School of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Amana, Ethiopia.
School of Health Sciences, Western Sydney University, Penrith, NSW, Australia.
Sci Rep. 2024 Feb 9;14(1):3326. doi: 10.1038/s41598-024-53280-0.
Undernourishment is a persistent public health problem contributing to increased mortality in children under five in low-income countries, likely exacerbated by socio-economic disparities within communities. This paper aimed to examine the effect of wealth-related inequality on undernutrition in children under five in low, lower-middle, and upper-middle-income countries (LMICs). We analyzed cross-sectional data from the demographic and health survey program collected between 2017 and 2022 from 24 LMICs. Children born within 5 years preceding the survey were included in the analysis. Child undernutrition was the dependent variable (measured by stunting, wasting, and underweight) and country-level wealth-based inequality was the independent variable assessed by concentration index values stratified by the World Bank's income categories. Within country inequality of child undernutrition was determined by concentration index (C) values with 95% confidence intervals (95% CI) and sub-group analysis by place of residence and sex of the child. We then fit bootstrapped meta-regression to check the variation in inequality of child undernutrition across different income category countries. The analysis was controlled by potential confounding variables. From the total sample size of 334,502 children included in the study, 35% were undernourished. Wealth-related inequality in child undernutrition was observed in 11 countries, consistently across income categories. Child undernutrition was highly concentrated among the poor households of Türkiye [C: - 0.26, 95% CI - 0.31 to - 0.20], and Cameroon [C: - 0.19, 95% CI - 0.22 to - 0.17], and relatively it was less concentrated among the poor in Liberia [C: - 0.07, 95% CI - 0.11 to - 0.04], and Gambia [C: - 0.07, 95% CI - 0.11 to - 0.04]. There is no difference in undernutrition associated with inequality between the three broad LMIC categories. The wealth-related inequality in child undernutrition within many of the included countries is still very significant. However, the economic category of countries made no difference in explaining wealth-related inequality in child undernutrition. Inter-sectoral collaboration to fight poverty and render special attention to the disadvantaged population segments would potentially help to address the observed inequity.
营养不足是低收入国家五岁以下儿童死亡率上升的一个持续存在的公共卫生问题，这种情况可能因社区内部的社会经济差距而加剧。本文旨在研究财富相关不平等对低收入国家、中下收入国家和中上收入国家（LMICs）五岁以下儿童营养不足的影响。我们分析了 2017 年至 2022 年期间来自 24 个 LMICs 的人口与健康调查计划的横断面数据。调查前 5 年内出生的儿童被纳入分析。儿童营养不足是因变量（通过发育迟缓、消瘦和体重不足来衡量），国家层面的财富相关不平等是自变量，通过世界银行收入类别分层的集中指数值来评估。国家内部儿童营养不足的不平等程度是通过集中指数（C）值来确定的，这些值带有 95%置信区间（95%CI），并通过儿童居住地和性别进行亚组分析。然后，我们进行了 bootstrap 元回归分析，以检查不同收入类别国家儿童营养不足不平等程度的变化。分析通过潜在混杂变量进行了控制。在研究中，共有 334502 名儿童被纳入总样本量，其中 35%存在营养不足。在 11 个国家观察到了儿童营养不足与财富相关的不平等，这一现象在所有收入类别中都存在。儿童营养不足在土耳其[C：-0.26，95%CI-0.31 至-0.20]和喀麦隆[C：-0.19，95%CI-0.22 至-0.17]的贫困家庭中高度集中，而在利比里亚[C：-0.07，95%CI-0.11 至-0.04]和冈比亚[C：-0.07，95%CI-0.11 至-0.04]的贫困家庭中相对较少集中。在三个广泛的 LMIC 类别中，营养不足与不平等之间没有差异。在许多被纳入的国家中，儿童营养不足与财富相关的不平等仍然非常显著。然而，国家的经济类别并不能解释儿童营养不足与财富相关的不平等。部门间合作以消除贫困并特别关注弱势群体，这可能有助于解决所观察到的不平等现象。
