Inequality in child undernutrition among urban population in India: a decomposition analysis

Abstract Background With increasing urbanization in India, child growth among urban poor has emerged as a paramount public health concern amidst the continuously growing slum population and deteriorating quality of life. This study analyses child undernutrition among urban poor and non-poor and decomposes the contribution of various factors influencing socio-economic inequality. This paper uses data from two recent rounds of National Family Health Survey (NFHS-3&4) conducted during 2005–06 and 2015–16. Methods The concentration index (CI) and the concentration curve (CC) measure socio-economic inequality in child growth in terms of stunting, wasting, and underweight. Wagstaff decomposition further analyses key contributors in CI by segregating significant covariates into five groups-mother’s factor, health-seeking factors, environmental factors, child factors, and socio-economic factors. Results The prevalence of child undernutrition was more pronounced among children from poor socio-economic strata. The concentration index decreased for stunting (− 0.186 to − 0.156), underweight (− 0.213 to − 0.162) and wasting (− 0.116 to − 0.045) from 2005 to 06 to 2015–16 respectively. The steepness in growth was more among urban poor than among urban non-poor in every age interval. Maternal education contributed about 19%, 29%, and 33% to the inequality in stunting, underweight and wasting, respectively during 2005–06. During 2005–06 as well as 2015–16, maternal factors (specifically mother’s education) were the highest contributory factors in explaining rich-poor inequality in stunting as well as underweight. More than 85% of the economic inequality in stunting, underweight, and wasting among urban children were explained by maternal factors, environmental factors, and health-seeking factors. Conclusion All the nutrition-specific and nutrition-sensitive interventions in urban areas should be prioritized, focusing on urban poor, who are often clustered in low-income slums. Rich-poor inequality in child growth calls out for integration and convergence of nutrition interventions with policy interventions aimed at poverty reduction. There is also a need to expand the scope of the Integrated Child Development Services (ICDS) program to provide mass education regarding nutrition and health by making provisions of home visits of workers primarily focusing on pregnant and lactating mothers.

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Mother's education is the most important factor in socio-economic inequality of child stunting in Iran

Public Health Nutrition ◽

10.1017/s1368980013002280 ◽

2013 ◽

Vol 17 (9) ◽

pp. 2010-2015 ◽

Cited By ~ 13

Author(s):

Mohammad Hassan Emamian ◽

Mansooreh Fateh ◽

Neman Gorgani ◽

Akbar Fotouhi

Keyword(s):

Concentration Index ◽

Maternal Education ◽

Economic Inequality ◽

Child Growth ◽

International Standards ◽

Cluster Sampling ◽

Cross Sectional ◽

Mother’S Education ◽

Height For Age ◽

Mother's Education

AbstractObjectiveMalnutrition is one of the most important health problems, especially in developing countries. The present study aimed to describe the socio-economic inequality in stunting and its determinants in Iran for the first time.DesignCross-sectional, population-based survey, carried out in 2009. Using randomized cluster sampling, weight and height of children were measured and anthropometric indices were calculated based on child growth standards given by the WHO. Socio-economic status of families was determined using principal component analysis on household assets and social specifications of families. The concentration index was used to calculate socio-economic inequality in stunting and its determinants were measured by decomposition of this index. Factors affecting the gap between socio-economic groups were recognized by using the Oaxaca–Blinder decomposition method.SettingShahroud District in north-eastern Iran.SubjectsChildren (n 1395) aged <6 years.ResultsThe concentration index for socio-economic inequality in stunting was −0·1913. Mother's education contributed 70 % in decomposition of this index. Mean height-for-age Z-score was −0·544 and −0·335 for low and high socio-economic groups, respectively. Mother's education was the factor contributing most to the gap between these two groups.ConclusionsThere was a significant socio-economic inequality in the studied children. If mother's education is distributed equally in all the different groups of Iranian society, one can expect to eliminate 70 % of the socio-economic inequalities. Even in high socio-economic groups, the mean height-for-age Z-score was lower than the international standards. These issues emphasize the necessity of applying new interventions especially for the improvement of maternal education.

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Perceptions of Child Body Size and Health Care Seeking for Undernourished Children in Southern Malawi

Qualitative Health Research ◽

10.1177/1049732315610522 ◽

2016 ◽

Vol 26 (14) ◽

pp. 1939-1948 ◽

Cited By ~ 4

Author(s):

Valerie L. Flax ◽

Chrissie Thakwalakwa ◽

Ulla Ashorn

Keyword(s):

Health Care ◽

Low Income ◽

Child Growth ◽

Low Income Countries ◽

Health Care Seeking ◽

Care Seeking ◽

Health Seeking ◽

Poor Child ◽

Child Undernutrition ◽

Growth Faltering

Child undernutrition affects millions of children globally, but little is known about the ability of adults to detect different types of child undernutrition in low-income countries. We used focused ethnographic methods to understand how Malawian parents and grandparents describe the characteristics they use to identify good and poor child growth, their actual or preferred patterns of health seeking for undernourished children, and the perceived importance of child undernutrition symptoms in relation to other childhood illnesses. Malawians value adiposity rather than stature in assessing child growth. Symptoms of malnutrition, including wasting and edema, were considered the least severe childhood illness symptoms. Parents delayed health care seeking when a child was ill. When they sought care, it was for symptoms such as diarrhea or fever, and they did not recognize malnutrition as the underlying cause. These findings can be used to tailor strategies for preventing and treating growth faltering in Malawian children.

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Inequalities in stunting among under-five children in Tanzania: Decomposing the Concentration Indexes using Demographic Health Surveys from 2004/5 to 2015/6

10.21203/rs.3.rs-24183/v2 ◽

2020 ◽

Author(s):

Edwin Musheiguza ◽

Michael Johnson Mahande ◽

Elias Malamala ◽

Sia E Msuya ◽

Festo Charles ◽

...

Keyword(s):

Social Services ◽

Health Surveys ◽

Concentration Index ◽

Maternal Education ◽

Child Survival ◽

Wealth Index ◽

Health Concern ◽

Demographic And Health Surveys ◽

Contributing Factors ◽

Absolute Level

Abstract Background Child stunting is a global health concern. It has consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania although the prevalence is still high (34%), varying across socioeconomic determinants with a larger burden among the disadvantaged group. The reduction of inequalities in stunting is very crucial as we aim to reduce stunting to 28% by 2021. Objectives This study aimed to determine the trend, contributing factors and changes of inequalities in stunting among children aged 3 – 59 months from 2004 to 2016 Methodology Data were drawn from the Tanzania Demographic and Health Surveys. The dependent variable was stunting. The concentration index was used to quantify the magnitude of inequalities in stunting for each year. To get the contribution of each determinant on the inequality in stunting, the concentration index was decomposed by using the Wagstaff and Watanabe decomposition methods of the concentration index. Results Inequalities in stunting insignificantly declined from -0.019 (p<0.001) in 2004 to -0.018 (p<0.001) in 2010 and then to -0.0096 (p<0.001). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) increased the levels of inequalities in stunting in all survey years. Rural-urban differences reduced inequalities in stunting although its contribution changed over time. Conclusion Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution to the levels of inequalities. To significantly reduce the larder burden of stunting among the disadvantaged groups, initiatives should be embarked on the distribution of social services like water, health infrastructures, and education.

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Inequalities in stunting among under-five children in Tanzania: decomposing the concentration indexes using demographic health surveys from 2004/5 to 2015/6

International Journal for Equity in Health ◽

10.1186/s12939-021-01389-3 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Edwin Musheiguza ◽

Michael J. Mahande ◽

Elias Malamala ◽

Sia E. Msuya ◽

Festo Charles ◽

...

Keyword(s):

Social Services ◽

Health Surveys ◽

Concentration Index ◽

Maternal Education ◽

Wealth Index ◽

Reproductive Age ◽

Health Concern ◽

Demographic And Health Surveys ◽

Contributing Factors ◽

Absolute Level

Abstract Background Child stunting is a global health concern. Stunting leads to several consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania from from 50% in 1991/92 to 34% in 2016 although the prevalence is still high (34%)Stunting varyies across socioeconomic determinants with a larger burden among the socioeconomic disadvantaged group. The reduction of inequalities in stunting is very crucial as we aim to reduce stunting to 28% by 2021 and hence attain zero malnutrition by 2030 under Sustainable Development Goal 2.2.This study aimed at determining the trend, contributing factors and changes of inequalities in stunting among children aged 3–59 months from 2004 to 2016. Methods Data were drawn from the Tanzania Demographic and Health Surveys. The concentration index (CIX) was used to quantify the magnitude of inequalities in stunting. The pooled Poisson regression model was used to determine the factors for stunting, decision criterion for significant determinants was at 5% level of significance. The CIX was decomposed using the Wagstaff and Watanabe decomposition methods., the percentage contribution of each factor to the toal concentration index was used to rank the factors for socioeconomic inequalities in stutning. Results Inequalities in stunting were significantly concentrated among the poor; evidenced by CIX = − 0.019 (p < 0.001) in 2004, − 0.018 (p < 0.001) in 2010 and − 0.0096 (p < 0.001) in 2015. There was insignificant decline in inequalities in stunting; the difference in CIX from 2004 to 2010 was 0.0015 (p = 0.7658), from 2010 to 2015/6 was − 0.0081 (p = 0.1145). The overall change in CIX from 2004 to 2015/6 was 0.00965 (p = 0.0538). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) had positive impacts on the levels of inequalities in stunting for all surveyed years. Rural-urban differences reduced inequalities in stunting although the contribution changed over time. Conclusion Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution to the levels of inequalities in stunting. Reducing stunting among the disadvantaged groups requires initiatives which should be embarked on the distribution of social services including maternal and reproductive education among women of reproductive age, water and health infrastructures in remote areas.

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Maternal factors associated with moderate and severe stunting in Ethiopian children: analysis of some environmental factors based on 2016 demographic health survey

Nutrition Journal ◽

10.1186/s12937-021-00677-6 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Nebyu Daniel Amaha ◽

Berhanu Teshome Woldeamanuel

Keyword(s):

Environmental Factors ◽

Antenatal Care ◽

Health Survey ◽

Maternal Education ◽

Predictor Variable ◽

Demographic Health Survey ◽

Maternal Height ◽

Maternal Factors ◽

Severe Stunting ◽

Factors Associated

Abstract Background Stunting or chronic undernutrition is a significant public health problem in Ethiopia. In 2019, 37% of Ethiopian children under-5 were stunted. Stunting results from a complex interaction of individual, household and social (environmental) factors. Improving the mother’s overall care is the most important determinant in reducing the stunting levels in developing countries. We aimed to determine the most important maternal factors associated with stunting and quantify their effects. Methods This study used data from the nationally representative 2016 Ethiopian Demographic Health Survey (EDHS). Common maternal factors were first selected and analyzed using Pearson’s chi-square of association followed by multiple logistic regression. To quantify the effect of a unit change of a predictor variable a model for the continuous maternal factors was developed. All analyses were carried out using IBM SPSS© Version 23. Results Higher maternal educational level, better maternal autonomy, average or above maternal height and weight, having at least 4 antenatal care (ANC) clinic visits, and delivering in a health facility were significantly associated with lower severe stunting levels. Unemployed mothers were 23% less likely (p = 0.003) to have a stunted child compared with employed mothers. Mothers delivering at home had 32% higher odds of stunting (p = 0.002). We found that short mothers (< 150 cm) were 2.5 more likely to have stunted children when compared with mothers above 160 cm. Every visit to the ANC clinic reduces stunting odds by 6.8% (p < 0.0001). The odds of stunting were reduced by 7% (p = 0.028) for every grade a girl spent in school. A unit increase in Body Mass Index (BMI) reduced the odds of stunting by 4% (p = 0.014) and every centimeter increase in maternal height reduced the odds of stunting by 0.5% (p = 0.01). Conclusion Maternal education, number of antenatal care visits, and place of delivery appear to be the most important predictors of child stunting in Ethiopia.. Therefore, educating and empowering women, improving access to family planning and ANC services, and addressing maternal malnutrition are important factors that should be included in policies aiming to reduce childhood stunting in Ethiopia.

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Inequalities in stunting among under-five children in Tanzania: Decomposing the Concentration Indexes using Demographic Health Surveys from 2004/5 to 2015/6

10.21203/rs.3.rs-24183/v3 ◽

2020 ◽

Author(s):

Edwin Musheiguza ◽

Michael Johnson Mahande ◽

Elias Malamala ◽

Sia E Msuya ◽

Festo Charles ◽

...

Keyword(s):

Social Services ◽

Health Surveys ◽

Concentration Index ◽

Maternal Education ◽

Wealth Index ◽

Reproductive Age ◽

Health Concern ◽

Demographic And Health Surveys ◽

Contributing Factors ◽

Absolute Level

Abstract Background: Child stunting is a global health concern. Stunting leads to several consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania although the prevalence is still high (34%), varying across socioeconomic determinants with a larger burden among the disadvantaged group. The reduction of inequalities in stunting is very crucial as we aim to reduce stunting to 28% by 2021 and hence attain zero malnutrition by 2030 under Sustainable Development Goal 2.2.. Objectives: This study aimed to determine the trend, contributing factors and changes of inequalities in stunting among children aged 3 – 59 months from 2004 to 2016 Methodology: Data were drawn from the Tanzania Demographic and Health Surveys. The dependent variable was stunting. The concentration index was used to quantify the magnitude of inequalities in stunting for each year. To get the contribution of each determinant on the inequality in stunting, the concentration index was decomposed by using the Wagstaff and Watanabe decomposition methods of the concentration index. Results: Inequalities in stunting insignificantly declined from -0.019 (p<0.001) in 2004 to -0.018 (p<0.001) in 2010 and then to -0.0096 (p<0.001). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) increased the levels of inequalities in stunting in all survey years. Rural-urban differences reduced inequalities in stunting although the contribution changed over time. Conclusion: Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution to the levels of inequalities in stunting. To significantly reduce the larger burden of stunting among the disadvantaged groups, initiatives should be embarked on the distribution of social services including maternal and reproductive education among women of reproductive age, water and health infrastructures in local areas.

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Inequalities in stunting among under-five children in Tanzania: Decomposing the Concentration Indexes using Demographic Health Surveys from 2004/5 to 2015/6

10.21203/rs.3.rs-24183/v1 ◽

2020 ◽

Author(s):

Edwin Musheiguza ◽

Michael Johnson Mahande ◽

Sia E Msuya ◽

Elias Malamala ◽

Rune Philemon ◽

...

Keyword(s):

Social Services ◽

Health Surveys ◽

Concentration Index ◽

Maternal Education ◽

Child Survival ◽

Wealth Index ◽

Health Concern ◽

Demographic And Health Surveys ◽

Contributing Factors ◽

Absolute Level

Abstract Background: Child stunting is a global health concern. It has consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania although the prevalence is still high (34%), varying across socioeconomic determinants with a larger burden among the disadvantaged group. Reduction of inequalities in stunting are very crucial as we aim to reduce stunting to 28% by 2021. Objectives: This study aimed to determine the trend, contributing factors and changes of inequalities in stunting among children aged 3 – 59 months from 2004 to 2016 Methodology: Data were drawn from the Tanzania Demographic and Health Surveys. The dependent variable was stunting. The concentration index was used to quantify the magnitude of inequalities in stunting for each year. In order to get the contribution of each determinant on the inequality in stunting, the concentration index was decomposed by using the Wagstaff and Watanabe decomposition methods of the concentration index. Results: Inequalities in stunting insignificantly declined from -0.019 (p<0.001) in 2004 to -0.018 (p<0.001) in 2010 and then to -0.0096 (p<0.001). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) increased the levels of inequalities in stunting in all survey years. Rural-urban differences reduced inequalities in stunting although its contribution changed over time. Conclusion: Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution on the levels of inequalities. To significantly reduce the larder burden of stunting among the disadvantaged groups, initiatives should be embarked on distribution of social services like water, health infrastructures and education.

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Stunting as a Synonym of Social Disadvantage and Poor Parental Education

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18031350 ◽

2021 ◽

Vol 18 (3) ◽

pp. 1350

Author(s):

Christiane Scheffler ◽

Michael Hermanussen ◽

Sugi Deny Pranoto Soegianto ◽

Alexandro Valent Homalessy ◽

Samuel Yan Touw ◽

...

Keyword(s):

Private School ◽

Parental Education ◽

Maternal Education ◽

Clinical Signs ◽

Social Background ◽

Social Disadvantage ◽

Child Growth ◽

Anthropometric Data ◽

Disadvantaged Children ◽

Self Confidence

Socially, economically, politically and emotionally (SEPE) disadvantaged children are shorter than children from affluent background. In view of previous work on the lack of association between nutrition and child growth, we performed a study in urban schoolchildren. We measured 723 children (5.83 to 13.83 years); Kupang, Indonesia; three schools with different social background. We investigated anthropometric data, clinical signs of malnutrition, physical fitness, parental education, and household equipment. Subjective self-confidence was assessed by the MacArthur test. The prevalence of stunting was between 8.5% and 46.8%. Clinical signs of under- or malnutrition were absent even in the most underprivileged children. There was no delay in tooth eruption. Underprivileged children are physically fitter than the wealthy. The correlation between height and state of nutrition (BMI_SDS, skinfold_SDS, MUAC_SDS) ranged between r = 0.69 (p < 0.01) and r = 0.43 (p < 0.01) in private school children, and between r = 0.07 (ns) and r = 0.32 (p < 0.01) in the underprivileged children. Maternal education interacted with height in affluent (r = 0.20, p < 0.01) and in underprivileged children (r = 0.20, p < 0.01). The shortness of SEPE disadvantaged children was not associated with anthropometric and clinical signs of malnutrition, nor with delay in physical development. Stunting is a complex phenomenon and may be considered a synonym of social disadvantage and poor parental education.

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The impact of environmental variables on the spread of COVID-19 in the Republic of Korea

Scientific Reports ◽

10.1038/s41598-021-85493-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yong Kwan Lim ◽

Oh Joo Kweon ◽

Hye Ryoun Kim ◽

Tae-Hyoung Kim ◽

Mi-Kyung Lee

Keyword(s):

Environmental Factors ◽

Virus Disease ◽

Environmental Parameters ◽

Environmental Data ◽

Republic Of Korea ◽

Metropolitan Region ◽

Health Concern ◽

Ozone Level ◽

The Republic ◽

The Impact

AbstractCorona virus disease 2019 (COVID-19) has been declared a global pandemic and is a major public health concern worldwide. In this study, we aimed to determine the role of environmental factors, such as climate and air pollutants, in the transmission of COVID-19 in the Republic of Korea. We collected epidemiological and environmental data from two regions of the Republic of Korea, namely Seoul metropolitan region (SMR) and Daegu-Gyeongbuk region (DGR) from February 2020 to July 2020. The data was then analyzed to identify correlations between each environmental factor with confirmed daily COVID-19 cases. Among the various environmental parameters, the duration of sunshine and ozone level were found to positively correlate with COVID-19 cases in both regions. However, the association of temperature variables with COVID-19 transmission revealed contradictory results when comparing the data from SMR and DGR. Moreover, statistical bias may have arisen due to an extensive epidemiological investigation and altered socio-behaviors that occurred in response to a COVID-19 outbreak. Nevertheless, our results suggest that various environmental factors may play a role in COVID-19 transmission.

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Factors in Toddlers With Late Language Emergence in a Middle-Income South African Sample

Communication Disorders Quarterly ◽

10.1177/15257401211054754 ◽

2021 ◽

pp. 152574012110547

Author(s):

Elmien Kraamwinkel ◽

Alta Kritzinger

Keyword(s):

South Africa ◽

Environmental Factors ◽

South African ◽

Maternal Education ◽

Receptive Language ◽

Control Group ◽

Play Skills ◽

Middle Income ◽

Language Emergence ◽

Genetic And Environmental Factors

Late language emergence (LLE) may result from genetic and environmental factors. Little is known about environmental factors in LLE in South Africa. The study describes the nature of differences in language functioning between toddlers with LLE and without LLE, and which factors were associated with LLE in a middle-income area in South Africa. Toddlers, aged 24 to 36 months with LLE ( n = 20) were matched with a control group (CG, n = 21) for household income, age, gender, maternal education, and parental employment. The research group (RG) showed moderate delays in expressive and receptive language, and play skills, while the controls exhibited no delay. Significant differences in early feeding history and multilingual exposure were found between the groups. As far as known, it is the first study utilizing a South African middle-income sample indicating that multilingual exposure may play a role in LLE. The study focuses the attention on environmental factors which are potentially modifiable in LLE.

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