Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria; Division of Health Sciences, Populations, Evidence and Technologies Group, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Department of Economics, School of Management Technology, Federal University of Technology, Akure, Nigeria.
Public Health. 2021 Apr;193:83-93. doi: 10.1016/j.puhe.2020.12.009. Epub 2021 Mar 18.
The aim of the study was to assess the magnitude of wealth inequalities in the development of diarrhoea among under-five children in low- and middle-income countries (LMICs) and to identify and quantify contextual and compositional factors' contribution to the inequalities.
This is a cross-sectional study.
We used cross-sectional data from 57 Demographic and Health Surveys conducted between 2010 and 2018 in LMICs. Descriptive statistics were used to understand the gap in having diarrhoea between the children from poor and non-poor households and across the selected covariates using Fairlie decomposition techniques with multivariable binary logistic regressions at P = 0.05.
Of the 57 countries, we found a statistically significant pro-poor odds ratio in only 29 countries, 7 countries showed pro-non-poor inequality and others showed no statistically significant inequality. Among the countries with statistically significant pro-poor inequality, the risk difference was largest in Cameroon (94.61/1000), whereas the largest pro-non-poor risk difference in diarrhoea was widest in Timor-Leste (-41.80/1000). Important factors responsible for pro-poor inequality varied across countries. The largest contributors to the pro-poor inequalities in having diarrhoea are maternal education, access to media, neighbourhood socio-economic status, place of residence, birth order and maternal age.
Diarrhoea remains a major challenge in most LMICs, with a wide range of pro-poor inequalities. These disparities were explained by both compositional and contextual factors, which varied widely across the countries. Thus, multifaceted geographically specific economic alleviation intervention may prove to be a potent approach for addressing the poor and non-poor differentials in the risk of diarrhoea with policies tailored to country-specific risk factors. There is a need for further investigation of factors that drive pro-non-poor inequalities found in 9 of the LMICs.
本研究旨在评估低收入和中等收入国家（LMICs）五岁以下儿童腹泻发展过程中的财富不平等程度，并确定和量化背景和构成因素对不平等的贡献。
这是一项横断面研究。
我们使用了 2010 年至 2018 年期间在 LMICs 进行的 57 项人口与健康调查的横断面数据。使用描述性统计数据来了解贫困家庭和非贫困家庭儿童之间以及通过 Fairlie 分解技术和多变量二项逻辑回归在 P = 0.05 下在选定协变量方面的腹泻发生率差距。
在 57 个国家中，我们仅在 29 个国家中发现了具有统计学意义的有利于穷人的优势比，7 个国家表现出有利于非穷人的不平等，其他国家则没有表现出统计学意义上的不平等。在具有统计学意义的有利于穷人的不平等国家中，喀麦隆的风险差异最大（94.61/1000），而东帝汶腹泻的最大非穷人风险差异最宽（-41.80/1000）。造成有利于穷人不平等的重要因素因国家而异。导致腹泻有利于穷人不平等的最大因素是母亲教育、媒体获取、邻里社会经济地位、居住地、出生顺序和母亲年龄。
腹泻仍然是大多数 LMICs 的主要挑战，存在广泛的有利于穷人的不平等。这些差异由构成和背景因素解释，这些因素在各国之间差异很大。因此，针对具体国家特定风险因素量身定制的政策，采取多方面的、具有地域针对性的经济缓解干预措施，可能是解决贫困和非贫困人口腹泻风险差异的有效方法。需要进一步调查导致 9 个 LMICs 中非贫困人口不平等的因素。
