Levels and trends of childhood undernutrition by wealth and education according to a Composite Index of Anthropometric Failure: evidence from 146 Demographic and Health Surveys from 39 countries

Abstract

Background: Governments have endorsed global targets to reduce childhood undernutrition as part of the Sustainable Development Goals. Understanding the socioeconomic differences in childhood undernutrition has the potential to be helpful for targeting policy to reach these goals.

Methods: We specify a logistic regression model with the Composite Index of Anthropometric Failure (CIAF) as the outcome and indicator variables for wealth quartiles, maternal education categories and a set of covariates as explanatory variables. Wealth and education variables are interacted with a period indicator for 1990-2000 compared with 2001-2014 to observe differences over time. Based on these regressions we calculate predicted CIAF prevalence by wealth and education categories and over time.

Results: The sample included 146 surveys from 39 low-income and lower-middle-income countries with an overall sample size of 533 217 children. CIAF prevalence was 47.5% in 1990-2000, and it declined to 42.6% in 2001-2014. In 1990-2000 the CIAF prevalence of children with mothers with less than primary education was 31 percentage points higher than for mothers with secondary or higher education. This difference slightly decreased to 27 percentage points in 2001-2014. The difference in predicted CIAF prevalence of children from the highest and lowest wealth quartiles was 21 percentage points and did not change over time.

Conclusions: We find evidence for persistent and even increasing socioeconomic inequalities in childhood undernutrition, which underlines the importance of previous calls for equity-driven approaches targeting the most vulnerable to reduce childhood malnutrition.

Keywords: CIAF; Childhood undernutrition; Inequality.

Figure 1

Absolute and relative differences in predicted prevalence of CIAF and CISAF between lowest and highest wealth and education categories for 1990–2000 and 2001–2014. Predicted prevalence is based on regression models adjusting for age in months, gender, birth order of child, age of mother at birth, household wealth, matejrnal education, urban residence and marital status of mother. Source: Demographic and Health Surveys data. CIAF, Composite Index of Anthropometric Failure; CISAF, Composite Index of Severe Anthropometric Failure.

Figure 2

Absolute differences in predicted prevalence of CIAF among children aged less than 3 in the final analytic sample between the periods 1990–2000 and 2001–2014 for the total sample. Predicted prevalence is based on regression models adjusting for age in months, gender, birth order of child, age of mother at birth, household wealth, maternal education, urban residence and marital status of mother. Source: Demographic and Health Surveys data. CIAF, Composite Index of Anthropometric Failure.

Figure 3

Number of countries for which predicted prevalence in CIAF and CISAF among children aged less than 3 increased from 1990–2000 to 2001–2014 in the full sample and by wealth quartiles. Predicted prevalence is based on regression models adjusting for age in months, gender, birth order of child, age of mother at birth, household wealth, maternal education, urban residence and marital status of mother. Source: Demographic and Health Surveys data. CIAF, Composite Index of Anthropometric Failure; CISAF, Composite Index of Severe Anthropometric Failure.

Figure 4

Number of countries for which predicted prevalence in CIAF and CISAF among children aged less than 3 increased from 1990–2000 to 2001–2014 by educational attainment of the mother. Predicted prevalence is based on regression models adjusting for age in months, gender, birth order of child, age of mother at birth, household wealth, maternal education, urban residence and marital status of mother. Source: Demographic and Health Surveys data. CIAF, Composite Index of Anthropometric Failure; CISAF, Composite Index of Severe Anthropometric Failure.

Figure 5

Absolute differences between the poorest and richest quartile predicted prevalence (PP) in CIAF and CISAF among children aged less than 3 in 1990–2000 and 2001–2014. PP is based on regression models adjusting for age in months, gender, birth order of child, age of mother at birth, household wealth, maternal education, urban residence and marital status of mother. Source: Demographic and Health Surveys data. Country codes: AM (Armenia), BD (Bangladesh), BJ (Benin), BO (Bolivia), BF (Burkina Faso), CM (Cameroon), TD (Chad), CO (Colombia), CD (Congo, Democratic Republic), CG (Congo, Republic), CI (Cote d'Ivoire), DR (Dominican Republic), EG (Egypt, Arab Republic), ET (Ethiopia), GH (Ghana), GN (Guinea), HT (Haiti), IA (India), JO (Jordan), KE (Kenya), LS (Lesotho), MD (Madagascar), MW (Malawi), ML (Mali), MA (Morocco), MZ (Mozambique), NM (Namibia), NP (Nepal), NC (Nicaragua), NI (Niger), NG (Nigeria), PE (Peru), RW (Rwanda), SN (Senegal), TZ (Tanzania), TR (Turkey), UG (Uganda), ZM (Zambia), ZW (Zimbabwe). CIAF, Composite Index of Anthropometric Failure; CISAF, Composite Index of Severe Anthropometric Failure.

Figure 6

Absolute differences between the no education and secondary or higher education of the mother predicted prevalence (PP) in CIAF and CISAF among children aged less than 3 in 1990–2000 and 2001–2014. Predicted prevalence is based on regression models adjusting for age in months, gender, birth order of child, age of mother at birth, household wealth, maternal education, urban residence and marital status of mother. Source: Demographic and Health Surveys data. Country codes: AM (Armenia), BD (Bangladesh), BJ (Benin), BO (Bolivia), BF (Burkina Faso), CM (Cameroon), TD (Chad), CO (Colombia), CD (Congo, Democratic Republic), CG (Congo, Republic), CI (Cote d'Ivoire), DR (Dominican Republic), EG (Egypt, Arab Republic), ET (Ethiopia), GH (Ghana), GN (Guinea), HT (Haiti), IA (India), JO (Jordan), KE (Kenya), LS (Lesotho), MD (Madagascar), MW (Malawi), ML (Mali), MA (Morocco), MZ (Mozambique), NM (Namibia), NP (Nepal), NC (Nicaragua), NI (Niger), NG (Nigeria), PE (Peru), RW (Rwanda), SN (Senegal), TZ (Tanzania), TR (Turkey), UG (Uganda), ZM (Zambia), ZW (Zimbabwe). CIAF, Composite Index of Anthropometric Failure; CISAF, Composite Index of Severe Anthropometric Failure.