Department of Statistics, Vivekananda College, Thakurpukur, Kolkata, India.
Department of Population & Development, International Institute for Population Sciences, Mumbai, Maharashtra, Indiaa.
PLoS One. 2024 Nov 14;19(11):e0313596. doi: 10.1371/journal.pone.0313596. eCollection 2024.
Almost two-fifth of the children in India is stunted and among various factors, poverty differential in child undernutrition is the largest. Using the latest population-based survey of National Family Health Survey, 2015-16 and 2019-21 this paper examined the poverty induced inequality in child stunting across the sub-populations of India.
A sample of 213,136 children aged between 0-5 years from NFHS fourth round and 98,222 children in the same age group from the NFHS fifth round constitute the study sample. The wealth index is used as the proxy of household's economic wellbeing and height-for-age (HAZ) z-score of a child is used to identify the stunting status of the child. Box plots are drawn to understand the distributional characteristics of the HAZ score for both the study sample. We calculate the Erreygers corrected concentration index and decomposed the concentration indices using Gonzalo-Almorox and Urbanos-Garrido method.
During 2015-16, more than half of the children from the poorest wealth quintile were stunted (52%), compared to 22% among the children from richest wealth quintile. In 2015-16, stunting was as high as 65% among the children of mothers with low stature (height less than 145 cm) and from the poorest wealth quintile whereas, the prevalence was observed 56% from the same sub-population during 2019-21. Among various factors, the concentration index of stunting was observed highest among the children of 36-47 months (-0.28) followed by children of age 48-59 months (-0.27) and among the fully immunized children (-0.25). Similar to NFHS-4, NFHS-5 also shows a predominantly higher socio-economic inequality among 24+ months children and among the fully immunised children. Factors like child age, birth order and sanitation showed positive elasticity. Decomposition analysis of NFHS-4 data shows that due to uneven distribution of wealth, mother's education as a determinant of child stunting solely explained 33% of the overall inequality followed by improved access to sanitation (24%), mother's height (8%) and place of residence (5%). Similar to NFHS-4, NFHS-5 data also shows that mother's education, sanitation, mother's height and place of residence predominantly contributes to the overall wealth inequality in child stunting.
In India, poverty differential in child undernutrition is acute among the different sub-population of children. And the concentration of stunted children is higher among the different sub-population with higher wealth poverty. Mother's education, improved sanitation and mother's height explained larger variation in the overall inequalities in child nutrition across India.
印度近五分之二的儿童发育迟缓，在各种因素中，儿童营养不足的贫困差异最大。本文利用最新的基于人口的全国家庭健康调查（NFHS）2015-16 年和 2019-21 年的数据，研究了印度各亚人群中因贫困导致的儿童发育迟缓的不平等现象。
本研究的样本包括 NFHS 第四轮调查中年龄在 0-5 岁之间的 213136 名儿童和同年龄组的 NFHS 第五轮调查中的 98222 名儿童。财富指数被用作家庭经济福祉的代表，儿童的身高年龄（HAZ）z 分数用于确定儿童发育迟缓的状况。绘制箱线图以了解研究样本中 HAZ 分数的分布特征。我们计算了 Erreygers 校正的集中指数，并使用 Gonzalo-Almorox 和 Urbanos-Garrido 方法对集中指数进行了分解。
在 2015-16 年，最贫困的五分之一财富阶层的儿童中，有一半以上（52%）发育迟缓，而最富裕的五分之一财富阶层的儿童中只有 22%发育迟缓。在 2015-16 年，母亲身高较矮（身高低于 145 厘米）且来自最贫困财富阶层的儿童中，发育迟缓的比例高达 65%，而在 2019-21 年，同一亚人群中观察到的比例为 56%。在各种因素中，36-47 个月儿童的发育迟缓集中指数最高（-0.28），其次是 48-59 个月儿童（-0.27）和完全免疫儿童（-0.25）。与 NFHS-4 相似，NFHS-5 也显示出 24 个月以上儿童和完全免疫儿童之间的社会经济不平等程度更高。儿童年龄、出生顺序和卫生等因素表现出正弹性。NFHS-4 数据的分解分析表明，由于财富分布不均，母亲的教育作为儿童发育迟缓的决定因素，仅单独解释了整体不平等的 33%，其次是改善卫生设施（24%）、母亲身高（8%）和居住地（5%）。与 NFHS-4 相似，NFHS-5 数据还表明，母亲的教育、卫生、母亲的身高和居住地主要导致了印度儿童营养整体财富不平等。
在印度，不同儿童亚人群中儿童营养不足的贫困差异很严重。在不同的高财富贫困亚人群中，发育迟缓儿童的集中程度更高。母亲的教育、改善的卫生条件和母亲的身高解释了印度儿童营养整体不平等的更大变化。
