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. 2017 Oct 30;16(1):189.
doi: 10.1186/s12939-017-0684-x.

Social and environmental determinants of child health in Mongolia across years of rapid economic growth: 2000-2010

Nehal Joshi  1 , Bolormaa Bolorhon  2 , Indermohan Narula  3 , Shihua Zhu  4 , Semira Manaseki-Holland  5
Affiliations

Social and environmental determinants of child health in Mongolia across years of rapid economic growth: 2000-2010

Nehal Joshi et al. Int J Equity Health. .

Erratum in

Abstract

Background: To understand the effect of economic growth on health, we investigated the trend in socio-economic and regional determinants of child health in Mongolia. This Central Asian country had the fastest economic growth amongst low and middle-income countries (LMICs) from 2000 to 2010 and a healthcare system in transition.

Methods: Data was from Mongolian multiple indicator cluster surveys (MICS) in 2000, 2005 and 2010. Child nutrition/growth was measured by height-for-age z-score (HAZ), weight-for-age z-score (WAZ), prevalence of stunted (HAZ < -2) and underweight (WAZ < -2) children. Access to health care was measured by prevalence of fully immunised children <5 years. Multivariate multi-level logistic mixed modelling was used to estimate the effect of socio-economic and environmental health determinants on each outcome in each year; 2000, 2005 and 2010. T-tests were used to measure significant change in HAZ and WAZ over the decade.

Results: Overall, from 2000 to 2010, there was a significant improvement (p < 0.001) in all three outcomes, but the effect of socio-economic factors increased on both stunting and weight. In 2000, region was a significant determinant: children living in three provinces were significantly more likely to be stunted and less likely to be immunised than Ulaanbaatar, but this was not significant by 2010. By 2010, none of the factors were significant determinants of immunisation in children. In 2000, economic status had no effect on stunting (OR = 0.91; 95%CI:0.49,1.66), however by 2010, children in the poorest economic quintile were 4 times more likely to be stunted than the richest (OR = 0.24; 95% CI:0.13,0.45; p < 0.001). The effect of maternal education on stunting prevalence continued over the 10 years, in both 2000 and 2010 children were twice as likely to be stunted if their mother had no education compared to university education (2000 OR = 0.45; 95% CI:0.28,0.73, p < 0.01,2010 OR =0.55; 95% CI:0.35,0.87, p < 0.05).

Conclusion: Economic growth in Mongolia from 2000 to 2010 resulted in an increase in the effect of social determinants of child health; whilst focused policy improved access to immunisation. Children with less educated mothers and lower household incomes should be targeted in interventions to reduce health inequity.

Keywords: Child nutrition; Health equity; Immunisation coverage; Maternal education; Mongolia; Multiple indicator cluster surveys (MICS); Socioeconomic status.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was granted by the University of Birmingham BMedSci Population Sciences and Humanities Internal Ethics Review Committee. Consent for the MICS survey was carried out by UNICEF when collecting the data.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Distribution of stunting, underweight and immunisations across socio-economic household factors in 2000, 2005 and 2010. This figure depicts the prevalence of stunted, underweight and fully immunised children across the years 2000, 2005 and 2010. The colours represent the different determinants of health (a) maternal education, (b) household economic status and (c) total number of children under age 5 in the household. The * denotes the variables which were significant determinants of the outcome in multivariate analysis
See this image and copyright information in PMC

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