An Intersectional Analysis of the Composite Index of Anthropometric Failures in India

Abstract Background: Nutritional inequality in India has been estimated typically using stunting, wasting and underweight separately which hide the overall magnitude and severity of undernutrition. We used the Composite Index of Anthropometric Failure (CIAF) that combines all three forms of anthropometric failures to assess the severity of undernutrition and identify the most vulnerable social groups and geographical hotspots.Method: CIAF was constructed using child anthropometric data from the fourth round of the National Family Health Survey (NFHS-4, 2015-16). We considered 24 intersecting sub-groups based on intersections across four main axes of inequality i.e., caste [Scheduled Tribe (ST), Scheduled Caste (SC) and Other], economic position (poor and non-poor), place of residence (rural and urban) and gender (male and female) (eg. ST-Poor-Rural-Female). Cross-tabulation and logistic regression were done to assess the odds of CIAF among intersecting groups and to identify the most vulnerable sub-groups. Concentration curve was plotted to visualise economic position inequality in child undernutrition across caste categories. Choropleth maps were constructed and descriptive analysis of the district-level prevalence of CIAF was performed to identify the geographic clustering of undernutrition.Results: Overall 55.32% of children were undernourished by CIAF and 6.62% of children have simultaneous three anthropometric failure. In sub-group analysis, children from ST and SC caste have a higher risk of undernutrition irrespective of other axis of inequality. Compared with CIAF, economic position inequality was amplified for simultaneous-three-failures among all caste categories. Economic position inequalities within caste are more for other caste and SC categories than with ST. Economic position, caste and gender based inequality in all three failures is more consistent in rural areas than with urban areas. Based on the analysis of the high prevalence in the co-occurrence of two or three failures, 111 districts from 12 of 29 states in India were identified across four geographic clusters.Conclusions: The study shows social and eco-geographical clustering of multi-dimensional anthropometric failures and indicates the need for focused nutritional interventions among SC and ST community in general and ST children from the poor households. Furthermore, governance interventions that target entire regions across districts and states combined with decentralised planning are needed.

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An intersectional analysis of the composite index of anthropometric failures in India

International Journal for Equity in Health ◽

10.1186/s12939-021-01499-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Sabu Ulahannan Kochupurackal ◽

Yogish Channa Basappa ◽

Sangeetha Joice Vazhamplackal ◽

Prashanth N Srinivas

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Descriptive Analysis ◽

Group Analysis ◽

Composite Index ◽

Family Health ◽

Nutritional Interventions ◽

Child Undernutrition ◽

Economic Position ◽

And Gender

Abstract Background Nutritional inequality in India has been estimated typically using stunting, wasting and underweight separately which hide the overall magnitude and severity of undernutrition. We used the Composite Index of Anthropometric Failure (CIAF) that combines all three forms of anthropometric failures to assess the severity of undernutrition and identify the most vulnerable social groups and geographical hotspots. Method CIAF was constructed using child anthropometric data from the fourth round of the National Family Health Survey (NFHS-4, 2015–16). We considered 24 intersecting sub-groups based on intersections across four main axes of inequality i.e., caste [Scheduled Tribe (ST), Scheduled Caste (SC) and Other], economic position (poor and non-poor), place of residence (rural and urban) and gender (male and female) (eg. ST-Poor-Rural-Female). Cross-tabulation and logistic regression were done to assess the odds of CIAF among intersecting groups and to identify the most vulnerable sub-groups. Concentration curve was plotted to visualise economic position inequality in child undernutrition across caste categories. Choropleth maps were constructed and descriptive analysis of the district-level prevalence of CIAF was performed to identify the geographic clustering of undernutrition. Results Overall 55.32% of children were undernourished by CIAF and 6.62% of children have simultaneous three anthropometric failure. In sub-group analysis, children from ST and SC caste have a higher risk of undernutrition irrespective of other axis of inequality. Compared with CIAF, economic position inequality was amplified for simultaneous-three-failures among all caste categories. Economic position inequalities within caste are more for other caste and SC categories than with ST. Economic position, caste and gender based inequality in all three failures is more consistent in rural areas than with urban areas. Based on the analysis of the high prevalence in the co-occurrence of two or three failures, 111 districts from 12 of 29 states in India were identified across four geographic clusters. Conclusions The study shows social and eco-geographical clustering of multi-dimensional anthropometric failures and indicates the need for focused nutritional interventions among SC and ST community in general and ST children from the poor households. Furthermore, governance interventions that target entire regions across districts and states combined with decentralised planning are needed.

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An Intersectional Analysis of the Composite Index of Anthropometric Failures in India

10.21203/rs.3.rs-36685/v1 ◽

2020 ◽

Author(s):

Sabu K Ulahannan ◽

Yogish Channa Basappa ◽

Sangeetha V Joice ◽

Prashanth N Srini

Keyword(s):

Descriptive Analysis ◽

Economic Inequality ◽

Group Analysis ◽

Composite Index ◽

Family Health ◽

Nutritional Interventions ◽

Child Undernutrition ◽

Rural And Urban ◽

Poor Households ◽

And Gender

Abstract Background: Nutritional inequality in India has been estimated typically using stunting, wasting and underweight separately which hide the overall magnitude and severity of undernutrition. We used the Composite Index of Anthropometric Failure (CIAF) that combines all three forms of anthropometric failures to assess the severity of undernutrition and identify the most vulnerable social groups and geographical hotspots.Method: CIAF was constructed using child anthropometric data from the fourth round of the National Family Health Survey (NFHS-4, 2015-16). We considered 24 intersecting sub-groups based on intersections across four main axes of inequality i.e., caste [Scheduled Tribe (ST), Scheduled Caste (SC) and Other], economic position (poor and non-poor), place of residence (rural and urban) and gender (male and female) (eg. ST-Poor-Rural-Female). Cross-tabulation and logistic regression were done to assess the odds of CIAF among intersecting groups and to identify the most vulnerable sub-groups. Concentration curve was plotted to visualise economic inequality in child undernutrition across caste categories. Choropleth maps were constructed and descriptive analysis of the district-level prevalence of CIAF was performed to identify the geographic clustering of undernutrition.Results: Overall 55.1% of children were undernourished by CIAF and 6.7% of children have simultaneous three anthropometric failure. In sub-group analysis, children from ST and SC caste have a higher risk of undernutrition irrespective of other axis of inequality. The typical urban advantage is reversed among the children from poor SC and other-caste in most sub-groups. Compared with CIAF, socio-economic inequality was amplified for simultaneous-three-failures among all caste categories. Socio-economic inequalities within caste are more for other caste and SC categories than with ST. Based on the analysis of the high prevalence in the co-occurrence of two or three failures, 111 districts from 12 of 29 states in India were identified across four geographic clusters.Conclusions: The study shows social and eco-geographical clustering of multi-dimensional anthropometric failures and indicates the need for focused nutritional interventions among SC and ST community in general and ST children from the poor households. Furthermore, governance interventions that target entire regions across districts and states combined with decentralised planning are needed.

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Urban-rural differences in the associated factors of severe under-5 child undernutrition based on the composite index of severe anthropometric failure (CISAF) in Bangladesh

BMC Public Health ◽

10.1186/s12889-021-12038-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Asibul Islam Anik ◽

Mohammad Rocky Khan Chowdhury ◽

Hafiz T. A. Khan ◽

Md Nazrul Islam Mondal ◽

Nirmala K. P. Perera ◽

...

Keyword(s):

Birth Weight ◽

Socioeconomic Factors ◽

Rural Areas ◽

Urban Areas ◽

Composite Index ◽

Bivariate Analysis ◽

Urban Context ◽

Severe Stunting ◽

Child Undernutrition ◽

Composite Indices

Abstract Introduction Severe undernutrition among under-5 children is usually assessed using single or conventional indicators (i.e., severe stunting, severe wasting, and/or severe underweight). But these conventional indicators partly overlap, thus not providing a comprehensive estimate of the proportion of malnourished children in the population. Incorporating all these conventional nutritional indicators, the Composite Index of Severe Anthropometric Failure (CSIAF) provides six different undernutrition measurements and estimates the overall burden of severe undernutrition with a more comprehensive view. This study applied the CISAF indicators to investigate the prevalence of severe under-5 child undernutrition in Bangladesh and its associated socioeconomic factors in the rural-urban context. Methods This study extracted the children dataset from the 2017–18 Bangladesh Demographic Health Survey (BDHS), and the data of 7661 children aged under-5 were used for further analyses. CISAF was used to define severe undernutrition by aggregating conventional nutritional indicators. Bivariate analysis was applied to examine the proportional differences of variables between non-severe undernutrition and severe undernutrition group. The potential associated socioeconomic factors for severe undernutrition were identified using the adjusted model of logistic regression analysis. Results The overall prevalence of severe undernutrition measured by CISAF among the children under-5 was 11.0% in Bangladesh (rural 11.5% vs urban 9.6%). The significant associated socioeconomic factors of severe undernutrition in rural areas were children born with small birth weight (AOR: 2.84), children from poorest households (AOR: 2.44), and children aged < 36 months, and children of uneducated mothers (AOR: 2.15). Similarly, in urban areas, factors like- children with small birth weight (AOR: 3.99), children of uneducated parents (AOR: 2.34), poorest households (APR: 2.40), underweight mothers (AOR: 1.58), mothers without postnatal care (AOR: 2.13), and children’s birth order ≥4 (AOR: 1.75), showed positive and significant association with severe under-5 undernutrition. Conclusion Severe undernutrition among the under-5 children dominates in Bangladesh, especially in rural areas and the poorest urban families. More research should be conducted using such composite indices (like- CISAF) to depict the comprehensive scenario of severe undernutrition among the under-5 children and to address multi-sectoral intervening programs for eradicating severe child undernutrition.

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Child Undernutrition in the States of India: An Analysis Based on Change in Composite Index of Anthropometric Failure from 2006 to 2016

Review of Development and Change ◽

10.1177/09722661211010376 ◽

2021 ◽

pp. 097226612110103

Author(s):

J. R. Jith ◽

Rajshree Bedamatta

Keyword(s):

Child Nutrition ◽

Composite Index ◽

Family Health ◽

Wealth Index ◽

Household Wealth ◽

Population Projections ◽

Indian Children ◽

Indian States ◽

Child Undernutrition ◽

Low Weight

Stunting, wasting and underweight—the three traditional indicators of undernourishment among children—provide mutually non-exclusive categories of anthropometric failures: low height for age, low weight for height and low weight for age. Although these indicators are essential for designing specific clinical and child nutrition policy interventions, they fall short of estimating the prevalence of overall anthropometric failure, which provides a sense of the scale of the nutrition problem. This article estimates the alternative, more comprehensive measure Composite Index of Anthropometric Failure (CIAF) for Indian states, based on data from the National Family Health surveys of 2006 and 2016, for children under five years (Ch–U5). The CIAF-based undernutrition estimates show significantly high anthropometric failure levels among Indian children compared to only stunting, wasting and underweight. Based on population projections for Ch–U5, we also show that a sizeable number of states may have seen an increase in child undernutrition between 2006 and 2016. We also correlated CIAF with household wealth index scores and found a positive relationship with children facing no anthropometric failure.

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Examining the Dietary Diversity of Children in Niger

Nutrients ◽

10.3390/nu13092961 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2961

Author(s):

Nafissatou Cisse Egbuonye ◽

Ariun Ishdorj ◽

E.L.J. McKyer ◽

Rahma Mkuu

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Dietary Diversity ◽

Descriptive Analysis ◽

Age Groups ◽

Wealth Index ◽

Cross Sectional Study ◽

Health Concern ◽

Cross Sectional ◽

Child Factors

Malnutrition is a major public health concern in Niger. The stunting rate in children in Niger is over 50%, one of the highest in the world. The purpose of this cross-sectional study was to examine children’s dietary diversity (CDD) and the maternal factors that impact CDD. A total of 1265 mother–child pairs were analyzed. Descriptive analysis was conducted to present maternal and child characteristics. To compare the mean scores of CDD in relation to the region, an independent sample t-test was conducted. A one-way ANOVA test was conducted to evaluate the CDD score by different age groups. A linear regression model was estimated to identify household, maternal and child factors that affect the CDD score. Our results indicate that most of the participants of our survey resided in rural areas and the majority (80.7%) of the mothers had no education. Factors such as region, children’s age, woman’s empowerment, vitamin A intake and wealth index were significant predictors of CDD (p < 0.05). The children residing in rural areas were more likely to have lower CDD scores (p < 0.05) than the children in urban areas, therefore becoming more susceptible to malnutrition.

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How does household characteristics influence their waste management?

E3S Web of Conferences ◽

10.1051/e3sconf/20187406005 ◽

2018 ◽

Vol 74 ◽

pp. 06005 ◽

Cited By ~ 1

Author(s):

Dwini Handayani ◽

Beta Yulianita Gitaharie ◽

Restananda Nabilla Yussac ◽

Rian Sabrina Rahmani

Keyword(s):

Waste Management ◽

Rural Areas ◽

Urban Areas ◽

Positive Impact ◽

Demographic Variables ◽

Probit Regression ◽

Age And Gender ◽

Household Characteristics ◽

Management Behaviour ◽

And Gender

The amount of waste generated is ever-increasing due to population growth, however adequate waste management has never been a focus in everyday life. The action of the household as the beginning stage of waste management is also crucial. How households manage their waste is also influenced by their socio-economic characteristics. This study aims to investigate household characteristics that influence their waste management. This study employed the Indonesian Family Life Survey 2014 data using probit regression method. The result shows that location significantly affect waste management behaviour which households in urban areas hold higher probability to manage their waste compared to those in rural areas. The level of education and knowledge also have positive impact on household’s waste management. The level of income also positively affect waste management behaviour of households. Demographic variables such as age and gender are significant and indicate that women and older people have better waste management compared to men and younger people. These results support the hypothesis that household’s waste management behaviour is significantly influenced by their characteristics.

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Relationship of rural work with gender and education level / Relação do trabalho rural com gênero e nível de escolaridade

Brazilian Journal of Business ◽

10.34140/bjbv3n3-025 ◽

2021 ◽

Vol 3 (3) ◽

pp. 2364-2378

Author(s):

Eveline Barbosa S. Carvalho ◽

Felipe Rocha Campos ◽

José Wellington Saraiva Sousa Junior ◽

Luis Henrique B. De Araújo

Keyword(s):

Elementary Education ◽

Rural Areas ◽

Urban Areas ◽

Demand Curve ◽

Descriptive Analysis ◽

Sao Paulo ◽

Education Level ◽

São Paulo ◽

Gender And Education ◽

Rural Work

The research analyzes the relationship between rural work gender and education level based on microdata from the Brazilian Federal Government's General Register of Employed and Unemployed. Using data from employment in the states of Ceará and São Paulo as a case study, the descriptive analysis from the demand curve confirms that male workers have higher average salary level than female workers, in rural areas and also in urban areas, regardless of schooling. The research used the calculation of the price elasticity of demand coefficient to capture the behavior of employment in response to wage variations and showed that for illiterate workers job is more stable in Ceará regardless of gender. On the other hand, for São Paulo illiterate workers have less job stability. For workers with incomplete elementary education, the demand for men and women is inelastic for both Ceará and São Paulo. The cross-elasticity coefficients showed that the higher the level of education, the lower the possibility of discrimination as both gender are considered substitute factors of production.

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Sociodemographic inequalities in cardiovascular risk factors among adolescents from indigenous areas of Chiapas, Mexico

10.1101/2020.11.12.20230110 ◽

2020 ◽

Author(s):

Elena Flores-Guillen ◽

Itandehui Castro-Quezada ◽

Hector Ochoa ◽

Rosario Garcia-Miranda ◽

Miguel Cruz ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Rural Areas ◽

Urban Areas ◽

Descriptive Analysis ◽

Geographic Area ◽

Secondary Outcome ◽

Cross Sectional

Objectives: The objective of this study was to determine the prevalence of cardiovascular risk factors among different sociodemographic and geographic areas of adolescents from indigenous areas of Chiapas, Mexico. Design: A cross-sectional study. Setting: Communities in the Totzil - Tseltal and Selva region of Chiapas, Mexico, were studied. Urban and rural areas of high marginalization according to the Human Development Index. Participants: 253 adolescents were studied, of which 48.2% were girls and 51.8% were boys. Primary and secondary outcome measures: a descriptive analysis of the quantitative variables was performed through central tendency and dispersion measures. Prevalence of cardiovascular risk factors and 95% confidence intervals (95% CI), stratified by sex, geographic area (rural/urban), schooling and ethnicity of mothers were estimated. Results: the predominant risk factor in the study population was low HDL-c (51%). Higher prevalences of abdominal obesity and high triglycerides in girls were found and abnormal diastolic blood pressure in boys was identified. In urban areas were found greater prevalences of overweight/obesity and of insulin resistance while abnormal blood pressure levels were more prevalent in rural areas. Differences were found in the educational levels and ethnicity of the adolescents' mothers. Prevalence of metabolic syndrome was 10% according to NCEP-ATPIII. Conclusions: In this study, sociodemographic and geographical disparities were found in cardiovascular risk factors. Prevalence of risk factors was high, affecting mostly girls and urban population. Thus, there is a great need to promote healthy lifestyles and health, social and economic interventions to prevent chronic diseases in adulthood.

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Does Rural to Urban Migration Improves Indian Women's Health Status and Knowledge of AIDS

Asian Journal of Health Sciences ◽

10.15419/ajhs.v1i1.429 ◽

2013 ◽

Vol 1 (1) ◽

Author(s):

Sutapa Agrawal ◽

Praween Agrawal

Keyword(s):

Health Status ◽

Urban Area ◽

Rural Area ◽

Rural Areas ◽

Urban Areas ◽

Family Health ◽

Multivariate Techniques ◽

Urban Migration ◽

Cross Sectional ◽

Condition Of Women

The present paper explores the effect of patterns and duration of migration upon health and morbidity condition of women and knowledge and awareness of AIDS. Cross-sectional data from India's second National Family Health Survey (NFHS-2, 1998-99) is used for this study. Analysis is based on 73,558 women age 15-49 years who belonged to different streams of migration. Bivariate as well as multivariate techniques have been used for data analysis.Women migrating towards rural area are more underweight than migrating towards urban area whereas reverse for overweight. However, women migrating from rural to rural area were more anaemic than women migrating from rural to urban area. Significant differences were also found for morbidity conditions like Asthma, Tuberculosis, Jaundice, Malaria and some reproductive health problems according to streams of migration. Knowledge of AIDS also significantly differs according to the stream and duration of migration. We found stream of migration and duration of migration plays a key role in health, morbidity condition and knowledge of AIDS among women. Therefore, quality of health care in urban areas should be more widely disseminated in rural areas to improve the health status of women. Also the information-education-communication (IEC) programmes related to AIDS should be made more strengthened and effective through television, radio and also through the school teachers to reach the rural masses in India.

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Assessing inequalities and regional disparities in child nutrition outcomes in India using MANUSH – a more sensitive yardstick

10.21203/rs.2.23291/v2 ◽

2020 ◽

Author(s):

Ayushi Jain ◽

Satish Balram Agnihotri

Keyword(s):

Child Nutrition ◽

Geometric Mean ◽

Composite Index ◽

Family Health ◽

Regional Disparities ◽

Nutrition Survey ◽

Balanced Development ◽

Child Undernutrition ◽

Linear Aggregation ◽

Context Specific

Abstract Background: India is strongly committed to reducing the burden of child malnutrition, which has remained a persistent concern issue. Findings from recent surveys indicate co-existence of child undernutrition, micronutrient deficiency and overweight/obesity, i.e. the triple burden of malnutrition in children below five years. While considerable efforts are being made to address this challenging issue, and several composite indices are being explored to inform policy actions, the methodology used for creating such indices, i.e., linear averaging, has its limitations. Briefly put, it could mask the uneven improvement across different indicators by discounting the ‘lagging’ indicators, and hence not incentivising a balanced improvement. signifying negative implications on policy discourse for improved nutrition. To address this gap, we attempt to develop a composite index for estimating the triple burden of malnutrition in India, using a more sensitive measure, MANUSH. Methodology: Data from publicly available nation-wide surveys - National Family Health Survey (NFHS) and Comprehensive National Nutrition Survey (CNNS), was used for this study. First, we addressed the robustness of MANUSH method of composite indexing over conventional aggregation methods. Second, using MANUSH scores, we assessed the triple burden of malnutrition at the subnational level over different periods NHFS- 3(2005-06), NFHS-4 (2015-16) and CNNS (2106-18). Using mapping and spatial analysis tools, we assessed neighbourhood dependency and formation of clusters, within and across states. Result: MANUSH method scores over other aggregation measures that use linear aggregation or geometric mean. It does so by fulfilling additional conditions of Shortfall and Hiatus Sensitivity, implicitly discounting cases where the improvement in worst-off dimension is lesser than the improvement in best-off dimension, or where, even with an overall improvement in the composite index, the gap between different dimensions does not reduce. MANUSH scores helped in revealing the gaps in the improvement of nutrition outcomes among different indicators and, the rising inequalities within and across states and districts in India. Significant clusters (p<0.05) of high burden and low burden districts were found, revealing geographical heterogeneities and sharp regional disparities. A MANUSH based index is useful in context-specific planning and prioritising different interventions, an approach advocated by the newly launched National Nutrition Mission. Conclusion: MANUSH based index emphasises balanced development in nutritional outcomes and is hence relevant for diverse and unevenly developing economy like India.

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