Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Tanzania.
Department of Mathematics and Statistics, College of Business Education, P.O. Box 1968, Dar es Salaam, Tanzania.
Int J Equity Health. 2021 Jan 23;20(1):46. doi: 10.1186/s12939-021-01389-3.
Child stunting is a global health concern. Stunting leads to several consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania from from 50% in 1991/92 to 34% in 2016 although the prevalence is still high (34%)Stunting varyies across socioeconomic determinants with a larger burden among the socioeconomic disadvantaged group. The reduction of inequalities in stunting is very crucial as we aim to reduce stunting to 28% by 2021 and hence attain zero malnutrition by 2030 under Sustainable Development Goal 2.2.This study aimed at determining the trend, contributing factors and changes of inequalities in stunting among children aged 3-59 months from 2004 to 2016.
Data were drawn from the Tanzania Demographic and Health Surveys. The concentration index (CIX) was used to quantify the magnitude of inequalities in stunting. The pooled Poisson regression model was used to determine the factors for stunting, decision criterion for significant determinants was at 5% level of significance. The CIX was decomposed using the Wagstaff and Watanabe decomposition methods., the percentage contribution of each factor to the toal concentration index was used to rank the factors for socioeconomic inequalities in stutning.
Inequalities in stunting were significantly concentrated among the poor; evidenced by CIX = - 0.019 (p < 0.001) in 2004, - 0.018 (p < 0.001) in 2010 and - 0.0096 (p < 0.001) in 2015. There was insignificant decline in inequalities in stunting; the difference in CIX from 2004 to 2010 was 0.0015 (p = 0.7658), from 2010 to 2015/6 was - 0.0081 (p = 0.1145). The overall change in CIX from 2004 to 2015/6 was 0.00965 (p = 0.0538). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) had positive impacts on the levels of inequalities in stunting for all surveyed years. Rural-urban differences reduced inequalities in stunting although the contribution changed over time.
Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution to the levels of inequalities in stunting. Reducing stunting among the disadvantaged groups requires initiatives which should be embarked on the distribution of social services including maternal and reproductive education among women of reproductive age, water and health infrastructures in remote areas.
儿童发育迟缓是全球关注的健康问题。发育迟缓会导致儿童生存、生长和发育方面的一系列后果。坦桑尼亚的发育迟缓绝对水平已经从 1991/92 年的 50%下降到 2016 年的 34%，尽管这一比例仍然很高（34%）。发育迟缓在社会经济决定因素方面存在差异，社会经济劣势群体的负担更大。减少发育迟缓方面的不平等至关重要，因为我们的目标是到 2021 年将发育迟缓率降低到 28%，并在可持续发展目标 2.2 下到 2030 年实现零营养不良。本研究旨在确定 2004 年至 2016 年间 3-59 个月儿童发育迟缓的趋势、促成因素和不平等变化。
数据来自坦桑尼亚人口与健康调查。集中指数（CIX）用于量化发育迟缓不平等的程度。使用多泊松回归模型确定发育迟缓的因素，显著决定因素的决策标准为 5%的显著性水平。使用 Wagstaff 和 Watanabe 分解方法对 CIX 进行分解，每个因素对总集中指数的贡献百分比用于对发育迟缓的社会经济不平等因素进行排名。
贫困儿童的发育迟缓程度显著集中；2004 年的 CIX 为-0.019（p<0.001），2010 年为-0.018（p<0.001），2015 年为-0.0096（p<0.001）。发育迟缓不平等程度没有明显下降；2004 年至 2010 年的 CIX 差异为 0.0015（p=0.7658），2010 年至 2015/6 年的差异为-0.0081（p=0.1145）。2004 年至 2015/6 年期间 CIX 的总体变化为 0.00965（p=0.0538）。财富指数（平均贡献>84.7%）和产妇受教育年限（平均贡献>22.4%）的分布差异对所有调查年份的发育迟缓不平等程度都有积极影响。城乡差异虽然随着时间的推移而变化，但减少了发育迟缓的不平等。
发育迟缓不平等程度下降，财富指数和产妇教育方面的差异增加了发育迟缓不平等程度。减少弱势群体的发育迟缓需要采取措施，在偏远地区分配包括产妇和生殖教育在内的社会服务，以及水和卫生基础设施。
