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

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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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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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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Trends and determinants of stunting among under-5s: evidence from the 1995, 2001, 2006 and 2011 Uganda Demographic and Health Surveys

Public Health Nutrition ◽

10.1017/s1368980018001982 ◽

2018 ◽

Vol 21 (16) ◽

pp. 2915-2928 ◽

Cited By ~ 4

Author(s):

Ying Ying Yang ◽

Gabriella Kaddu ◽

David Ngendahimana ◽

Hope Barkoukis ◽

Darcy Freedman ◽

...

Keyword(s):

Health Surveys ◽

Maternal Education ◽

Vulnerable Groups ◽

Health Concern ◽

Demographic And Health Surveys ◽

Linear Regression Models ◽

Wealth Creation ◽

Sampling Weights ◽

The Impact ◽

Childhood Stunting

AbstractObjectiveTo describe trends of childhood stunting among under-5s in Uganda and to assess the impact of maternal education, wealth and residence on stunting.DesignSerial and pooled cross-sectional analyses of data from Uganda Demographic and Health Surveys (UDHS) of 1995, 2001, 2006 and 2011. Prevalence of stunting and mean height-for-age Z-score were computed by maternal education, wealth index, region and other sociodemographic characteristics. Multivariable logistic and linear regression models were fitted to survey-specific and pooled data to estimate independent associations between covariates and stunting or Z-score. Sampling weights were applied in all analyses.SettingUganda.SubjectsChildren aged <5 years.ResultsWeighted sample size was 14 747 children. Stunting prevalence decreased from 44·8% in 1995 to 33·2% in 2011. UDHS reported stunting as 38% in 1995, underestimating the decline because of transitioning from National Center for Health Statistics/Centers for Disease Control and Prevention standards to WHO standards. Nevertheless, one in three Ugandan children was still stunted by 2011. South Western, Mid Western, Kampala and East Central regions had highest odds of stunting. Being born in a poor or middle-income household, of a teen mother, without secondary education were associated with stunting. Other persistent stunting predictors included small birth size, male gender and age 2–3 years.ConclusionsSustained decrease in stunting suggests that child nutrition interventions have been successful; however, current prevalence does not meet Millennium Development Goals. Stunting remains a public health concern and must be addressed. Customizing established measures such as female education and wealth creation while targeting the most vulnerable groups may further reduce childhood stunting.

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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

BMC Public Health ◽

10.1186/s12889-021-12178-6 ◽

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.

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Wasting and Associated Factors among Children under 5 Years in Five South Asian Countries (2014–2018): Analysis of Demographic Health Surveys

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094578 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4578

Author(s):

Nidhi Wali ◽

Kingsley E. E. Agho ◽

Andre M. N. Renzaho

Keyword(s):

South Asia ◽

South Asian ◽

Health Surveys ◽

Associated Factors ◽

Common Factor ◽

Household Wealth ◽

Health Concern ◽

Demographic And Health Surveys ◽

Asian Countries ◽

Sampling Weights

Child wasting continues to be a major public health concern in South Asia, having a prevalence above the emergency threshold. This paper aimed to identify factors associated with wasting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent demographic and health surveys (2014–2018) of five countries in South Asia was combined. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. Wasting prevalence was higher for children aged 0–23 months (25%) as compared to 24–59 months (18%), with variations in prevalence across the South Asian countries. The most common factor associated with child wasting was maternal BMI [adjusted odds ratio (AOR) for 0–23 months = 2.02; 95% CI: (1.52, 2.68); AOR for 24–59 months = 2.54; 95% CI: (1.83, 3.54); AOR for 0–59 months = 2.18; 95% CI: (1.72, 2.77)]. Other factors included maternal height and age, household wealth index, birth interval and order, children born at home, and access to antenatal visits. Study findings suggest need for nutrition specific and sensitive interventions focused on women, as well as adolescents and children under 2 years of age.

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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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Socioeconomic inequality in intermittent preventive treatment using Sulphadoxine pyrimethamine among pregnant women in Nigeria

BMC Public Health ◽

10.1186/s12889-020-09967-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Fatima Mahmud Muhammad ◽

Reza Majdzadeh ◽

Saharnaz Nedjat ◽

Haniye Sadat Sajadi ◽

Mahboubeh Parsaeian

Keyword(s):

Pregnant Women ◽

Concentration Index ◽

Socioeconomic Inequality ◽

Intermittent Preventive Treatment ◽

Wealth Index ◽

Preventive Treatment ◽

Educational Status ◽

P Value ◽

Contributing Factors ◽

Sulphadoxine Pyrimethamine

Abstract Background Intermittent preventive treatment using Sulphadoxine pyrimethamine (IPTp-SP) for malaria prevention is recommended for all pregnant women in malaria endemic areas. However, there is limited evidence on the level of socioeconomic inequality in IPTp-SP use among pregnant women in Nigeria. Thus, this study aimed to determine the level of socioeconomic inequality in IPTp-SP use among pregnant women in Nigeria and to decompose it into its contributing factors. Methods A secondary data analysis of Nigerian demographic and health survey of 2018 was conducted. A sample of 21,621 pregnant women aged between 15 and 49 years and had live birth in the previous 2 years before the survey were included in this analysis. The study participants were recruited based on a stratified two-stage cluster sampling method. Socioeconomic inequality was decomposed into its contributing factors by concentration index. Result Totally 63.6% of pregnant women took at least one dose of IPTp-SP prophylaxis. Among IPTp-SP users, 35.1% took one dose, 38.6% took two doses and 26.2% took three doses and more. Based on both concentration index of 0.180 (p-value = < 0.001, 95% CI: 0.176 to 0.183) and Erreyger’s normalization concentration index 0.280 (p-value = < 0.001, 95% CI: 0.251 to 0.309), the IPTp-SP utilization was pro-rich. The largest contributors to the inequality in IPTp-SP uptake were wealth index (47.81%) and educational status (28.66%). Conclusion Our findings showed that IPTp-SP use was pro-rich in Nigeria. Wealth index and educational status were the factors that significantly contributed to the inequality. The disparities could be reduced through free IPTp service expansion by targeting pregnant women from low socioeconomic status.

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Determinants of newborn care utilization in Pakistan: Findings from the Demographic and Health Surveys

F1000Research ◽

10.12688/f1000research.25700.2 ◽

2020 ◽

Vol 9 ◽

pp. 1061

Author(s):

Sathirakorn Pongpanich ◽

Abdul Ghaffar ◽

Najma Ghaffar ◽

Hafiz Abdul Majid

Keyword(s):

Maternal Health ◽

Health Services ◽

Postnatal Care ◽

Health Surveys ◽

Newborn Care ◽

Wealth Index ◽

Maternal Health Services ◽

Care Utilization ◽

Demographic And Health Surveys ◽

Cross Sectional

Background: Information on determinants of postnatal care is essential for maternal health services, and this information is scarce in Pakistan. This study aimed to determine the factors of newborn postnatal care utilization from the Pakistan Demographic and Health Surveys (PDHS) conducted from 2006–2018. Methods: We analyzed data from three rounds of cross-sectional, nationally representative PDHS 2006–07, 2012–13, and 2017–18. Multivariable logistic regression models were applied to explore factors associated with utilization of newborn postnatal care within two months. Results: This study included 5724 women from the 2006–07 PDHS, 7461 from the 2012–13 survey, and 8287 from the 2017–18 survey. The proportion of women receiving newborn postnatal care within the first two months of delivery increased from 13% in 2006–07 to 43% in 2012–13 but dropped to 27% in 2017–18. Respondent’s occupation and prenatal care utilization of maternal health services were common factors that significantly influenced newborn postnatal care utilization within two months. The utilization of postnatal care was greater among women having educated husbands and where the first child was a male in PDHS 2007 round. Higher wealth index and educated respondent had higher postnatal care utilization odds in DHS 2012 and DHS 2018. However, the odds of using postnatal care decreased with the number of household members and total number of children ever born in DHS 2012 and 2018 rounds. Conclusions: There was a general increase in the proportion of women who utilized postnatal care for their newborns during 2006–2013 but a decrease in 2018. The decreased utilization in 2018 warrants further investigation. Improving women’s economic status, education, employment, and antenatal care attendance and reducing parity may increase newborn postnatal care utilization.

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Enablers of vitamin A coverage among children under five years of age from multi-country analyses of global demographic and health surveys in selected LMIC and LIC countries in Africa and Asia: a random forest analysis

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20185279 ◽

2018 ◽

Vol 6 (1) ◽

pp. 395 ◽

Cited By ~ 1

Author(s):

Manoj Kumar Raut ◽

J. C. Reddy ◽

Debabrata Bera ◽

Kirti Warvadekar

Keyword(s):

Random Forest ◽

Mass Media ◽

Vitamin A ◽

Health Surveys ◽

Vitamin A Deficiency ◽

Wealth Index ◽

Demographic And Health Surveys ◽

Vitamin A Supplementation ◽

Mother’S Education ◽

Mother's Education

Background: Vitamin A deficiency is a common form of micronutrient malnutrition. The estimated relative risks associated with vitamin A deficiency in children were 1.86 (95% CI 1.32–2.59) for measles mortality, 2.15 (95% CI 1.83–2.58) for diarrhoea mortality, 1.78 (95% CI 1.43–2.19) for malaria mortality, 1.13 (95% CI 1.01–1.32) for other infectious disease mortality. Vitamin A supplementation reduces night blindness, child morbidity and mortality.Methods: This paper tries to explore the socio-demographic causes of receipt of vitamin A in selected lower-middle-income and low income countries by analysing the data of the demographic and health surveys from 2012 and 2016 using PASW 18.0 software. Multivariate binary logistic regressions were conducted to explore the role of socio-demographic covariates in the receipt of vitamin A supplementation. In addition, random forest (RF) analyses were conducted using Python 3.6.Results: After adjusting for related socio-economic and demographic factors, mother’s work status and education and among mass media channels, exposure to television seems to play an important role in predicting receipt of vitamin A in the selected countries in Asia, while education of the mother was significantly associated with the receipt of vitamin A in the selected countries of Africa. In all the selected countries, the RF analyses revealed mother’s education followed by wealth index and mass media (TV), as the variable of most importance.Conclusions: It can be concluded that mother’s education and mass media seems to be working well in making the mothers aware about the vitamin A campaign, especially, the exposure to television. It also figures in the variable importance matrix in addition to wealth index.

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