Skip to main content
Top
Published in: International Journal for Equity in Health 1/2006

Open Access 01-12-2006 | Research

Relationship between household wealth inequality and chronic childhood under-nutrition in Bangladesh

Authors: Rathavuth Hong, James E Banta, Jose A Betancourt

Published in: International Journal for Equity in Health | Issue 1/2006

Login to get access

Abstract

Background

Household food insecurity and under-nutrition remain critically important in developing countries struggling to emerge from the scourge of poverty, where historically, improvements in economic conditions have benefited only certain privileged groups, causing growing inequality in health and healthcare among the population.

Methods

Utilizing information from 5,977 children aged 0-59 months included in the 2004 Bangladesh Demographic and Health Survey , this study examined the relationship between household wealth inequality and chronic childhood under-nutrition. A child is defined as being chronically undernourished or whose growth rate is adversely stunted, if his or her z-score of height-for-age is more than two standard deviations below the median of international reference. Household wealth status is measured by an established index based on household ownership of durable assets. This study utilized multivariate logistic regressions to estimate the effect of household wealth status on adverse childhood growth rate.

Results

The results indicate that children in the poorest 20% of households are more than three time as likely to suffer from adverse growth rate stunting as children from the wealthiest 20% of households (OR=3.6; 95% CI: 3.0, 4.3). The effect of household wealth status remain significantly large when the analysis was adjusted for a child's multiple birth status, age, gender, antenatal care, delivery assistance, birth order, and duration that the child was breastfed; mother's age at childbirth, nutritional status, education; household access to safe drinking water, arsenic in drinking water, access to a hygienic toilet facility, cooking fuel cleanliness, residence, and geographic location (OR=2.4; 95% CI: 1.8, 3.2).

Conclusion

This study concludes that household wealth inequality is strongly associated with childhood adverse growth rate stunting. Reducing poverty and making services more available and accessible to the poor are essential to improving overall childhood health and nutritional status in Bangladesh.
Literature
1.
go back to reference World Bank: World Development Report 2000. 2000, Washington DC: World Bank World Bank: World Development Report 2000. 2000, Washington DC: World Bank
2.
go back to reference United Nations System, Standing Committee on Nutrition: 5 ft report on the world nutrition situation: Nutrition for improved development outcomes. 2004, New York: United Nations United Nations System, Standing Committee on Nutrition: 5 ft report on the world nutrition situation: Nutrition for improved development outcomes. 2004, New York: United Nations
3.
go back to reference Auerbach JA, Krimgold BK: Scientific Research on Socioeconomic status and health: Domestic and international evidence "Improving Health: It doesn't take a revolution". Income, socioeconomic status and health: Exploring the relation. Edited by: Auerbach JA, Krimgold BK. 2001, Washington DC: National Policy Association, 1-11. Auerbach JA, Krimgold BK: Scientific Research on Socioeconomic status and health: Domestic and international evidence "Improving Health: It doesn't take a revolution". Income, socioeconomic status and health: Exploring the relation. Edited by: Auerbach JA, Krimgold BK. 2001, Washington DC: National Policy Association, 1-11.
5.
go back to reference Thang NM, Popkin BM: In an era of economic growth, is inequity holding back reduction in child malnutrition in Vietnam?. Asian Pa J Clin Nutr. 2003, 12: 405-10. Thang NM, Popkin BM: In an era of economic growth, is inequity holding back reduction in child malnutrition in Vietnam?. Asian Pa J Clin Nutr. 2003, 12: 405-10.
6.
go back to reference Asian Development Bank, Japan International Cooperation Agency: Economic Growth and Poverty Reduction in Bangladesh 2004. 2004, Dhaka: ADB, JICA Asian Development Bank, Japan International Cooperation Agency: Economic Growth and Poverty Reduction in Bangladesh 2004. 2004, Dhaka: ADB, JICA
7.
go back to reference United Nations Development Program: Human development report 2005. 2005, New York: UNDP United Nations Development Program: Human development report 2005. 2005, New York: UNDP
8.
go back to reference Bangladesh Bureau of Statistic: Household Expenditure Survey 1995–1996. 1998, Dhaka: BBS Bangladesh Bureau of Statistic: Household Expenditure Survey 1995–1996. 1998, Dhaka: BBS
9.
go back to reference Larrea C, Kawachi I: Does economic inequality affect child malnutrition? The case of Ecuador. Soc Sci Med. 2005, 60: 165-78. 10.1016/j.socscimed.2004.04.024.CrossRefPubMed Larrea C, Kawachi I: Does economic inequality affect child malnutrition? The case of Ecuador. Soc Sci Med. 2005, 60: 165-78. 10.1016/j.socscimed.2004.04.024.CrossRefPubMed
10.
go back to reference Pelletier DL: The relationship between child anthropometry and mortality in developing countries: Implication for policy, program and future research. J Nutr. 1994, 2047S-81S. Suppl 124 Pelletier DL: The relationship between child anthropometry and mortality in developing countries: Implication for policy, program and future research. J Nutr. 1994, 2047S-81S. Suppl 124
11.
go back to reference 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: 1207-21.PubMedPubMedCentral 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: 1207-21.PubMedPubMedCentral
12.
go back to reference Pelletier DL: Malnutrition, morbidity and child mortality in developing countries. Too young to die: Genes or gender?. 1998, United Nations. New York: Department of Economic and Social Affairs, Population Division, United Nations, 109-32. Pelletier DL: Malnutrition, morbidity and child mortality in developing countries. Too young to die: Genes or gender?. 1998, United Nations. New York: Department of Economic and Social Affairs, Population Division, United Nations, 109-32.
13.
go back to reference McFarlane H: Malnutrition and impaired immune response to infection. Proc Nutr Soc. 1976, 35: 263-72. 10.1079/PNS19760045.CrossRefPubMed McFarlane H: Malnutrition and impaired immune response to infection. Proc Nutr Soc. 1976, 35: 263-72. 10.1079/PNS19760045.CrossRefPubMed
14.
go back to reference United Nations System, Standing Committee on Nutrition: 5 ft report on the world nutrition situation: Nutrition for improved development outcomes. 2004, New York: United Nations United Nations System, Standing Committee on Nutrition: 5 ft report on the world nutrition situation: Nutrition for improved development outcomes. 2004, New York: United Nations
15.
go back to reference World Health Organization: World Health Report 2002. 2002, Geneva: World Health Organization World Health Organization: World Health Report 2002. 2002, Geneva: World Health Organization
16.
go back to reference Jacobs B, Robert E: Baseline assessment for addressing acute malnutrition by public health staff in Cambodia. J Health Pop Nutr. 2004, 22: 212-9. Jacobs B, Robert E: Baseline assessment for addressing acute malnutrition by public health staff in Cambodia. J Health Pop Nutr. 2004, 22: 212-9.
17.
go back to reference Reyes H, Perez-Cuevas R, Sandoval A, Castillo R, Santos JI, Doubova S, Gutierrez G: The family as a determinant of stunting in children living in conditions of extreme poverty: a case-control study. BMC Public Health. 2004, 4: 57-10.1186/1471-2458-4-57.CrossRefPubMedPubMedCentral Reyes H, Perez-Cuevas R, Sandoval A, Castillo R, Santos JI, Doubova S, Gutierrez G: The family as a determinant of stunting in children living in conditions of extreme poverty: a case-control study. BMC Public Health. 2004, 4: 57-10.1186/1471-2458-4-57.CrossRefPubMedPubMedCentral
18.
go back to reference Frongillo EA, Onis M, Hanson KMP: Socioeconomic and demographic factors are associated with worldwide pattern of stunting and wasting of children. J Nutr. 1997, 127: 2302-9.PubMed Frongillo EA, Onis M, Hanson KMP: Socioeconomic and demographic factors are associated with worldwide pattern of stunting and wasting of children. J Nutr. 1997, 127: 2302-9.PubMed
19.
go back to reference Gopalan C: Current food and nutrition situation in south Asian and south-east Asian countries. Biomed Environ Sci. 1996, 9: 102-16.PubMed Gopalan C: Current food and nutrition situation in south Asian and south-east Asian countries. Biomed Environ Sci. 1996, 9: 102-16.PubMed
20.
go back to reference Esrey JP, Habicht JP, Latham MC: Drinking water source, diarrheal morbidity, and child growth in villages with both traditional and improved water supplies in rural Lesotho, Southern Africa. Am J Public Health. 1988, 78: 1451-5.CrossRefPubMedPubMedCentral Esrey JP, Habicht JP, Latham MC: Drinking water source, diarrheal morbidity, and child growth in villages with both traditional and improved water supplies in rural Lesotho, Southern Africa. Am J Public Health. 1988, 78: 1451-5.CrossRefPubMedPubMedCentral
21.
go back to reference Jaffar S, Jepson A, Leach A, Greenwood A, Whittle H, Greenwood B: Causes of mortality in twins in a rural region of The Gambia, West Africa. Ann Trop Paediatr. 1998, 18: 231-8.CrossRefPubMed Jaffar S, Jepson A, Leach A, Greenwood A, Whittle H, Greenwood B: Causes of mortality in twins in a rural region of The Gambia, West Africa. Ann Trop Paediatr. 1998, 18: 231-8.CrossRefPubMed
22.
go back to reference Vella VA, Tomkins J, Marshall T: Determinants of child mortality in south-west Uganda. J Biosoc Sci. 1992, 24: 103-12.CrossRefPubMed Vella VA, Tomkins J, Marshall T: Determinants of child mortality in south-west Uganda. J Biosoc Sci. 1992, 24: 103-12.CrossRefPubMed
23.
go back to reference Ross NA, Wolfson MC, Dunn JR, Berthelot J, Kaplan GA, Lynch JW: Relation between income inequality and mortality in Canada and in the United States: cross sectional assessment using census data and vital statistics. BMJ. 2000, 320: 898-902. 10.1136/bmj.320.7239.898.CrossRefPubMedPubMedCentral Ross NA, Wolfson MC, Dunn JR, Berthelot J, Kaplan GA, Lynch JW: Relation between income inequality and mortality in Canada and in the United States: cross sectional assessment using census data and vital statistics. BMJ. 2000, 320: 898-902. 10.1136/bmj.320.7239.898.CrossRefPubMedPubMedCentral
24.
go back to reference Wilkinson RG: Putting the picture together: prosperity, redistribution, health, and welfare. Social determinants of health. Edited by: Marmot MG, Wilkinson RG. 1999, New York: Oxford University Press, 256-74. Wilkinson RG: Putting the picture together: prosperity, redistribution, health, and welfare. Social determinants of health. Edited by: Marmot MG, Wilkinson RG. 1999, New York: Oxford University Press, 256-74.
25.
go back to reference Hertzman C, Frank J, Evans RG: Heterogeneities in health status and the determinants of population health. Why are some people healthy and others not. The determinants of health of the populations. Edited by: Evans RG, Barer ML, Marmor TR. 1994, New York: Aldine de Gruyter, 67-92. Hertzman C, Frank J, Evans RG: Heterogeneities in health status and the determinants of population health. Why are some people healthy and others not. The determinants of health of the populations. Edited by: Evans RG, Barer ML, Marmor TR. 1994, New York: Aldine de Gruyter, 67-92.
26.
go back to reference Larrea C, Freire W: Social inequality and child malnutrition in four Aden countries. Rev Panam Salud Publica. 2002, 11: 356-64.CrossRefPubMed Larrea C, Freire W: Social inequality and child malnutrition in four Aden countries. Rev Panam Salud Publica. 2002, 11: 356-64.CrossRefPubMed
27.
go back to reference Wang Y, Monteiro C, Popkin BM: Trend of obesity and underweight in older children and adolescence in the United States, Brazil, China, and Russia. Am J Clin Nutr. 2002, 75: 971-7.PubMed Wang Y, Monteiro C, Popkin BM: Trend of obesity and underweight in older children and adolescence in the United States, Brazil, China, and Russia. Am J Clin Nutr. 2002, 75: 971-7.PubMed
28.
go back to reference Doak C, Adair L, Bentley M, Fengying Z, Popkin B: The underweight/overweight household: an exploration of household sociodemographic and dietary factors in China. Public Health Nutr. 2002, 5: 215-21. 10.1079/PHN2001296.PubMed Doak C, Adair L, Bentley M, Fengying Z, Popkin B: The underweight/overweight household: an exploration of household sociodemographic and dietary factors in China. Public Health Nutr. 2002, 5: 215-21. 10.1079/PHN2001296.PubMed
29.
go back to reference Armstrong J, Dorosty AR, Reilly JJ, Emmett PM: Coexistence of social inequalities in undernutrition and obesity in preschool children: population based cross sectional study. Achieves Diseases of Childhood. 2003, 88: 671-5. 10.1136/adc.88.8.671.CrossRef Armstrong J, Dorosty AR, Reilly JJ, Emmett PM: Coexistence of social inequalities in undernutrition and obesity in preschool children: population based cross sectional study. Achieves Diseases of Childhood. 2003, 88: 671-5. 10.1136/adc.88.8.671.CrossRef
30.
go back to reference National Institute of Population Research and Training, Mitra and Associates, ORC Macro: The Bangladesh Demographic and Health Survey 2004. 2001, Dhaka, Bangladesh; Calverton Maryland: National Institute of Population Research and Training, Mitra and Associates, ORC Macro National Institute of Population Research and Training, Mitra and Associates, ORC Macro: The Bangladesh Demographic and Health Survey 2004. 2001, Dhaka, Bangladesh; Calverton Maryland: National Institute of Population Research and Training, Mitra and Associates, ORC Macro
31.
go back to reference Dibley MJ, Goldsby JB, Staehling NW, Trowbridge FL: Development of normalized curves for the international growth reference: Historical and technical considerations. Am J Clin Nutr. 1987, 46: 736-748.PubMed Dibley MJ, Goldsby JB, Staehling NW, Trowbridge FL: Development of normalized curves for the international growth reference: Historical and technical considerations. Am J Clin Nutr. 1987, 46: 736-748.PubMed
32.
go back to reference Dibley MJ, Staehling NW, Neiburg P, Trowbridge FL: Interpretation of z-score anthropometric indicators derived from the international growth reference. Am J Clin Nutr. 1987, 46: 749-762.PubMed Dibley MJ, Staehling NW, Neiburg P, Trowbridge FL: Interpretation of z-score anthropometric indicators derived from the international growth reference. Am J Clin Nutr. 1987, 46: 749-762.PubMed
33.
go back to reference Rutstein SO, Johnson K: DHS Comparative Report No. 6: The DHS wealth index. 2004, Calverton MD: ORC Macro Rutstein SO, Johnson K: DHS Comparative Report No. 6: The DHS wealth index. 2004, Calverton MD: ORC Macro
34.
go back to reference Acheson D, Barker D, Chambers J, Graham H, Marmot M, Whitehead M: Independent inquiry into inequalities in health. 1998, London: Stationary Office, Report to the Secretary of State for Health Acheson D, Barker D, Chambers J, Graham H, Marmot M, Whitehead M: Independent inquiry into inequalities in health. 1998, London: Stationary Office, Report to the Secretary of State for Health
35.
go back to reference Berkman LK, Kawachi I: Social Epidemiology. 2000, New York: Oxford University Press Berkman LK, Kawachi I: Social Epidemiology. 2000, New York: Oxford University Press
36.
go back to reference Stata Corporation, Inc: STATA Release 8.1. 2003, College Station Texas: Stata Press Stata Corporation, Inc: STATA Release 8.1. 2003, College Station Texas: Stata Press
38.
go back to reference Mishra V: Indoor air pollution from biomass combustion and acute respiratory illness in preschool age children in Zimbabwe. Int J Epidemiol. 2003, 32: 847-853. 10.1093/ije/dyg240.CrossRefPubMed Mishra V: Indoor air pollution from biomass combustion and acute respiratory illness in preschool age children in Zimbabwe. Int J Epidemiol. 2003, 32: 847-853. 10.1093/ije/dyg240.CrossRefPubMed
39.
go back to reference Peña R, Wall S, Persson L: The effect of poverty, social inequality, and maternal education on infant mortality in Nicaragua, 1988–1993. Am J Public Health. 2000, 90: 64-9.CrossRefPubMedPubMedCentral Peña R, Wall S, Persson L: The effect of poverty, social inequality, and maternal education on infant mortality in Nicaragua, 1988–1993. Am J Public Health. 2000, 90: 64-9.CrossRefPubMedPubMedCentral
40.
go back to reference Casa JA, Dachs N, Bambas A: Health disparities in Latin America and the Caribbean: The role of social and economic determinants. Equity and health. 2001, Washington DC: Pan American Health Organization, 22-49. Casa JA, Dachs N, Bambas A: Health disparities in Latin America and the Caribbean: The role of social and economic determinants. Equity and health. 2001, Washington DC: Pan American Health Organization, 22-49.
Metadata
Title
Relationship between household wealth inequality and chronic childhood under-nutrition in Bangladesh
Authors
Rathavuth Hong
James E Banta
Jose A Betancourt
Publication date
01-12-2006
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2006
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/1475-9276-5-15

Other articles of this Issue 1/2006

International Journal for Equity in Health 1/2006 Go to the issue