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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2016

Open Access 01-12-2016 | Research

Trends and determinants of inequities in childhood stunting in Bangladesh from 1996/7 to 2014

Authors: Atonu Rabbani, Akib Khan, Sifat Yusuf, Alayne Adams

Published in: International Journal for Equity in Health | Issue 1/2016

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Abstract

Background

We explore long-term trends and determinants of socioeconomic inequities in chronic childhood undernutrition measured by stunting among under-five children in Bangladesh. Given that one in three children remain stunted in Bangladesh, the socioeconomic mapping of stunting prevalence may be critical in designing public policies and interventions to eradicate childhood undernutrition.

Methods

Six rounds of Bangladesh Demographic and Health Survey data are utilized, spanning the period 1996/97 to 2014. Using recognized measures of absolute and relative inequality (namely, absolute and relative difference, concentration curve and index), we quantify trends, and decompose changes in the concentration index to identify factors that best explain observed dynamics.

Results

Despite remarkable improvements in average nutritional status over the last two decades, socio-economic inequalities have persisted, and according to some measures, even worsened. For example, expressed as rate-ratios, the relative inequality in under-five stunting increased by 56% and the concentration index more than doubled between 1996/97 and 2014. Decomposition analyses find that wealth and maternal factors such as mothers’ schooling and short stature are major contributors to observed socio-economic inequalities in child undernutrition and their changes over time.

Conclusions

Reflecting on recent success around socioeconomic and gender equity in child mortality, and the weak legacy of nutrition policy in Bangladesh, we suggest that nutrition programming energies be focused specifically on the most disadvantaged and applied at scale to close socioeconomic gaps in stunting prevalence.
Appendix
Available only for authorised users
Footnotes
1
The conclusions do not change remarkably when we consider negative height-for-age z scores as the outcome variables. The results are reported in Tables 7 and 8 in Appendix.
 
2
Statistically, the variables included in our model can only capture observed variation generating the inequality in the stunting outcomes. We have included the determinants as allowed by the data we are using (DHS) and also guided by the prior literature (see Wagstaff et al. [44], Headey et al. [16]). It is interesting that the typical set of explanatory variables used to explain inequality in stunting outcomes had less statistical power in 2014, and suggests the need for renewed thinking about best policy approaches for redressing inequities.
 
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Metadata
Title
Trends and determinants of inequities in childhood stunting in Bangladesh from 1996/7 to 2014
Authors
Atonu Rabbani
Akib Khan
Sifat Yusuf
Alayne Adams
Publication date
01-12-2016
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2016
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-016-0477-7

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