Trends and predictors of inequality in childhood stunting in Nepal from 1996 to 2016
Trends and predictors of inequality in childhood stunting in Nepal from 1996 to 2016
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DOI：
10.1186/s12939-019-0944-z
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发表时间：
2019-03-05
影响因子：
4.8
通讯作者：
Karn, Sumit
中科院分区：
文献类型：
--
作者：
Angdembe, Mirak Raj;Dulal, Bishnu Prasad;Karn, Sumit
背景尽管呈下降趋势，但尼泊尔三分之一的儿童仍然发育迟缓，而且在不同的社会经济和地理亚群中分布不平等。因此，至关重要的是，要评估发育迟缓方面的不平等现象，以便设计针对发育迟缓负担较高的弱势群体的注重公平的干预措施。这项研究措施的趋势和预测的社会经济不平等的儿童发育迟缓在Nepal.MethodsData从五轮（1996-2016）的尼泊尔人口与健康调查，全国代表性的横断面调查，被使用。通过计算绝对和相对差异、集中度曲线和指数，评估了最贫穷和最富有的五分之一人口之间以及所有五分之一人口之间发育迟缓的绝对和相对差异水平和趋势。预测因子对发育迟缓的平均边际效应采用概率单位回归计算。随后将集中指数分解为促成因素。结果尽管1996年至2016年间所有财富五分之一人群的发育迟缓率持续下降，但较富裕的五分之一人群的下降幅度相对高于较贫困的五分之一人群。最贫穷和最富有的五分之一之间的绝对差距从1996年的24.7（最贫穷的64.5%-最富有的39.8%）增加到2016年的32.7个百分点（49.2-16.5%）。相对差距也在扩大; 1996年最贫穷的五分之一人口与最富有的五分之一人口的发育迟缓比率为1.6，2016年为3.0。集中指数（绝对值）从1996年的-0.078增加到2016年的-0.147，表明发育迟缓不成比例地集中在贫困家庭，社会经济不平等从1996年到2016年恶化。分解分析表明，1996年，财富（61%）、种姓/种族（12%）、母亲教育（12%）和出生顺序（9%）是造成发育迟缓方面社会经济不平等的主要因素; 2016年，财富（72%），母亲的体重指数（12%）和出生顺序（9%）是主要的贡献者。结论尽管在过去的二十年中，平均发育迟缓有了显着的改善，发育迟缓方面存在着严重的社会经济不平等，这不仅是由直接因素决定的，也是由潜在的背景因素决定的，这些因素强调需要在不同部门采取协调一致的行动。除了减少财富的不平等外，营养方案的制定应侧重于最弱势的亚群体，这些亚群体容易发育迟缓和相对贫穷。
BackgroundAlthough decreasing in trend, one-in-three children remain stunted in Nepal and its distribution is unequal among different socioeconomic and geographical subgroups. Thus, it is crucial to assess inequalities in stunting for designing equity focused interventions that target vulnerable groups with higher burden of stunting. This study measures trends and predictors of socioeconomic inequalities in childhood stunting in Nepal.MethodsData from five rounds (1996-2016) of Nepal Demographic and Health Survey, nationally representative cross-sectional surveys, were used. Levels and trends of absolute and relative disparity in stunting between the poorest and the richest wealth quintiles, and among all quintiles were assessed by calculating absolute and relative difference, concentration curve and index. Average marginal effects of predictors on stunting were calculated using probit regression. The concentration index was subsequently decomposed into contributing factors.ResultsEven though stunting consistently declined in all wealth quintiles between 1996 and 2016, reduction was relatively higher among the richer quintiles compared to poorer ones. The absolute difference between the poorest and the richest quintile increased from 24.7 in 1996 (64.5% in poorest - 39.8% in richest) to 32.7 percentage points in 2016 (49.2-16.5%). The relative disparity also increased; the ratio of stunting in the poorest to the richest quintile was 1.6 in 1996 and 3.0 in 2016. The concentration index increased (in absolute value) from -0.078 in 1996 to -0.147 in 2016 indicating that stunting was disproportionately concentrated in poorer households and socioeconomic inequalities worsened from 1996 to 2016. Decomposition analysis revealed that in 1996, wealth (61%), caste/ethnicity (12%), mother's education (12%) and birth order (9%) were the major contributors to observed socioeconomic inequalities in stunting; while in 2016, wealth (72%), mother's BMI (12%) and birth order (9%) were the major contributors.ConclusionsDespite remarkable improvements in average stunting over the last two decades, substantial socioeconomic inequalities in stunting exists and is determined not only by immediate factors but also by underlying and contextual factors which emphasize the need for coherent actions across different sectors. In addition to reducing inequalities in wealth, nutrition programming should be focused on most disadvantaged subgroups which are prone to both stunting and relative poverty.