scholarly journals Stories of Change in Nutrition in Ghana: a focus on stunting and anemia among children under-five years (2009 – 2018)

Food Security ◽  
2021 ◽  
Author(s):  
Richmond Aryeetey ◽  
Afua Atuobi-Yeboah ◽  
Lucy Billings ◽  
Nicholas Nisbett ◽  
Mara van den Bold ◽  
...  
Keyword(s):  
Health Care Access ◽  
Maternal Education ◽  
Social Protection ◽  
Care Service ◽  
National Level ◽  
Decomposition Analysis ◽  
Household Wealth ◽  
Quantitative Evidence ◽  
Stakeholder Relationships ◽  
Policies And Programs

AbstractThe current study aimed to understand why child stunting and anemia (CS&A) rates declined in Ghana between 2009 and 2018, and which priority policies and programs will further improve nutrition outcomes. Trends and potential drivers of stunting (height-for-age z-score < -2.0 SD) and anemia (hemoglobin < 11.0 g/dL), and decomposition analysis of DHS data (2003 to 2014) were conducted. The quantitative evidence was triangulated with Net-Map analysis of nutrition stakeholder relationships and influence, desk review of policies and programs 2009–2019, and in-depth interviews with 25 stakeholders who provided additional insights to explain CS&A trends. Declines in stunting (29.6%) and anemia (14.1%) in children were observed at the national level, but with important subgroup variations. Decomposition analyses identified changes in the household, maternal, and child characteristics (including wealth, use of antenatal services, maternal education, and immunization) as correlates of anemia reduction. Stunting reduction was linked with changes in bed-net utilization, household wealth, and pregnancy care service utilization. Additionally, multiple policies and programs initiated/implemented across multiple sectors were considered potentially relevant to CS&A reduction over time, including those focused on infant and young child feeding, water and sanitation, social protection, and health care access. Initiation/strengthening of these interventions was stimulated by awareness creation and subsequently increased prioritization of stunting. However, program delivery was limited by deficits in government funding, perceived low priority of child anemia, low implementation capacity and coverage, and weak coherence across sectors. Reduced CS&A resulted from improved access to services implemented across multiple sectors, albeit limited by implementation scale and capacity. Further reduction in CS&A requires enhanced multi-sectorally coordinated actions and capacity.

scholarly journals No Magic Bullets: Insights on Drivers of Stunting Decline from an Analysis of Subnational Success Cases in India

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 803-803
Author(s):  
Rasmi Avula ◽  
Phuong Nguyen ◽  
Neha Kohli ◽  
Shubhada Kanani ◽  
Purnima Menon
Keyword(s):  
Civil Society ◽  
Maternal Education ◽  
National Level ◽  
Decomposition Analysis ◽  
Political Leadership ◽  
State Level ◽  
Well Being ◽  
Child Growth ◽  
Drivers Of Change ◽  
Gates Foundation

Abstract Objectives Global attention to reducing childhood stunting has increased the demand for guidance on translating policies into impact. Evidence from national-level success cases is emerging but little is known about how subnational entities can accelerate change. In India, despite a common national framework of programs/policies targeting many determinants of child growth, stunting reduction has varied across states. We aimed to understand drivers of change in stunting at state-level and to identify programmatic, social and political factors that contributed to these changes. Methods We studied three states that had achieved substantial stunting declines between 2005 and 2016 [Chhattisgarh (CG) 14 percentage points (pp); Gujarat (GJ) 13pp; Odisha (OD) 11 pp]. We used regression-decomposition analysis to assess contributions of various determinants of height-for-age Z-score (HAZ) using two rounds of national data. We reviewed nutrition-relevant policies and programs linked to these drivers of change and interviewed stakeholders in government, development partners (DPs), academia and civil society (n = 61) to understand how change occurred. Results Main contributors to gains in HAZ were coverage of health and nutrition interventions (21% CG; 11% GJ; 25% OD), household assets (10% CG; 13% GJ; 18% OD), and sanitation (7% CG; 6% GJ; 5% OD). Maternal education, age at marriage, community-level hygiene, and electrification also contributed. Political leadership and an outcome-focused vision were crucial for action. Although vision varied, capable administrators were able to secure adequate finances, strengthen implementation systems, and invest in state-specific innovations, creating an enabling environment for change. Varied actors, including civil society and DPs, played a catalytic role in spurring action through advocacy, technical and financial inputs, and vigilance. Conclusions Similar drivers were responsible for stunting reduction in 3 states. Ingredients for success highlight the importance of political leadership, targeting multiple determinants and improving implementation systems. Supportive civil society, political and bureaucratic leadership motivated by the well-being of communities remain crucial. Funding Sources Bill & Melinda Gates Foundation through POSHAN, led by IFPRI.

scholarly journals Childhood vaccination coverage and equity impact in Ethiopia by socioeconomic, geographic, maternal and child characteristics

2020 ◽  
Author(s):  
Anne Geweniger ◽  
Kaja M. Abbas
Keyword(s):  
Vaccination Coverage ◽  
Health Survey ◽  
Maternal Education ◽  
National Level ◽  
Household Head ◽  
Household Wealth ◽  
Demographic And Health Survey ◽  
Childhood Vaccination ◽  
Child Characteristics ◽  
Single Vaccination

AbstractBackgroundEthiopia is a priority country of Gavi, the Vaccine Alliance to improve vaccination coverage and equitable uptake. The Ethiopian National Expanded Programme on Immunisation (EPI) and the Global Vaccine Action Plan set coverage goals of 90% at national level and 80% at district level by 2020. This study aims to analyse basic vaccination coverage among children in Ethiopia and to estimate the equity impact by socioeconomic, geographic, maternal and child characteristics based on data from the Ethiopia Demographic and Health Survey 2016.MethodsBasic vaccination coverage (1-dose BCG, 3-doses DPT-HepB-Hib, 3-doses polio, 1-dose measles vaccine) of 2,004 children aged 12-23 months was analysed. Mean coverage was disaggregated by socioeconomic (household wealth, religion, ethnicity), geographic (area of residence, region), maternal (maternal age at birth, maternal education, maternal marital status, sex of household head) and child (sex of child, birth order) characteristics. Concentration indices assessed wealth and education-related inequalities. Multiple logistic regression estimated associations between basic vaccination coverage and socioeconomic, maternal and child characteristics.ResultsNational coverage for basic vaccinations was 39.7% in 2016. Single vaccination coverage ranged between between 53.2% (DTP3) and 69.2% (BCG). Wealth and maternal education related inequities were present for all vaccines. Children from richer households, urban regions, primary maternal education and male headed households were associated with higher vaccination coverage. The Ethiopia Mini Demographic and Health Survey 2019 reports national coverage for basic vaccinations at 43.3% with single vaccination coverage ranging between 57.8% (measles) and 74.2% (BCG).ConclusionsVaccination coverage has improved from 2016 to 2019, but remains below the coverage goals of the EPI. Low vaccination coverage is associated with poorer households, rural regions of Afar and Somali, no maternal education and female headed households. Targeted approaches are necessary to improve vaccination coverage among these population subgroups and equitable uptake of vaccines in Ethiopia.

scholarly journals Nobody left behind? Equity and the drivers of stunting reduction in Vietnamese ethnic minority populations

Food Security ◽  
2021 ◽  
Author(s):  
Jody Harris ◽  
Phuong Huynh ◽  
Hoa T. Nguyen ◽  
Nga Hoang ◽  
Lan Tran Mai ◽  
...  
Keyword(s):  
Ethnic Minority ◽  
Maternal Education ◽  
Minority Groups ◽  
National Development ◽  
Decomposition Analysis ◽  
Household Wealth ◽  
Large Set ◽  
Ethnic Minority Groups ◽  
Minority Communities ◽  
Left Behind

AbstractVietnam has successfully reduced population stunting, but ethnic minority groups are being systematically left behind, limiting progress on national reductions. This mixed methods study aims to understand how policy drivers of stunting reduction differ between ethnic majority and minority communities. We used decomposition analysis to explain key determinants of stunting change between 2000 and 2010; and framework analysis to qualitatively assess changes in policy, actors and narratives that have underpinned these over decades. Our analysis shows that stunting reductions are associated with increased household wealth (accounting for 61% of change), improved access to specific health services (16%), and changes in level of maternal education (12%). Despite multiple actors involved in change and a large set of policies designed to address inequities, many among Vietnam’s defined ethnic minority groups are not finding themselves able to effectively engage with central government plans for their communities, and central policies often do not consider their preferences or limitations. This in turn impacts the nutrition of minority groups through the determinants above. Vietnam has achieved the easier portion of stunting reduction through national economic growth and sustained commitment to socially-oriented policy. In order to tackle the remaining pockets of high malnutrition, more attention, thought and funding will need to focus on marginalised ethnic minority communities. The current national development discourse aims to incorporate minorities into mainstream majority systems. This paper argues that policy should rather take into account their particular needs and preferences to address and overcome the identified determinants of malnutrition.

scholarly journals The persistent influence of caste on under-five mortality: Factors that explain the caste-based gap in high focus Indian states

2019 ◽  
Author(s):  
Jayanta Kumar Bora ◽  
Rajesh Raushan ◽  
Wolfgang Lutz
Keyword(s):  
Maternal Education ◽  
Positive Impact ◽  
Decomposition Analysis ◽  
Mortality Rates ◽  
Household Wealth ◽  
Mortality Factors ◽  
Binary Logistic Regression Model ◽  
Indian States ◽  
Under Five ◽  
Caste Groups

AbstractObjectiveAlthough under-five mortality (U5M) is declining in India, it is still high in a few selected states and among the scheduled caste (SC) and scheduled tribe (ST) population of the country. This study re-examines the association between castes and U5M in high focus Indian states following the implementation of the country’s National Rural Health Mission (NRHM) program. In addition, we aim to quantify the contribution of socioeconomic determinants in explaining the gap in U5M between the SC/ST population and non-SC/ST population in high focus states in India.Data and methodUsing data from the National Family Health Survey (NFHS), we calculated the under-five mortality rate (U5MR) by applying a synthetic cohort probability approach. We applied a binary logistic regression model to examine the association of U5M with the selected covariates. Further, we used Fairlie’s decomposition technique to understand the relative contribution of socioeconomic variables on U5M risk between the caste groups.FindingsIn high focus Indian states, the parallel gap in U5M between well-off and deprived caste children has disappeared in the post-NRHM period, indicating a positive impact in terms of reducing caste-based inequalities in the high focus states. Despite the reduction in U5M, particularly among children belonging to STs, children belonging to the SC and ST population still experience higher mortality rates than children belonging to the non-SC/ST population from 1992 to 2016. Both macro level (district level mortality rates) and individual (regression analysis) analyses showed that children belonging to SCs experience the highest likelihood of dying before their fifth birthday. A decomposition analysis revealed that 78% of the caste-based gap in U5M is due to the effect of women’s level of educational attainment and household wealth between the SC/ST and non-SC/ST population. Program indicators such as place of delivery and number of antenatal care (ANC) visits also contributed significantly to widening caste-based gaps in U5M.ConclusionThe study indicates that there is still scope to improve access to health facilities for mothers and children belonging to deprived caste groups in India. Continuous efforts to raise the level of maternal education and the economic status of people belonging to deprived caste groups should be pursued simultaneously.

scholarly journals Factors contributing to the reduction in childhood stunting in Bangladesh: a pooled data analysis from the Bangladesh demographic and health surveys of 2004 and 2017–18

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pradeep Kumar ◽  
Rashmi Rashmi ◽  
T. Muhammad ◽  
Shobhit Srivastava
Keyword(s):  
Health Surveys ◽  
Maternal Education ◽  
Descriptive Analysis ◽  
Decomposition Analysis ◽  
Wealth Inequality ◽  
Household Wealth ◽  
Bivariate Analysis ◽  
Demographic And Health Surveys ◽  
Age At First Birth ◽  
Contributing Factors

Abstract Background Over the last two decades, Bangladesh has made progress in reducing the percentage of stunted children under age 5 years from 51% in 2004 to 31% in 2017. Such reduction has created a source for new research to understand its contributing factors. The present study aims to identify such crucial factors which contributed in reducing the percentage of under-five stunting status of children from 2004 to 2017–18. Methods The study used data from the Bangladesh Demographic and Health Surveys (BDHS), conducted in 2004 and in 2017–18, focused on children under-5-years of age (U5). The sample sizes were n = 6375 children included in the 2004 survey and n = 8312 children included in the 2017–18 survey. Descriptive analysis and bivariate analysis were conducted for a general characterization of the samples. Logistic regression was used to find out the significant factors contributing to the prevalence of stunting among U5 children. Furthermore, the Fairlie decomposition technique was used to identify the crucial factors that contributed to the reduction of stunting. Results The prevalence of stunting among U5 children has declined significantly, from 49.8 to 30.7% between the two survey periods (2004 and 2017–18). Estimates of decomposition analysis show that overall, the selected variables explained 50.6% of the decrease in the prevalence of stunting. Mother’s characteristics such as age at first birth, education level, working status and BMI (body mass index) status were the primary contributors of this change. Father’s characteristics, such as education explained 9% of this change. Conclusion The results of the study highlight the importance of increasing maternal education and reducing inter-household wealth inequality to improve nutritional status of U5 children. In order to achieve further reduction in stunting, among U5 children in Bangladesh, this paper calls for policymakers to develop effective programs to improve maternal education, raise parental awareness of parents regarding children’s height and weight, and aim to significantly reduce inter-household inequalities.

Legal and Institutional Functionality in the Protection of Women – Victims of Domestic Violence in the Republic of Macedonia – Present Situation and Future Perspectives

2017 ◽  
Vol 10 (2) ◽  
pp. 131
Author(s):  
Zorica Saltirovska Professor ◽  
Sunchica Dimitrijoska Professor
Keyword(s):  
Domestic Violence ◽  
Women Victims ◽  
Violence Against Women ◽  
Social Protection ◽  
National Level ◽  
Gender Based Violence ◽  
Republic Of Macedonia ◽  
The Law ◽  
The Republic ◽  
Gender Based

Gender-based violence is a form of discrimination that prevents women from enjoying the rights and liberties on an equal level with men. Inevitably, domestic violence shows the same trend of victimizing women to such a degree that the term “domestic violence” is increasingly becoming synonymous with “violence against women”. The Istanbul Convention defines domestic violence as "gender-based violence against women", or in other words "violence that is directed against a woman because she is a woman or that affects women disproportionately." The situation is similar in the Republic of Macedonia, where women are predominantly victims of domestic violence. However, the Macedonian legal framework does not define domestic violence as gender-based violence, and thus it does not define it as a specific form of discrimination against women. The national legislation stipulates that victims are to be protected in both a criminal and a civil procedure, and the Law on Prevention and Protection from Domestic Violence determines the actions of the institutions and civil organizations in the prevention of domestic violence and the protection of victims. The system for protection of victims of domestic violence closely supports the Law on Social Protection and the Law on Free Legal Aid, both of which include provisions on additional assistance for women victims of domestic violence. However, the existing legislation has multiple deficiencies and does not allow for a greater efficacy in implementing the prescribed measures for the protection of victims of domestic violence. For this reason, as well as due to the inconsistent implementation of legal solutions of this particular issue, the civil sector is constantly expressing their concern about the increasingly wider spread of domestic violence against women and about the protection capabilities at their disposal. The lack of recognition of all forms of gender-based violence, the trivial number of criminal sentences against persons who perform acts of domestic violence, the insufficient support offered to victims – including victim shelters, legal assistance, and counseling, and the lack of systematic databases on domestic violence cases on a national level, are a mere few of the many issues clearly pointing to the inevitable conclusion that the protection of women-victims of domestic violence is inadequate. Hence, the functionality and efficiency of both the existing legislation and the institutions in charge of protection and support of women – victims of domestic violence is being questioned, which is also the subject for analysis in this paper.

Diverging Paths

2018 ◽  
Author(s):  
Dirk Luyten
Keyword(s):  
World War Ii ◽  
Welfare State ◽  
Social Protection ◽  
National Level ◽  
Gain Control ◽  
Political Strategy ◽  
State Development ◽  
Social Reforms ◽  
Welfare State Development ◽  
The Impact

For the Netherlands and Belgium in the twentieth century, occupation is a key concept to understand the impact of the war on welfare state development. The occupation shifted the balance of power between domestic social forces: this was more decisive for welfare state development than the action of the occupier in itself. War and occupation did not result exclusively in more cooperation between social classes: some interest groups saw the war as a window of opportunity to develop strategies resulting in more social conflict. Class cooperation was often part of a political strategy to gain control over social groups or to legitimate social reforms. The world wars changed the scale of organization of social protection, from the local to the national level: after World War II social policy became a mission for the national state. For both countries, war endings had more lasting effects for welfare state development than the occupation itself.

Socioeconomic effects of pension spending: evidence from Spain

2020 ◽  
Vol 47 (5) ◽  
pp. 599-617
Author(s):  
Fernando Bermejo ◽  
Eladio Febrero ◽  
Andre Fernandes Tomon Avelino
Keyword(s):  
Peer Review ◽  
Social Protection ◽  
Pension System ◽  
Decomposition Analysis ◽  
Value Added ◽  
Total Output ◽  
Alternative View ◽  
Input Output ◽  
Structural Decomposition Analysis ◽  
Content Type

PurposeThe purpose of this study is to provide broader understanding of the significant role that the pension system has in the Spanish economy by estimating the sectoral production, employment and income sustained by pensioners' consumption.Design/methodology/approachBased on input–output tables by the World Input–Output Database and consumption data from the Household Budget Survey by the Spanish Statistical Office, a demoeconomic model is applied to quantify the direct impacts, indirect impacts from interindustry links and induced impacts from income–consumption connections over a nine-year period (2006–2014). Then, the factors driving the evolution of total output, employment and value added during such period have been examined by using structural decomposition analysis.FindingsThe growing participation of consumption by pensioner households in final demand had proven crucial during the 2008 crisis to alleviate the negative trend in production and employment derived from the collapse in consumption suffered by the rest of households.Practical implicationsDetermining the underlying factors driving changes in both employment and income during the 2008 crisis can be of interest in political decision-making on the sustainability of the Spanish pension system.Social implicationsThe results of estimating both the employment and income supported by pensioners' consumption reveal the significant stabilizing effect of the public spending on pensions, particularly during the 2008 crisis.Originality/valueThe current Spanish approach of attaining the pension system sustainability by merely reducing social protection costs ignores the adverse consequences of a lower pensioners' demand. This paper addresses an alternative view in which pension spending is not considered a burden on economic growth but rather a means of improving the level of production and employment.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-01-2019-0047

scholarly journals Decomposing the rural–urban gap in factors associated with childhood immunisation in sub-Saharan Africa: evidence from surveys in 23 countries

2021 ◽  
Vol 6 (1) ◽  
pp. e003773
Author(s):  
Edward Kwabena Ameyaw ◽  
Yusuf Olushola Kareem ◽  
Bright Opoku Ahinkorah ◽  
Abdul-Aziz Seidu ◽  
Sanni Yaya
Keyword(s):  
Decomposition Analysis ◽  
Household Wealth ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Childhood Immunisation ◽  
Urban Settings ◽  
Factors Associated ◽  
Rural And Urban ◽  
Full Immunisation ◽  
Sub Saharan

BackgroundAbout 31 million children in sub-Saharan Africa (SSA) suffer from immunisation preventable diseases yearly and more than half a million children die because of lack of access to immunisation. Immunisation coverage has stagnated at 72% in SSA over the past 6 years. Due to evidence that full immunisation of children may be determined by place of residence, this study aimed at investigating the rural–urban differential in full childhood immunisation in SSA.MethodsThe data used for this study consisted of 26 241 children pooled from 23 Demographic and Health Surveys conducted between 2010 and 2018 in SSA. We performed a Poisson regression analysis with robust Standard Errors (SEs) to determine the factors associated with full immunisation status for rural and urban children. Likewise, a multivariate decomposition analysis for non-linear response model was used to examine the contribution of the covariates to the observed rural and urban differential in full childhood immunisation. All analyses were performed using Stata software V.15.0 and associations with a p<0.05 were considered statistically significant.ResultsMore than half of children in urban settings were fully immunised (52.8%) while 59.3% of rural residents were not fully immunised. In all, 76.5% of rural–urban variation in full immunisation was attributable to differences in child and maternal characteristics. Household wealth was an important component contributing to the rural–urban gap. Specifically, richest wealth status substantially accounted for immunisation disparity (35.7%). First and sixth birth orders contributed 7.3% and 14.9%, respectively, towards the disparity while 7.9% of the disparity was attributable to distance to health facility.ConclusionThis study has emphasised the rural–urban disparity in childhood immunisation, with children in the urban settings more likely to complete immunisation. Subregional, national and community-level interventions to obviate this disparity should target children in rural settings, those from poor households and women who have difficulties in accessing healthcare facilities due to distance.

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