Persistent inequalities in child undernutrition: evidence from 80 countries, from 1990 to today
Persistent inequalities in child undernutrition: evidence from 80 countries, from 1990 to today
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DOI：
10.1093/ije/dyu075
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发表时间：
2014-08-01
影响因子：
7.7
通讯作者：
Van de Poel, Ellen
中科院分区：
文献类型：
--
作者：
Bredenkamp, Caryn;Buisman, Leander R.;Van de Poel, Ellen
背景：全球在减轻营养不良负担方面的进展往往是在人口一级衡量的。有人假设，人口水平的改善可能掩盖了社会经济不平等的扩大，但几乎没有人试图评估这是否属实。利用1990年至2011年131项人口健康调查和48项多指标类集调查的原始数据，研究发育迟缓和体重不足方面的社会经济不平等趋势，以及流行率变化与不平等变化之间的关系。社会经济不平等的测量使用校正浓度index.Results：发育迟缓的患病率较高的国家往往有较大的社会经济不平等的发育迟缓（斯皮尔曼等级相关= -0.27 P = 0.014）。在大多数国家，发育迟缓方面的不平等没有变化：在53个国家中的31个国家，变化的90%置信区间与零值重叠。在其余22个国家中，11个国家的不平等程度有所减少，11个国家有所增加。不平等统计数据汇总的分布模式在各国之间差异很大，但在大多数情况下，最贫穷的五分之一人口都有相当大的收益。然而，不平等也没有缩小。相反，情况是现有不平等现象持续存在。此外，不平等总指数的变化背后存在着不同的分配模式，在设计惠及穷人的方案时需要考虑到这些模式。
Background: Global progress in reducing the burden of undernutrition tends to be measured at the population level. It has been hypothesized that population-level improvements may mask widening socioeconomic inequalities, but little attempt has been made to assess whether this is true.Methods: Original data from 131 demographic health surveys and 48 multiple indicator cluster surveys from 1990 to 2011 were used to examine trends in socioeconomic inequalities in stunting and underweight, as well as the relationship between changes in prevalence and changes in inequality, in 80 countries. Socioeconomic inequality is measured using the corrected concentration index.Results: Countries with a higher prevalence of stunting tend to have larger socioeconomic inequalities in stunting (Spearman rank correlation = -0.27 P = 0.014). In most countries, there has been no change in inequality in stunting: in 31 out of 53, the 90% confidence intervals around the changes overlap the zero value. In the remaining 22, there was a reduction in inequality in 11 and an increase in 11. The distributional patterns underlying the summary inequality statistics vary considerably across countries, but in most there have been considerable gains to the poorest quintile.Conclusions: Reductions in the prevalence of undernutrition have generally not been accompanied by widening inequalities. However, inequalities have also not been narrowing. Rather, the picture is one of a strong persistence of existing inequalities. In addition, there are different distributional patterns underlying changes in the summary indices of inequality which will need to be taken into consideration in designing programmes to reach the poor.