and stored and no one but the project staffs will have access to them.

The results of this study will be communicated to you and to the local health authorities. We hope
that the findings of this study will help to improve food programmes for the elderly in your
community, as well as to re-define food assistance for the household.

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The World Bank Group

Project: "Malnutrition, food insecurity and poverty in older persons from Mexico City"
Main investigator: Jose Alberto Rivera-Marquez

Consent form

I have read the information sheet concerning this study and I understand what will be required of
me if I take part in the study.

My questions concerning this study have been answered by _

I understand that any time I may withdraw from this study without giving a reason and without
affecting my normal care and management

I agree to take part in this study

Signed _ Date _

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