Abstract--Relationships among women's employment, child care strategies, and nutritional status of children 12-18 months of age were examined in 80 Nicaraguan households sampled by randomized block design in 10 low income urban communities. Multiple regression analyses showed that children of employed mothers (56%) fared better in weight/height than those whose mothers were not employed, with and without controlling for socioeconomic status and maternal education, paternal financial support, child care adequacy, and sex and age of the child. Children with inadequate alternate child care (care by a preteen or care at the work place) had lower height for age, even controlling for the same variables and for maternal employment. Differences in 10 caregiving behaviors between families as a function of work status of the mother and adequacy of child care were examined. In families with working mothers, caregivers were less likely to be observed washing their hands, suggesting that the positive associations of work for earnings might be due to income rather than improved care. Inadequate care was associated with less food variety, less use of health care, and marginally less handwashing. Inadequate child care, which tends to be associated with informal work, nuclear families and poverty, should be a concern for child welfare.

The Tallstick is a new, simplified anthropometric field tool which allows immediate visual interpretation of height-for-age. This tool was field tested in community-based programmes in Managua, Nicaragua, and the rural community of Los Zarzales, screening 1004 children aged 0-60 months for nutritional stunting. Overall sensitivity and specificity analysis comparing HAZ scores and Tallstick results revealed that the Tallstick correctly identified 83-85 per cent of severely stunted children (HAZ < -2.5) and two-thirds of those with HAZ of -2 and below. It also had good positive predictive value for the mildly stunted. As a screening tool for low weight-for-age, the Tallstick performed better than arm circumference. The best of the community volunteers trained with the Tallstick could use it as well as their trainers. Progressive stunting was found in the 280 children in the sample who did not receive any form of milk. The advantages of the Tallstick for community-level screening and the importance of sustained linear growth are discussed.