Department of Economics, University of Chitral, Chitral, Pakistan.
American University of Beirut, Beirut, Lebanon.
BMC Public Health. 2020 Jun 17;20(1):952. doi: 10.1186/s12889-020-09110-9.
Pakistan is facing a serious problem of child under-nutrition as about 38% of children in Pakistan are stunted. Punjab, the largest province by population and contributes high gross domestic product (GDP) share in economy has reported 27% moderately and 10% severely stunted children of less than 5 years. Thus, this study aims at examining the determinants of stunting (moderate and severe) at different level of hierarchy empirically in Punjab province of Pakistan.
Data for this study is coming from Punjab Multiple Indicators Cluster Survey (MICS-2014), used two-stage, stratified cluster sampling approach. Sub-national level data covering urban and rural areas were used for this study consists of 25,067 children less than 5 year's ages, from nine administrative divisions and 36 districts of Punjab province of Pakistan. Descriptive statistics and multilevel hierarchical models were estimated. Multilevel data analyses have an advantage because it provides robust standard error estimates and helps in finding variation in the data at various levels.
Punjab has a stunting prevalence of about 27% moderately and 10% severely stunted children of less than 5 years. The results depict that increasing the age of the child, increasing birth order, illiterate mothers and fathers, lack of sanitation facilities and being poor are associated significantly with the likelihood of moderate and severe stunting. Surprisingly, there is a gender bias in stunting in Punjab, Pakistan and being a girl child is more likely associated with moderate and severe stunting, which shows the patriarchal nature of the society and a substantial prevalence of gender bias in household resource allocations.
This outcome of our analysis points towards targeting not only households (focus on girls) but also their families and communities.
巴基斯坦面临着儿童营养不足的严重问题，约有 38%的儿童发育不良。人口最多、国内生产总值（GDP）贡献份额最高的旁遮普省报告称，5 岁以下儿童中，有 27%存在中度发育迟缓，10%存在严重发育迟缓。因此，本研究旨在从实证角度研究旁遮普省不同层次中度和重度发育迟缓的决定因素。
本研究的数据来自旁遮普多指标类集调查（MICS-2014），采用两阶段、分层聚类抽样方法。本研究使用了涵盖城乡地区的省级数据，包括来自巴基斯坦旁遮普省 9 个行政分区和 36 个区的 25067 名 5 岁以下儿童。采用描述性统计和多层次层次模型进行估计。多水平数据分析具有优势，因为它提供了稳健的标准误差估计，并有助于在各个层面上发现数据的变化。
旁遮普省 5 岁以下儿童中度发育迟缓率约为 27%，重度发育迟缓率约为 10%。结果表明，儿童年龄增加、出生顺序增加、父母文盲、缺乏卫生设施和贫困与中度和重度发育迟缓的可能性显著相关。令人惊讶的是，旁遮普省存在性别偏见，女孩更有可能出现中度和重度发育迟缓，这反映了社会的父权性质和家庭资源分配中严重的性别偏见。
我们的分析结果表明，不仅要针对家庭（关注女孩），还要针对他们的家庭和社区。
