The trend of full vaccination coverage in infants and inequalities by wealth quintile and maternal education: analysis from four recent demographic and health surveys in Nepal

Abstract Background Despite policy intention to reach disadvantaged populations, inequalities in health care resource use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between Nepal Demographic and Health Surveys (NDHS) 2001 and 2016. Methods Using data from NDHS conducted in 2001, 2006, 2011 and 2016, we investigated the trend of coverage of six antigens: Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles during their infancy among children aged 12–23 months. We presented trends and correlates of full vaccination coverage by different socio-demographic factors. We measured inequalities in full vaccination coverage by wealth quintile and maternal education using absolute measure (slope index of inequality) and relative measures (Relative index of inequality, concentration index) of inequalities. Results Full vaccination coverage among infants steadily increased from 65.6% in 2001 to 87.0% in 2011; however, it decreased to 77.8% in 2016. Province 2 had a significantly lower full vaccination coverage compared to Province1.Although decreasing over time, there were significant inequalities by household wealth quintiles and maternal educational status. The slope index of inequality (SII) for wealth quintiles decreased from − 32.3 [− 45.5,-19.1] in 2001 to an SII of-8.4 [− 18.6,-1.7] in 2016. Similarly, the SII for education decreased from − 61.8 [− 73.5,-50.1] in 2001 to an SII of − 30.5 [− 40.7,-20.2] in 2016. Similarly, the relative index of inequality (RII) also showed an improvement over time, indicating the narrowing equity gap. Additionally, concentration index on full vaccination coverage by wealth quintiles dropped from 0.21 (0.12–0.28) in 2001 to 0.054 (− 0.01–0.12) in 2016. Absolute and relative inequalities were persistently larger by maternal educational status compared to household wealth quintiles throughout the study period. Conclusion Full vaccination coverage in Nepal increased from 2001 until 2011 but saw a significant decrement away from the national target after 2011. However, the equity gap by household wealth quintile and maternal education status has narrowed over time. National Immunization programs need to give higher emphasis to infants born to mothers with less education, those born in the poorer wealth quintile households, and those living in Province 2.

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The trend of full vaccination coverage in infants and inequalities by wealth quintile and maternal education: Analysis from four recent Demographic and Health Surveys in Nepal

10.21203/rs.2.13937/v3 ◽

2019 ◽

Author(s):

Kiran Acharya ◽

Yuba Raj Paudel ◽

Dinesh Dharel

Keyword(s):

Vaccination Coverage ◽

Maternal Education ◽

Immunization Coverage ◽

Wealth Quintile ◽

Educational Status ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Relative Index ◽

Index Of Inequality ◽

Over Time

Abstract Background Despite policy intention to reach disadvantaged populations, inequalities in child health care use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between Nepal Demographic and Health Surveys (NDHS) 2001 and 2016.Methods Using data from NDHS conducted in 2001, 2006, 2011 and 2016, we investigated the trend of coverage of six antigens:Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles during their infancy among children aged 12-23 months. We presented trends and correlates of vaccination coverage by different socio-demographic factors. We measured inequalities in full vaccination coverage by wealth quintile and maternal education using absolute measure (slope index of inequality) and relative measures (Relative index of inequality, concentration index) of inequalities.Results Full immunization coverage among infants steadily increased from 65.6% in 2001 to 87.0% in 2011; however, it decreased to 77.8% in 2016. Province 2 had a significantly lower full vaccination coverage compared to Province1.Although decreasing over time, there were significant inequalities by household wealth quintiles and maternal educational status. The slope index of inequality (SII) for wealth quintiles decreased from -32.3 [-45.5,-19.1] in 2001 to an SII of-8.4 [-18.6,-1.7] in 2016. Similarly, the SII for education decreased from -61.8 [-73.5,-50.1] in 2001 to an SII of -30.5 [-40.7,-20.2] in 2016. Similarly, the relative index of inequality (RII) also showed an improvement over time, indicating the narrowing equity gap. Additionally, concentration index on full immunization coverage by wealth quintiles dropped from 0.21 (0.12-0.28) in 2001 to 0.054 (-0.01-0.12) in 2016. Absolute and relative inequalities were persistently larger by maternal educational status compared to household wealth quintiles throughout the study period.Conclusion Full vaccination coverage in Nepal increased from 2001 until 2011 but saw a significant decrement away from the national target after 2011. However, the equity gap by household wealth quintile and maternal education status has narrowed over time. National Immunization programs need to give higher emphasis to infants born to mothers with less education, those born in the poorer wealth quintile households, and those living in Province 2.

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The trend of full vaccination coverage in infants and inequalities by wealth quintile and maternal education: Analysis from four recent Demographic and Health Surveys in Nepal

10.21203/rs.2.13937/v4 ◽

2019 ◽

Author(s):

Kiran Acharya ◽

Yuba Raj Paudel ◽

Dinesh Dharel

Keyword(s):

Vaccination Coverage ◽

Maternal Education ◽

Immunization Coverage ◽

Wealth Quintile ◽

Educational Status ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Relative Index ◽

Index Of Inequality ◽

Over Time

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The trend of full vaccination coverage in infants and inequalities by wealth quintile and maternal education: Analysis from four recent Demographic and Health Surveys in Nepal

10.21203/rs.2.13937/v2 ◽

2019 ◽

Author(s):

Kiran Acharya ◽

Yuba Raj Paudel ◽

Dinesh Dharel

Keyword(s):

Vaccination Coverage ◽

Maternal Education ◽

Immunization Coverage ◽

Wealth Quintile ◽

Educational Status ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Relative Index ◽

Index Of Inequality ◽

Over Time

Abstract Background Despite policy intention to reach disadvantaged populations, inequalities in child health care use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between Nepal Demographic and Health Surveys (NDHS) 2001 and 2016.Methods Using data from NDHS conducted in 2001, 2006, 2011 and 2016, we investigated the trend of coverage of six antigens:Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles during their infancy among children aged 12-23 months. We presented trends and correlates of vaccination coverage by different socio-demographic factors. We measured inequalities in full vaccination coverage by wealth quintile and maternal education using absolute measure (slope index of inequality) and relative measures (Relative index of inequality, concentration index) of inequalities.Results Full immunization coverage among infants steadily increased from 65.6% in 2001 to 87.0% in 2011; however, it decreased to 77.8% in 2016. Province 2 had a significantly lower full vaccination coverage compared to Province1.Although decreasing over time, there were significant inequalities by household wealth quintiles and maternal educational status. The slope index of inequality (SII) for wealth quintiles decreased from -32.3 [-45.5,-19.1] in 2001 to an SII of-8.4 [-18.6,-1.7] in 2016. Similarly, the SII for education decreased from -61.8 [-73.5,-50.1] in 2001 to an SII of -30.5 [-40.7,-20.2] in 2016. Similarly, the relative index of inequality (RII) also showed an improvement over time, indicating the narrowing equity gap. Additionally, concentration index on full immunization coverage by wealth quintiles dropped from 0.21 (0.12-0.28) in 2001 to 0.054 (-0.01-0.12) in 2016. Absolute and relative inequalities were persistently larger by maternal educational status compared to household wealth quintiles throughout the study period.Conclusion Full vaccination coverage in Nepal increased from 2001 until 2011 but saw a significant decrement away from the national target after 2011. However, the equity gap by household wealth quintile and maternal education status has narrowed over time. However, immunization programs need to give higher emphasis to infants born to mothers with less education, those born in the poorer wealth quintile households, and those living in Province 2.

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1097Inequalities in full vaccination coverage by maternal education and wealth quintiles in South Asian countries

International Journal of Epidemiology ◽

10.1093/ije/dyab168.154 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Dinesh Dharel ◽

Yuba Raj Paudel ◽

Asmita Bhattarai ◽

Rajkumar Subedi ◽

Kiran Acharya

Keyword(s):

South Asian ◽

Vaccination Coverage ◽

Maternal Education ◽

Critical Role ◽

Wealth Quintile ◽

Household Wealth ◽

Asian Countries ◽

Relative Index ◽

Absolute And Relative Inequalities ◽

Index Of Inequality

Abstract Background Estimated one in four children is not fully immunized in South Asia. This study aimed to compare full vaccination coverage in the region and its inequalities by maternal education and household wealth quintile. Methods We used data from the most recent Demographic and Health Survey (DHS) from Nepal, India, Pakistan, Bangladesh, Afghanistan, and the Maldives. Children aged 12-23 months were included. We defined full vaccination as receiving at least six antigen: Bacille Calmette Guerin, Diptheria, Pertussis, Tetanus, Polio, and Measles. We measured absolute inequalities using the slope index of inequality (SII), and relative inequalities using the relative index of inequality (RII) both for maternal education and household wealth quintiles. Results The full vaccination coverage ranged from 46% in Afghanistan to 84% in Bangladesh. Pakistan had the largest inequalities in coverage by maternal education (SII: -50.0, RII: 0.4) and household wealth quintile (SII: -47.1, RII: 0.5). The SII by wealth quintiles was smaller (-8.4) in Nepal compared to Bangladesh, India, Pakistan, and Afghanistan, but it was larger (-30.5) by maternal education compared to Bangladesh and India, although smaller than Pakistan and Afghanistan. The RII followed a similar trend. Conclusions All South Asian countries studied had full vaccination coverage under 85%. Both absolute and relative inequalities were larger by maternal education compared to wealth quintile in four of the six countries. Key messages Larger inequalities by maternal education compared to wealth-based inequalities in most South Asian countries indicate the critical role of maternal education to improve child health outcomes.

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Trends in stunting and overweight in Peruvian pre-schoolers from 1991 to 2011: findings from the Demographic and Health Surveys

Public Health Nutrition ◽

10.1017/s1368980014000275 ◽

2014 ◽

Vol 17 (11) ◽

pp. 2407-2418 ◽

Cited By ~ 16

Author(s):

Helga Bjørnøy Urke ◽

Maurice B Mittelmark ◽

Martín Valdivia

Keyword(s):

Urban Areas ◽

Health Surveys ◽

Maternal Education ◽

Wealth Quintile ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Sampling Weights ◽

Cross Sectional ◽

Growth Standards ◽

Low Educated

AbstractObjectiveTo examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria.DesignTrend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991–2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban–rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights).SettingPeru.SubjectsChildren aged 0–59 months surveyed in 1991–92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007–08 (n 8232) and 2011 (n 8186).ResultsChild stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991–2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020).ConclusionsThe 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

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Trends in educational and wealth inequalities in adult tobacco use in Nepal 2001–2016: secondary data analyses of four Demographic and Health Surveys

BMJ Open ◽

10.1136/bmjopen-2019-029712 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029712 ◽

Cited By ~ 1

Author(s):

Chandrashekhar T Sreeramareddy ◽

Sam Harper

Keyword(s):

Tobacco Use ◽

Health Surveys ◽

Secondary Data ◽

Vulnerable Groups ◽

Demographic And Health Surveys ◽

Relative Index ◽

Index Of Inequality ◽

Wealth Inequalities ◽

Current Tobacco ◽

Over Time

ObjectiveTo measure trends in socioeconomic inequalities tobacco use in Nepal.SettingAdults interviewed during house-to-house surveys.ParticipantsWomen (15–45 years) and men (15–49 years) surveyed in four Nepal Demographic and Health Surveys done in 2001, 2006, 2011 and 2016.Outcome measureCurrent tobacco use (in any form).ResultsThe prevalence of tobacco use for men declined from 66% in 2001 to 55% in 2016, and declined from 29% to 8.4% among women. Across both education and wealth quintiles for both men and women, the prevalence of tobacco use generally declines with increasing education or wealth. We found persistently larger absolute inequalities by education than by wealth among men. Among women we also found larger educational than wealth-related gradients, but both declined over time. For men, the Slope Index of Inequality (SII) for education was larger than for wealth (44% vs 26% in 2001) and changed very little over time. For women, the SII for both education and wealth were similar in magnitude to men, but decreased substantially between 2001 and 2016 (from 44% to 16% for education; from 37% to 16% for wealth). Women had a larger relative index of inequality than men for both education (6.5 vs 2.0 in 2001) and wealth (4.8 vs 1.5 in 2001), and relative inequality increased between 2001 and 2016 for women (from 6.5 to 16.0 for education; from 4.8 to 12.0 for wealth).ConclusionIncreasing relative inequalities indicates suboptimal reduction in tobacco use among the vulnerable groups suggesting that they should be targeted to improve tobacco control.

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Trends in socioeconomic inequalities in childhood BCG immunization coverage in Pakistan

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1127 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S Zaheer ◽

S Kanwal ◽

K Shafique

Keyword(s):

Vaccination Coverage ◽

Eastern Mediterranean ◽

Eastern Mediterranean Region ◽

Socioeconomic Inequalities ◽

Reproductive Age ◽

Demographic And Health Surveys ◽

High Burden ◽

Relative Index ◽

Bcg Vaccination ◽

Index Of Inequality

Abstract Background Although, WHO notes that there has been 'tremendous progress' towards controlling spread of Tuberculosis (TB) by 2015, situation in endemic countries like Pakistan need global attention. Pakistan currently ranks fifth among TB-high burden countries and it accounts for 61% of the TB burden in the WHO Eastern Mediterranean Region. We aim to explore the trends in relative and absolute socioeconomic inequalities in BCG vaccination coverage. Methods Data from Pakistan Demographic and Health Surveys (PDHS) 2006-7 (n = 9177 data used 8442), and 20012-13 (n = 13558, used n = 6982) were used. Information was collected from all mothers in reproductive age group, regarding BCG vaccination of their children aged < 5 years. Wealth index and education were used to assess socioeconomic position. Socioeconomic inequalities for BCG vaccination coverage were assessed by calculating Relative Index of Inequality (RII) and Absolute Index of Inequality (SII). Results Although reported frequency of not getting the child BCG vaccinated has decreased over the decade (25% in 2006, 18% in 2013). Nevertheless, socioeconomic inequalities in BCG vaccination have significantly widened over the last decade. Education related inequalities [2006-7 Urban: SII=-1.34 (-0.91, -1.76); 2012-13 Urban: SII=-1.88 (-1.43, -2.32)]; [2006-7 Rural: SII=-1.31 (-0.96, -1.65); 2012-13 Rural: SII=-1.54 (-1.13, -1.94)] have increased. Similarly, wealth related inequalities [2006-7 Urban: SII=-1.27 (-0.91, -1.62); 2012-13 Urban: SII=-1.75 (-1.37, -2.12)]; [2006-7 Rural: SII=-1.19 (-0.98, -1.39); 2012-13 Rural: SII=-1.72 (-1.43, -2.00)] have increased. Conclusions Widening absolute inequalities in BCG vaccination coverage among children over the last decade in a TB-high burden country gives rise to global concern, at a time when world aims for tuberculosis free future. The results warrant the essential public health efforts to avoid further widening in TB related socioeconomic inequalities in Pakistan. Key messages The results warrant the need to continue monitoring of TB control at population level. Study findings may help to improved TB management programs to initiate evidence-based guidelines for maternal and child health.

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National trends of childhood vaccination coverage in Bangladesh: Understanding gaps from 2011, 2014 and 2017-18 Demographic and Health Surveys data

10.21203/rs.3.rs-722674/v1 ◽

2021 ◽

Author(s):

Satyajit Kundu ◽

Subarna Kundu ◽

Bright Opoku Ahinkorah ◽

Abdul-Aziz Seidu ◽

Joshua Okyere ◽

...

Keyword(s):

Vaccination Coverage ◽

Urban Areas ◽

Health Surveys ◽

Maternal Education ◽

Vaccine Coverage ◽

Immunization Coverage ◽

Childhood Vaccination ◽

Demographic And Health Surveys ◽

Changes Over Time ◽

Over Time

Abstract Background Vaccination is a safe and cost-effective strategy for protecting children from life-threatening diseases. This study aimed to investigate the changes over time in proportion of vaccination coverage across demographic subgroups in Bangladesh. Method Vaccination coverage for children 12–59 months of age was obtained from Bangladesh’s 2011, 2014, and 2017-18 Demographic and Health Surveys. Three multivariable binary logistic regression models with complete vaccination status at each survey data were used to generate adjusted odds ratios to uncover immunization variations across socio-demographic categories. Further, to detect potential geographic disparities, changes over time were analyzed at both the country and district levels. Findings Vaccination coverage grew from 88.1% in 2011 to 89.2% in 2017–2018, indicating a gap of more than ten percent for complete immunization coverage among children aged 12–59 months. Children aged 23–35 were more likely to have full vaccination compared to those aged 12–23 in 2011 (AOR = 1.6, 95% CI = 1.3–1.9), 2014 (AOR = 1.6, 95% CI = 1.3-2.0), and 2017-18 (AOR = 1.4, 95% CI = 1.1–1.7). The likelihood of full vaccination of children increased with maternal education with the highest odds among women with higher education in 2011 (AOR = 7.2, 95% CI = 4.0-12.9), 2014 (AOR = 4.0, 95% CI = 2.7–5.9), and 2017-18 (AOR = 5.8, 95% CI = 3.5–9.6) compared to those with no formal education. Children born to mothers who lived in urban areas were more likely to have full vaccination in 2011 (AOR = 1.5, 95% CI = 1.3–1.8), 2014 (AOR = 1.4, 95% CI = 1.2–1.7), and 2017-18 (AOR = 1.4, 95% CI = 1.1–1.7) compared to those who lived in rural areas. Children born to mothers who had at least 4 ANC visits were more likely to have full vaccination compared to those with less than 3 ANC visits in 2011 (AOR = 1.6, 95% CI = 1.2-2.0), 2014 (AOR = 1.5, 95% CI = 1.2-2.0), and 2017-18 (AOR = 1.6, 95% CI = 1.2–2.1 During these three surveys, Rangpur division had the highest vaccine coverage rate, while Sylhet division had the lowest vaccination coverage. Conclusion Although there was an improvement in these nationally representative surveys from 2011 to 2017-18, a portion of children still needs to be vaccinated to ensure full immunization coverage. To achieve 100% immunization coverage for all Bangladeshi children, policymakers must integrate vaccine programs with personalized health messaging and assurances of health safety for impoverished children and low-educated mothers. Increased institutional deliveries and prenatal care visits by mothers could assist increase their children's vaccination coverage.

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1159Inequities in on-time childhood vaccination: Evidence from sub-Saharan Africa

International Journal of Epidemiology ◽

10.1093/ije/dyab168.467 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Martin Mutua

Keyword(s):

Rural Communities ◽

Vaccination Coverage ◽

Maternal Education ◽

Household Wealth ◽

Sub Saharan Africa ◽

Childhood Vaccination ◽

Demographic And Health Surveys ◽

Place Of Residence ◽

Multiple Indicator ◽

Sub Saharan

Abstract Introduction Vaccination coverage has improved over the past decade but inequalities persist; the poorest, least educated, and rural communities are left behind. Programming has focused on increasing coverage and reaching the hardest to reach children but vaccination timeliness is equally important as delays leave children vulnerable to infections. This study examines the levels and inequities of on-time vaccination in the sub-Saharan African (SSA) region. Methods: The most recent Demographic and Health Surveys or Multiple Indicator Clusters Surveys since 2000 from SSA were used to assess on-time vaccination and inequalities by household wealth, maternal education, and place of residence. Inequalities were quantified using slope index of inequality and concentration index. Results The analysis included 153,632 children aged 12-36 months from 40 SSA countries. Median on-time vaccination coverage was below 50% in all four sub-regions. Differences in on-time vaccination were observed by place of residence in Southern (20.8 pp, 95%CI (0.8; 40.8)), West (17.5 pp, 95%CI (5.1; 29.9)), and Eastern (20.9 pp, 95%CI (6.5; 35.2)) regions. Wealth-related inequities were observed in Southern (22.6 pp, 95%CI (4.0; 41.2)), West (30.6 pp, 95%CI (19.1; 42.1)), and Eastern (26.1 pp, 95%CI (8.2; 44.0)) regions. Significant education-related differences in on-time vaccination were observed in West (20.7 pp, 95%CI (10.9; 30.5)), and Eastern (21.2 pp, 95%CI (7.0; 35.4)) regions. Conclusions On-time vaccination coverage was low in all sub-regions and nearly all countries. Inequalities in on-time immunization by household wealth, place of residence, and education existed in most countries. Concrete strategies to improve levels of timeliness are needed

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Prevalence and Determinants of Nutritional Status Among Women and Children in Pakistan

10.21203/rs.3.rs-646383/v1 ◽

2021 ◽

Author(s):

Hanumant Waghmare ◽

Shekhar Chauhan ◽

Santosh Kumar Sharma

Keyword(s):

Risk Factors ◽

Nutritional Status ◽

Rural Women ◽

Urban Women ◽

Wealth Quintile ◽

Educational Status ◽

Household Wealth ◽

Poor Nutritional Status ◽

Women And Children ◽

Status Of Women

Abstract Background: Nutrition has been a low-priority area in Pakistan, with low visibility from the political leadership. Despite various efforts, Pakistan has been reported to have one of the highest prevalence of child and women malnutrition compared to other developing counties. Therefore, this study intends to examine the prevalence and determinants of nutritional status of women and children in Pakistan.Methods: The present study uses the Demographic Health Survey (DHS) data from Pakistan 2012-13 (PDHS-3). The nutritional status of women was examined through Body-Mass Index (Underweight, normal, overweight, & obese), and that of children was examined through stunting (severe and moderate), wasting (severe, moderate, overweight), and underweight (severe, moderate, overweight). Descriptive statistics and bivariate analysis have been used along with multinomial logistic regression.Results: A higher proportion of children in rural areas were severely stunted (19.57% vs. 12.49%), severe wasted (2.36% vs. 2.23%), and severe underweight (9.37% vs. 6%) than their urban counterparts. A higher proportion of rural women (9.5% vs. 5.45%) were underweight than urban women, whereas a higher proportion of urban women were obese (24.32% vs. 19.01%) than rural women. The odds of severe stunting (OR= 0.24; C.I.=0.15-0.37), severe underweight (OR= 0.11; C.I.=0.05-0.22) were lower among children from the richest wealth quintile than their poorest counterparts. The Relative Risk Ratio (RRR) of being overweight (RRR= 3.7; C.I.=2.47-5.54) and Obese (RRR= 4.35; C.I.=2.67-7.07) than normal BMI were higher among women from richest wealth quintile than women belonged to poorest wealth quintile.Conclusion: This study has highlighted determinants associated with maternal and child nutritional status, whereby child’s nutritional status was measured by stunting, wasting, and underweight, and the mother’s nutritional status was measured by BMI. The main risk factors for child’s poor nutritional status include low household wealth, urban residence, and mother’s educational status. Similarly, the main risk factors for women’s poor nutritional status include increasing the women's age, educational status, rural residence, and household wealth. Emphasis should be placed on educating mothers as it would improve their nutritional status and improve their child’s nutritional status simultaneously.

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