Ayres Aznamariam, Tsega Yawkal, Endawkie Abel, Kebede Shimels Derso, Abeje Eyob Tilahun, Enyew Ermias Bekele, Daba Chala, Asmare Lakew, Muche Amare, Bayou Fekade Demeke, Arefaynie Mastewal, Mekonen Asnakew Molla, Tareke Abiyu Abadi, Keleb Awoke, Abera Kaleab Mesfin, Kebede Natnael, Gebeyehu Endalkachew Mesfin
Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Department of Health System and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
BMC Public Health. 2025 Feb 3;25(1):430. doi: 10.1186/s12889-025-21634-6.
Undernutrition remains a global challenge and public health concern, despite the presence of policies, programs and interventions. There is substantial evidence that the majority of the rural children under-5 years old have composite index of anthropometric failure than the urban counter parts. Hence, identifying the main contributors of these disparities will help health policy makers, program designers and implementers for the reduction of composite index of anthropometric failures in children under-5 years old in the study areas.
The most recent and nationally representative samples of demographic and health surveys of five East African countries data were used for the current study. To appreciate the residence-based differences of composite index of anthropometric failure in under-5 children, the Blinder-Oaxaca decomposition analysis and its extensions were employed to determine the effects of covariates and coefficients. The country specific survey data analysis was performed.
The current study revealed that the burden of composite index of anthropometric failure (CIAF) in under-5 children were 40.69%, 22.04%, 34.06%, 31.99%, and 33.27% in Ethiopia, Kenya, Rwanda, Uganda, and Tanzania respectively. The residence-based differences in CIAF were 25.49%, 11.38%, 27%, 22.15%, and 20.55% in Ethiopia, Kenya, Rwanda, Uganda, and Tanzania respectively. Results of the Blinder-Oaxaca decomposition analysis and its extensions revealed that 100% of the rural-urban children under-5 composite index of anthropometric failure disparity was explained by endowment characteristics (covariate effect). Wealth index, mother's education, age of child, type of birth, sex of child and birth interval inequality between rural and urban households explains most of the composite index of anthropometric failure disparity in children under-5 years old.
The residence-based CIAF differences were high in all study countries. The rural-urban CIAF gap is ascribed by household, maternal and child characteristics. This result implies that rural children under-5 is disproportionally disadvantaged with respect to characteristics than their consequences. Through identification of the underlying factors behind the rural-urban CIAF disparities, the result of this study is important in planning effective intervention measures aiming at reducing residence-based inequalities and the population health outcomes. Therefore, should be given for rural children to reduce CIAF by improving house hold wealth index, women education and attentions to older children, and female children.
尽管存在相关政策、项目和干预措施，但营养不良仍然是一项全球性挑战和公共卫生问题。有大量证据表明，大多数5岁以下农村儿童的人体测量失败综合指数高于城市儿童。因此，确定这些差异的主要影响因素将有助于卫生政策制定者、项目设计者和实施者降低研究地区5岁以下儿童的人体测量失败综合指数。
本研究使用了五个东非国家人口与健康调查中最新的全国代表性样本数据。为了解5岁以下儿童人体测量失败综合指数的城乡差异，采用了布林德-奥萨克分解分析及其扩展方法来确定协变量和系数的影响。进行了各国具体调查数据分析。
本研究显示，埃塞俄比亚、肯尼亚、卢旺达、乌干达和坦桑尼亚5岁以下儿童人体测量失败综合指数（CIAF）的负担分别为40.69%、22.04%、34.06%、31.99%和33.27%。埃塞俄比亚、肯尼亚、卢旺达、乌干达和坦桑尼亚基于居住地的CIAF差异分别为25.49%、11.38%、27%、22.15%和20.55%。布林德-奥萨克分解分析及其扩展结果显示，5岁以下农村与城市儿童人体测量失败综合指数差异的100%可由禀赋特征（协变量效应）解释。财富指数、母亲教育程度、孩子年龄、出生类型、孩子性别以及城乡家庭之间的生育间隔不平等解释了5岁以下儿童人体测量失败综合指数差异的大部分原因。
在所有研究国家中，基于居住地的CIAF差异都很高。城乡CIAF差距归因于家庭、母亲和儿童的特征。这一结果意味着5岁以下农村儿童在特征方面比其后果方面处于不成比例的劣势。通过确定城乡CIAF差异背后的潜在因素，本研究结果对于规划有效的干预措施以减少基于居住地的不平等和改善人群健康状况具有重要意义。因此，应通过提高家庭财富指数、女性教育水平以及对大龄儿童和女童的关注来降低农村儿童的CIAF。
