Tan Lijing, Shahid Muhammad, Song Jiayi, Muhammad Naveed Hafiz, Khan Itbar
School of Management, Shenzhen University of Information Technology, Shenzhen, China.
College of Management, Shenzhen University, Shenzhen, China.
Front Public Health. 2025 Aug 15;13:1654403. doi: 10.3389/fpubh.2025.1654403. eCollection 2025.
In developing countries like Pakistan, the prevalence of malnutrition embodies a multifaceted development challenge, intricately linked to structural inequalities, with disproportionate burdens among socioeconomically and geographically disadvantaged populations.
Drawing on the most recent Pakistan Demographic and Health Survey (2017-18), this study examines the magnitude of child undernutrition disparities across wealth quintiles and geographic regions. This study employs the Concentration Index (CI) with decomposition analysis, alongside Oaxaca-Blinder decomposition as robust.
The results of the concentration index reveal that child undernutrition in Pakistan is deeply rooted in socioeconomic disparities, with household wealth contributing the largest share (45.6%) to overall inequality. The negative values of both relative and absolute CI confirm a pronounced pro-poor concentration of malnutrition. Regional disparities also play a significant role, with Sindh, Khyber Pakhtunkhwa, Balochistan, and FATA jointly accounting for 12.9% of inequality. Notably, maternal illiteracy emerges as a critical determinant, explaining 24.1% of the observed nutritional inequity. The results of the OaxacaBlinder decomposition disclose a pronounced wealth gap in child malnutrition, with poor households experiencing a 25.5 percentage point higher likelihood of malnutrition compared to their wealthier counterparts. Approximately 65% of the explained disparity is attributed to household wealth status, maternal education, and geographic region, underscoring the structural nature of nutritional inequalities in Pakistan.
The study concludes that child malnutrition in Pakistan is fundamentally a structural equity issue. Addressing this issue requires multisectoral policy interventions focused on economic empowerment, regional development, and girls' education to break the intergenerational cycle of undernutrition. Moreover, Pakistan's extreme concentration of wealth and regional marginalization create distinct disparities that standard regional models do not fully capture. The dominance of wealth and regional factors, accounting for 65% of the explained gap, highlights the need for structural solutions, such as wealth redistribution and provincial equity funds, rather than isolated health interventions.
在巴基斯坦这样的发展中国家，营养不良的流行体现了一个多方面的发展挑战，与结构不平等错综复杂地联系在一起，在社会经济和地理上处于不利地位的人群中负担不均衡。
本研究利用最新的巴基斯坦人口与健康调查（2017 - 18年），考察了不同财富五分位数和地理区域之间儿童营养不良差距的程度。本研究采用集中指数（CI）及分解分析，同时采用奥克萨卡 - 布林德分解法作为稳健方法。
集中指数结果显示，巴基斯坦儿童营养不良深深植根于社会经济差异，家庭财富对总体不平等的贡献最大（45.6%）。相对和绝对CI的负值证实了营养不良明显有利于穷人的集中情况。地区差异也起着重要作用，信德省、开伯尔 - 普赫图赫瓦省、俾路支省和联邦直辖部落地区共同占不平等的12.9%。值得注意的是，母亲文盲是一个关键决定因素，解释了观察到的营养不平等的24.1%。奥克萨卡 - 布林德分解结果揭示了儿童营养不良方面明显的财富差距，贫困家庭营养不良的可能性比富裕家庭高25.5个百分点 。大约65%的解释差距归因于家庭财富状况、母亲教育程度和地理区域，突出了巴基斯坦营养不平等的结构性本质。
该研究得出结论，巴基斯坦儿童营养不良从根本上说是一个结构公平问题。解决这个问题需要多部门政策干预，重点是经济赋权、区域发展和女童教育，以打破营养不良的代际循环。此外，巴基斯坦财富的极端集中和地区边缘化造成了标准区域模型无法完全捕捉的明显差距。财富和地区因素占解释差距的65%，这凸显了需要结构性解决方案，如财富再分配和省级公平基金，而不是孤立的卫生干预措施。
