Paul Pavitra, Arra Bhanu, Hakobyan Mihran, Hovhannisyan Marine G, Kauhanen Jussi
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
United Nations Children's Fund, Yerevan, Armenia.
PLoS One. 2021 May 26;16(5):e0249776. doi: 10.1371/journal.pone.0249776. eCollection 2021.
Stunting undermines economic growth by perpetuating the vicious cycle of poverty and labour market performance. Studies have captured the trend in stunting and present distributional evidence of policy effects in the country contexts. We identify the determinants of U5 (under 5 years of age) malnutrition for the poor and the Nonpoor and compare the distribution of stunting at four time points (2000, 2005, 2010 and 2015) over a 15-year period between different groups of population. Further, we decompose the gap in malnutrition into causes of differences in stunting between worse-off and better-off socioeconomic groups of the population and estimate the magnitude of distributional differences in stunting between two socioeconomic groups. We also present the inequality trend over time that provides insights into the dynamicity of the effect of different determinants on stunting at different time points. Using 35,490 observations from Armenian Demographic and Health Survey Data [four waves: Year2015,9533; Year2010,8644; Year2005,8919; Year2000,8334], we apply regression-based decomposition method and inequality measures to identify the determinants of malnutrition and distribution of stunting between and within socioeconomic groups. Although the proportional difference in prevalence of stunting between worse-off and better-off children of 13 months and above are reduced by 9.5% in 2015 compared to 2000, the association between socioeconomic position and stunting is statistically significant among children aged 13 months and above in 2000, as well as among children of 36 months and above in 2015. This study demonstrates that the less of socioeconomic distribution of the population, but rather more of the effect from in-country region and settlement of residence are significantly associated with stunting. The approach of our analysis is potentially also a useful tool to generate evidence for decision making towards achieving SDGs 2.2. We conclude that development in childhood is not independent from the distributional effect of region specific development initiatives. Understanding the regional characteristics and resources allocated for the maternal and child health is the necessity to address stunting.
发育迟缓通过使贫困和劳动力市场表现的恶性循环持续存在，从而损害经济增长。研究捕捉到了发育迟缓的趋势，并展示了各国政策效果的分布证据。我们确定了贫困和非贫困人群中5岁以下儿童营养不良的决定因素，并比较了15年间四个时间点（2000年、2005年、2010年和2015年）不同人群组之间发育迟缓的分布情况。此外，我们将营养不良差距分解为人口中经济状况较差和较好的社会经济群体之间发育迟缓差异的原因，并估计两个社会经济群体之间发育迟缓分布差异的程度。我们还展示了随时间变化的不平等趋势，这为不同决定因素在不同时间点对发育迟缓的影响动态提供了见解。利用亚美尼亚人口与健康调查数据中的35490条观测值[四个调查周期：2015年，9533条；2010年，8644条；2005年，8919条；2000年，8334条]，我们应用基于回归的分解方法和不平等度量来确定营养不良的决定因素以及社会经济群体之间和内部发育迟缓的分布情况。尽管与2000年相比，2015年13个月及以上经济状况较差和较好儿童之间发育迟缓患病率的比例差异降低了9.5%，但2000年13个月及以上儿童以及2015年36个月及以上儿童中，社会经济地位与发育迟缓之间的关联在统计学上具有显著性。这项研究表明，与发育迟缓显著相关的并非人口的社会经济分布情况，而是国内地区和居住定居点的影响。我们的分析方法可能也是为实现可持续发展目标2.2提供决策依据的有用工具。我们得出结论，儿童时期的发展并非独立于地区特定发展举措的分布效应。了解为母婴健康分配的地区特征和资源是解决发育迟缓问题的必要条件。
