Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2015

Open Access 01-12-2015 | Research

Are pre-school girls more likely to be under-nourished in rural Thatta, Pakistan?-a cross-sectional study

Authors: Rozina Nuruddin, Wilbur C. Hadden

Published in: International Journal for Equity in Health | Issue 1/2015

Login to get access

Abstract

Background

Pakistan ranks third lowest on a global gender index (2013) and 13th highest on the prevalence of underweight among under-five children (2010). Through this population-based study, we examined gender differentials in the prevalence of stunting, wasting and under-weight defined by World Health Organization (WHO) Growth Standard among rural pre-school Pakistani children.

Methods

We performed secondary analysis of data collected through a cross-sectional survey of Thatta district during 1992-93. Prevalence ratios were calculated for 1051 children aged 0-35 months from 95 randomly selected villages of rural Pakistan using a clustered adjusted log binomial model. Level 1 variables included child and household characteristics and level 2 included village characteristics.

Results

Based on the new WHO growth reference, a major proportion of children were stunted (52.9 %), wasted (22.9 %) and under-weight (46.5 %). In a two-level model, compared to boys, girls had significantly greater risk of stunting [Prevalence Ratio (PR) (95 % C.I.) = 1.18 (1.03, 1.36)] and under-weight [P.R. (95 % C.I.) 1.14 (1.03, 1.26)], after adjustment of maternal literacy and village variables. Risk of wasting did not differ with gender [P.R. (95 % C.I.) = 1.04 (0.99, 1.15)]. Mothers of stunted and underweight children were respectively, 21 and 20 % more likely to be illiterate than those of normally nourished children. Sick children were at 16 % greater risk of wasting than those not reported ill.

Conclusion

Greater prevalence of stunting and under-weight among girls suggests adoption of a gender sensitive approach in nutritional intervention programmes. Prompt management of childhood illnesses may reduce prevalence of wasting. Better literacy among rural mothers may reduce prevalence of stunting and under-weight. Whether gender differences in nutrition status are an underlying pathway for excessive girl mortality in rural Thatta needs further examination.
Literature
1.
Pelletier DL, Frongillo EAJ, Schroeder DG, Habicht JP. The effects of malnutrition on child mortality in developing countries. Bull World Health Organ. 1995;73(4):443–8.PubMedPubMedCentral
2.
Rice AL, Sacco L, Hyder A, Black RE. Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries. Bull World Health Organ. 2000;78(10):1207–21.PubMedPubMedCentral
3.
Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet. 2002;359:564–71.PubMedCrossRef
4.
Global framework for action. 2006. Ending child hunger and under-nutrition initiative. In: World Food Programme and UNICEF. 2006; 16.
5.
A Global Hunger Index: The challenge of hidden hunger. Washington, U.S.A. In: International food policy research institute, 2014; Chapter 02, 16.
6.
7.
National Nutrition Survey 2011, Planning Commission, Planning and Development Division, Government of Pakistan, Aga Khan University, Pakistan, UNICEF Pakistan. 2011: 35
8.
World Health Organization. World Health Statistics 2010. Geneva: World Health Organization; 2010. p. 106–7.
9.
Dey I, Chaudhuri RN. Gender inequality in nutritional status among under five children in a village in Hooghly district, West Bengal. Indian J Public Health. 2008;52(4):218–20.PubMed
10.
The Global Gender Gap Report, 2011. World Economic Forum. Geneva, Switzerland 2011.
11.
The Global Gender Gap Report, 2014. World Economic Forum. Geneva, Switzerland 2014.
12.
Baig-Ansari N, Rahbar MH, Bhutta ZA, Badruddin SH. Child's gender and household food insecurity are associated with stunting among young Pakistani children residing in urban squatter settlements. Food Nutr Bull. 2006;27(2):114–27.PubMedCrossRef
13.
Hazarika G. Gender differences in children’s nutrition and access to health care in Pakistan. J Dev Stud. 2000;37:73–92.CrossRef
14.
Shah SM, Selwyn BJ, Luby S, Merchant A, Bano R. Prevalence and correlates of stunting among children in rural Pakistan. Pediatr Int. 2003;45:49–53.PubMedCrossRef
15.
de Onis M, Habicht JP. Anthropometric reference data for international use: recommendations from a World Health Organization Expert Committee. Am J Clin Nutr. 1996;64:650–8.PubMed
16.
WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr. 2006;450:76–85.
17.
WHO Multicentre Growth Reference Study Group. Assessment of differences in linear growth among populations in the WHO Multicentre Growth Reference Study. Acta Paediatr. 2006;450:56–65.
18.
Nuruddin R, Meng-Kin L, Hadden WC, Azam I. Comparison of estimates of under-nutrition for pre-school rural Pakistani children based on the WHO standard and the National Center for Health Statistics NCHS reference. Public Health Nutr. 2009;12(5):716–22.PubMedCrossRef
19.
de Onis M, Onyango AW, Borghi E, Garza C, Yang H. WHO Multicentre Growth Reference Study Group. Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics/WHO international growth reference: implications for child health programmes. Public Health Nutr. 2006;9(7):942–7.PubMed
20.
Abul-Fadl A, Bagchi K, Cheikh IL. Practices in child growth monitoring in the countries of the Eastern Mediterranean Region. East Mediterr Health J. 2010;16(2):194–201.PubMed
21.
Mosley WH, Chen LC. An analytic framework for the study of child survival in developing countries. Popul Dev Rev. 1984;10:25–45.CrossRef
22.
UNICEF. Strategy for improved nutrition of children and women in developing countries. East Asia & Pacific Regional Office. Health and Nutrition Working Paper. New York: United Nations Children’s Fund. Nutrition Section; 2003. p. 7.
23.
Noorani NA, Sohani SB, Omair A, Amir Ali N, Khwaja RS, Jan A, Shah S. Thatta Health System Research Project, Phase III Year 1 Report In. Karachi: The Aga Khan University, Department of Health, Sindh and International Development Research Centre, Canada. 1993-94: B1 1-5.
24.
Noor Ali R, Hirani A, Hussain HF, Amir Ali N, Jan A. Thatta Health System Research Project, Phase III Year 2 Report. Research Information System. In. Karachi: The Aga Khan University, Karachi, Department of Health, Sindh and International Development Research Centre, Canada. 1994-95: B1 1-16.
25.
Report on the status of millennium development goals, Sindh. United Nations Development Programme Pakistan and Government of Sindh. 2012: 2, 12
26.
UNICEF. District-based Multiple Indicators Cluster Survey (MICS) 2003–04. Karachi: Planning and Development Department, Federal Bureau of Statistics and UNICEF (courtesy: the World Bank); 2005. p. 68, 91, 92,94,95.
27.
Pakistan Social and Living Standards Measurement Survey (PSLM) 2012-13. In: FBoS (ed). Statistics Division, Government of Pakistan, Statistics Division, Pakistan Bureau of Statistics, Islamabad, 2014.
28.
Nuruddin R, Hadden WC, Petersen MR, Lim MK. Does child gender determine household decision for health care in rural Thatta, Pakistan? J Public Health. 2009;31(3):389–97.CrossRef
29.
Population Welfare Department. District profiles. In: Governtment of Sindh. 2005.
30.
Pakistan Demographic and Health Survey 2012-13. National Institute of Population Studies Islamabad, Pakistan and USAID. Chapter 11; 165-7.
31.
Nuruddin R, Meng Kin L, Hadden WC, et al. Maternal chronic ill health negatively affects child survival in a poor rural population of Pakistan. World Health Popul. 2007;9(3):27–35.PubMedCrossRef
32.
Pakistan Social and Living Standards Measurement Survey (PSLM). In: FBoS (ed). Statistics Division, Government of Pakistan. 2004–05.
33.
Daniel WW. Biostatistics: a foundation analysis in the health sciences. 5th ed. Hoboken: John Wiley; 1987.
34.
de Onis M, Blossner M. WHO Global Database on Child Growth and Malnutrition. Organization: Geneva. World Health; 1997. p. 1–65.
35.
de Onis M, Onyango AW, Borghi E, Garza C, Yang H. WHO Multicentre Growth Reference Study Group. Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics / WHO international growth reference: implications for child health programmes. Public Health Nutr. 2006;9:942–7.PubMed
36.
Petersen MR, Deddens JA. A comparison of two methods for estimating prevalence ratios. BMC Med Res Methodol. 2008;28(8):9.CrossRef
37.
SAS. Statistical Analysis System. Version 9.1. North Carolina: SAS Institute Inc., USA, 2002–2003.
38.
Deddens JA, Petersen MR, Lei X. Estimation of Prevalence Ratios when PROC GENMOD Does Not Converge. SUGI Proceedings, 2003.
39.
Deddens JA, Petersen MR. Approaches for estimating prevalence ratios. Occup Environ Med. 2008;65:501–6.CrossRef
40.
Pakistan Millennium Development Goals, 2013. Ministry of Planning, Development and Reform. Planning Commission, Government of Pakistan. Islamabad. 2013: 18.
41.
Moestue H. Can anthropometry measure gender discrimination? An analysis using WHO standards to assess the growth of Bangladeshi children. Public Health Nutr. 2008;12:1085–91.PubMedCrossRef
42.
Moestue H, de Pee S, Hall A, Hye A, Sultana N, Ishtiaque MZ, et al. Conclusions about differences in linear growth between Bangladeshi boys and girls depend on the growth reference used. Eur J Clin Nutr. 2004;58:725–31.PubMedCrossRef
43.
Dancer D, Rammohan A, Murray SD. Infant mortality and child nutrition in Bangladesh. Health Econ. 2008;17:1015–35.PubMedCrossRef
44.
Ricci JA, Becker S. Risk factors for wasting and stunting among children in Metro Cebu, Philippines. Am J Clin Nutr. 1996;63:966–75.PubMed
45.
Arya A, Devi R. Influence of maternal literacy on the nutritional status of preschool children. Indian J Pediatr. 1991;58:265–8.PubMedCrossRef
46.
Wamani H, Tylleskar T, Astrom AN, Tumwine JK, Peterson S. Mothers’ education but not fathers’ education, household assets or land ownership is the best predictor of child health inequalities in rural Uganda. Int J Equity Health. 2004;3:1–8.CrossRef
47.
Hong R, Banta JE, Betancourt JA. Relationship between household wealth inequality and chronic childhood under-nutrition in Bangladesh. Int J Equity Health. 2006;5:15.PubMedPubMedCentralCrossRef
48.
Hong R, Mishra V. Effect of wealth inequality on chronic under-nutrition in Cambodian children. J Health Popul Nutr. 2006;24:89–99.PubMed
49.
Basu AM. How pervasive are sex differentials in childhood nutritional levels in South Asia? J Soc Biol. 1993;40:25–37.
50.
Filmer D, King EM, Pritchett L. Gender Disparity in South Asia: Comparisons between and within Countries. Washington, D.C: World Bank; 1998. p. 8.
51.
Choudhury KK, Hanifi MA, Rasheed S, Bhuiya A. Gender inequality and severe malnutrition among children in a remote rural area of Bangladesh. J Health Popul Nutr. 2000;18:123–30.PubMed
52.
Rousham EK. Socio-economic influences in gender inequalities in child health in rural Bangladesh. Eur J Clin Nutr. 1996;50:560–4.PubMed
53.
Pande RP. Selective gender differences in childhood nutrition and immunization in rural India: The role of siblings. Demography. 2003;40:395–418.PubMedCrossRef
54.
Gorstein J. Assessment of nutritional status: effects of different methods to determine age on the classification of under nutrition. Bull World Health Organ. 1989;67:143–50.PubMedPubMedCentral
Metadata
Title
Are pre-school girls more likely to be under-nourished in rural Thatta, Pakistan?-a cross-sectional study
Authors
Rozina Nuruddin
Wilbur C. Hadden
Publication date
01-12-2015
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2015
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-015-0287-3

Other articles of this Issue 1/2015

International Journal for Equity in Health 1/2015 Go to the issue

Research

Analysing implementer narratives on addressing health inequity through convergent action on the social determinants of health in India

Commentary

Health care financing and the sustainability of health systems

Research

Community perspectives on food insecurity and obesity: Focus groups with caregivers of Métis and Off-reserve First Nations children

Erratum

Erratum: Lessons from sexual and reproductive health voucher program design and function: a comprehensive review

Research

Exploring the social, emotional and behavioural development of preschool children: is Glasgow different?

Research

Reducing stigma in healthcare and law enforcement: a novel approach to service provision for street level sex workers