Department of Food Economics and Marketing, School of Agriculture, Policy and Development, University of Reading, Reading RG6 6AR, UK.
BMC Public Health. 2013 Jun 14;13:581. doi: 10.1186/1471-2458-13-581.
The persistence of rural-urban disparities in child nutrition outcomes in developing countries alongside rapid urbanisation and increasing incidence of child malnutrition in urban areas raises an important health policy question - whether fundamentally different nutrition policies and interventions are required in rural and urban areas. Addressing this question requires an enhanced understanding of the main drivers of rural-urban disparities in child nutrition outcomes especially for the vulnerable segments of the population. This study applies recently developed statistical methods to quantify the contribution of different socio-economic determinants to rural-urban differences in child nutrition outcomes in two South Asian countries - Bangladesh and Nepal.
Using DHS data sets for Bangladesh and Nepal, we apply quantile regression-based counterfactual decomposition methods to quantify the contribution of (1) the differences in levels of socio-economic determinants (covariate effects) and (2) the differences in the strength of association between socio-economic determinants and child nutrition outcomes (co-efficient effects) to the observed rural-urban disparities in child HAZ scores. The methodology employed in the study allows the covariate and coefficient effects to vary across entire distribution of child nutrition outcomes. This is particularly useful in providing specific insights into factors influencing rural-urban disparities at the lower tails of child HAZ score distributions. It also helps assess the importance of individual determinants and how they vary across the distribution of HAZ scores.
There are no fundamental differences in the characteristics that determine child nutrition outcomes in urban and rural areas. Differences in the levels of a limited number of socio-economic characteristics - maternal education, spouse's education and the wealth index (incorporating household asset ownership and access to drinking water and sanitation) contribute a major share of rural-urban disparities in the lowest quantiles of child nutrition outcomes. Differences in the strength of association between socio-economic characteristics and child nutrition outcomes account for less than a quarter of rural-urban disparities at the lower end of the HAZ score distribution.
Public health interventions aimed at overcoming rural-urban disparities in child nutrition outcomes need to focus principally on bridging gaps in socio-economic endowments of rural and urban households and improving the quality of rural infrastructure. Improving child nutrition outcomes in developing countries does not call for fundamentally different approaches to public health interventions in rural and urban areas.
发展中国家的城乡儿童营养状况存在差距，城市化进程迅速，城市地区儿童营养不良的发生率不断上升，这引发了一个重要的卫生政策问题——农村和城市地区是否需要根本不同的营养政策和干预措施。要回答这个问题，就需要深入了解导致城乡儿童营养状况差异的主要因素，特别是针对人口中的弱势群体。本研究应用最近开发的统计方法，定量分析了孟加拉国和尼泊尔这两个南亚国家城乡儿童营养结果差异的主要决定因素。
利用孟加拉国和尼泊尔的 DHS 数据集，我们应用基于分位数回归的反事实分解方法，量化了（1）社会经济决定因素水平差异（协变量效应）和（2）社会经济决定因素与儿童营养结果之间关联强度差异（系数效应）对儿童身高别体重（HAZ）得分观察到的城乡差异的贡献。该研究采用的方法允许协变量和系数效应在儿童营养结果的整个分布范围内变化。这在提供影响儿童 HAZ 得分分布低端城乡差异因素的具体见解方面特别有用。它还有助于评估个别决定因素的重要性及其在 HAZ 得分分布中的变化情况。
城乡地区决定儿童营养结果的特征没有根本差异。少数社会经济特征（母亲教育、配偶教育和财富指数（包含家庭资产所有权以及获得饮用水和卫生设施的情况））水平的差异，对儿童营养结果最低分位数的城乡差异贡献很大。社会经济特征与儿童营养结果之间关联强度的差异，在 HAZ 得分分布低端仅占城乡差异的不到四分之一。
旨在克服城乡儿童营养结果差距的公共卫生干预措施，需要主要集中在弥合城乡家庭社会经济赋存差距，改善农村基础设施质量上。在发展中国家改善儿童营养结果，并不需要对农村和城市地区的公共卫生干预措施采取根本不同的方法。
