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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2017

Open Access 01-12-2017 | Research

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

Authors: Nehal Joshi, Bolormaa Bolorhon, Indermohan Narula, Shihua Zhu, Semira Manaseki-Hollan

Published in: International Journal for Equity in Health | Issue 1/2017

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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.
Literature
1.
UNDP. Human development report 2014 sustaining human progress: reducing vulnerabilities and building resilience. New York: UNDP; 2014.CrossRef
2.
van Deurzen I, van Oorschot W, van Ingen E. The link between inequality and population health in low and middle income countries: policy myth or social reality? PLoS One. 2014;9(12):e115109.CrossRefPubMedPubMedCentral
3.
4.
Pop IA, van Ingen E, van Oorschot W. Inequality, wealth and health: is decreasing income inequality the key to create healthier societies? Soc Indic Res. 2013;113(3):1025–43.CrossRef
5.
Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health: final report of the commission on social determinants of health. 2008.
6.
Espey J, Holder A, Molina N, Cobham A. Born equal: how reducing inequality could give our children a better future. London: Save the Children; 2012.
7.
UNICEF. Nigeria demographic and health survey 2008 Abuja, Nigeria 2008.
8.
Balarajan Y, Selvaraj S, Subramanian SV. Health care and equity in India. Lancet (London, England). 2011;377(9764):505–15.CrossRef
9.
Carrera C, Azrack A, Begkoyian G, et al. The comparative cost-effectiveness of an equity-focused approach to child survival, health, and nutrition: a modelling approach. Lancet. 2012;380:9850.CrossRef
10.
Bhutta ZA, Chopra M, Axelson H, et al. Countdown to 2015 decade report (2000–10): taking stock of maternal, newborn, and child survival. Lancet (London, England). 2010;375(9730):2032.CrossRef
11.
Organization WH. Handbook on health inequality monitoring: with a special focus on low-and middle-income countries: World Health Organization; 2013.
12.
S. Kwon ER, editor. Mongolia health systems review. Asia Pacific observatory on health systems and policies: world health organisation; 2013.
13.
Victora CG, Barros AJ, Axelson H, et al. How changes in coverage affect equity in maternal and child health interventions in 35 countdown to 2015 countries: an analysis of national surveys. Lancet. 2012;380(9848):1149–56.CrossRefPubMed
14.
Marmot M. Achieving health equity: from root causes to fair outcomes. Lancet. 2007;370(9593):1153–63.CrossRefPubMed
15.
Webb P, Block S. Nutrition information and formal schooling as inputs to child nutrition*. Econ Dev Cult Chang. 2004;52(4):801–20.CrossRef
16.
Black RE, Allen LH, Bhutta ZA, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371(9608):243–60.CrossRefPubMed
17.
Merchant A, Jones C, Kiure A, et al. Water and sanitation associated with improved child growth. Eur J Clin Nutr. 2003;57(12):1562–8.CrossRefPubMed
18.
Frongillo EA, de Onis M, Hanson KM. Socioeconomic and demographic factors are associated with worldwide patterns of stunting and wasting of children. J Nutr. 1997;127(12):2302–9.CrossRefPubMed
19.
Berman S. Epidemiology of acute respiratory infections in children of developing countries. Rev Infect Dis. 1991;13(Supplement 6):S454–S62.CrossRefPubMed
20.
Checkley W, Gilman RH, Black RE, et al. Effect of water and sanitation on childhood health in a poor Peruvian peri-urban community. Lancet. 2004;363(9403):112–8.CrossRefPubMed
21.
22.
WHO. Health service delivery profile Mongolia. Compiled in collaboration between WHO and Ministry of Health 2012.
23.
Lhamsuren K, Choijiljav T, Budbazar E, Vanchinkhuu S, Chang Blanc D, Grundy J. Taking action on the social determinants of health: improving health access for the urban poor in Mongolia. Int J Equity Health. 2012;11:15.CrossRefPubMedPubMedCentral
24.
UNICEF. The living conditions of the children in peri-urban areas of Ulaanbaatar. Summary report 2003.
25.
Foggin PM, Farkas O, Shiirev-Adiya S, Chinbat B. Health status and risk factors of seminomadic pastoralists in Mongolia: a geographical approach. Soc Sci Med. 1997;44(11):1623–47.CrossRefPubMed
26.
National Statistics Office Mongolia. Multiple indicator cluster survey preliminary report. Ulaanbaatar: National Statistics Office; 2000.
27.
Lambert L, Baigalmaa O, Munkhzul Z. Mongolia "child and development 2005" survey (MICS-3), final report. Ulaanbaatar: National Statistical Office, UNICEF; 2007.
28.
Waterlow JC, Buzina R, Keller W, Lane J, Nichaman M, Tanner J. The presentation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years. Bull World Health Organ. 1977;55(4):489.PubMedPubMedCentral
29.
UNICEF. Progress for children: achieving the MDGs with equity: Unicef; 2010.
30.
Webster J, Lines J, Bruce J, Armstrong Schellenberg JR, Hanson K. Which delivery systems reach the poor? A review of equity of coverage of ever-treated nets, never-treated nets, and immunisation to reduce child mortality in Africa. Lancet Infect Dis. 2005;5(11):709–17.CrossRefPubMed
31.
Mongolia TGo. Proposal for support submitted to GAVI and the vaccine fund. 2004.
32.
O'Donnell OA, van Doorslaer EK, Wagstaff A, Lindelöw M. Analyzing health equity using household survey data: a guide to techniques and their implementation: World Bank publications; 2008.
33.
Duncan C, Jones K, Moon G. Context, composition and heterogeneity: using multilevel models in health research. Soc Sci Med. 1998;46(1):97–117.CrossRefPubMed
34.
Peugh JL, Enders CK. Using the SPSS mixed procedure to fit cross-sectional and longitudinal multilevel models. Educ Psychol Meas. 2005;65(5):717–41.CrossRef
35.
UNICEF. Immunization summary: a statistical reference containing data through 2011. Geneva: WHO; 2013.
36.
UNICEF. MICS instructions for interviewers 2000.
37.
Pongou R, Ezzati M, Salomon JA. Household and community socioeconomic and environmental determinants of child nutritional status in Cameroon. BMC Public Health. 2006;6(1):98.CrossRefPubMedPubMedCentral
38.
Rannan-Eliya R, Hossain S, Anuranga C, Wickramasinghe R, Jayatissa R, Abeykoon A. Trends and determinants of childhood stunting and underweight in Sri Lanka. Ceylon Med J. 2013;58(1):10–8.CrossRefPubMed
39.
Asian Development Bank. In: Joshi K, editor. Administrative data sources for Compliling Millenium development goals and related indicators (ADB report). Philippines: Asian Development Bank; 2010.
40.
Baigalmaa O, Todgerel S, Munkhzul Z. Multiple indicator cluster survey, 2010. Ulaanbaatar: UNICEF; 2011.
41.
Nyamkhorol D, Bayasgalan D, Ariuntuya S, Unurtsetseg T. Health indicators 2010. Ulaanbaatar: Government of Mongolia; 2010.
42.
43.
de Onis M, Blössner M, Borghi E. Prevalence and trends of stunting among pre-school children, 1990–2020. Public Health Nutr. 2012;15(1):142–8.CrossRefPubMed
44.
Bhutta ZA, Das JK, Walker N, et al. Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost? Lancet. 2013;381(9875):1417–29.CrossRefPubMed
45.
Lim SS, Stein DB, Charrow A, Murray CJ. Tracking progress towards universal childhood immunisation and the impact of global initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage. Lancet (London, England). 2008;372(9655):2031–46.CrossRef
46.
Bomela NJ. Social, economic, health and environmental determinants of child nutritional status in three central Asian republics. Public Health Nutr. 2009;12(10):1871–7.CrossRefPubMed
47.
World Vision International. FY12 ADP baseline survey report. Mongolia: World Vision International; 2012.
48.
Hill K, Upchurch DM. Gender differences in child health: evidence from the demographic and health surveys. Popul Dev Rev. 1995;1995:127–51.CrossRef
49.
Smith RJ. Ending poverty in Mongolia: from socialism to social development. Int J Soc Welf. 2015;24(2):159–69.CrossRef
50.
51.
Boyle MH, Racine Y, Georgiades K, et al. The influence of economic development level, household wealth and maternal education on child health in the developing world. Soc Sci Med. 2006;63(8):2242–54.CrossRefPubMed
52.
Heaton TB, Forste R, Hoffmann JP, Flake D. Cross-national variation in family influences on child health. Soc Sci Med. 2005;60(1):97–108.CrossRefPubMed
53.
Kriti V, Reeve V, Sonalde D. Linkages between maternal education and childhood immunization in India. Soc Sci Med. 2012;75(2):331–9.CrossRef
54.
Novignon J, Aboagye E, Agyemang OS, Aryeetey G. Socioeconomic-related inequalities in child malnutrition: evidence from the Ghana multiple indicator cluster survey. Heal Econ Rev. 2015;5(1):34.CrossRef
55.
56.
Victora CG, de Onis M, Hallal PC, Blössner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics. 2010;125(3):e473–e80.CrossRefPubMed
57.
Arabi M, Frongillo EA, Avula R, Mangasaryan N. Infant and young child feeding in developing countries. Child Dev. 2012;83(1):32–45.CrossRefPubMed
58.
Lander R, Enkhjargal T, Batjargal J, et al. Poor dietary quality of complementary foods is associated with multiple micronutrient deficiencies during early childhood in Mongolia. Public Health Nutr. 2010;13(09):1304–13.CrossRefPubMed
59.
Bayandorj T. Early infant nutrition with special regard to breastfeeding and swaddling practices in Mongolia. Bristol: University of the West of England; 2012.
60.
Mathew JL. Inequity in childhood immunization in India: a systematic review. Indian Pediatr. 2012;49(3):203–23.CrossRefPubMed
61.
Pande RP, Yazbeck AS. Beyond National Averages for immunization in India: income, gender, and regional inequalities. Washington, D.C.: The World Bank: Health, Nutrition and Popualtion; 2002.
62.
Mitchell S, Andersson N, Ansari NM, Omer K, Soberanis JL, Cockcroft A. Equity and vaccine uptake: a cross-sectional study of measles vaccination in Lasbela District, Pakistan. BMC international health and human rights. 2009;9(Suppl 1):S7.CrossRefPubMedPubMedCentral
63.
Hausmann R, Tyson LD, Zahidi S. The global gender gap report. World economic forum 2008.
64.
WHO. Immunization summary: a statistical reference containing data through 2013. New York City: WHO and UNICEF; 2014.
Metadata
Title
Social and environmental determinants of child health in Mongolia across years of rapid economic growth: 2000-2010
Authors
Nehal Joshi
Bolormaa Bolorhon
Indermohan Narula
Shihua Zhu
Semira Manaseki-Hollan
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-017-0684-x

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