Rural-urban disparities in child nutrition in Bangladesh and Nepal

Abstract

BackgroundThe persistence of rural-urban disparities in child nutrition outcomes in developing countries alongside rapid urbanisation and increasing incidence of child malnutrition in urban areas raises an important health policy question - whether fundamentally different nutrition policies and interventions are required in rural and urban areas. Addressing this question requires an enhanced understanding of the main drivers of rural-urban disparities in child nutrition outcomes especially for the vulnerable segments of the population. This study applies recently developed statistical methods to quantify the contribution of different socio-economic determinants to rural-urban differences in child nutrition outcomes in two South Asian countries – Bangladesh and Nepal.MethodsUsing DHS data sets for Bangladesh and Nepal, we apply quantile regression-based counterfactual decomposition methods to quantify the contribution of (1) the differences in levels of socio-economic determinants (covariate effects) and (2) the differences in the strength of association between socio-economic determinants and child nutrition outcomes (co-efficient effects) to the observed rural-urban disparities in child HAZ scores. The methodology employed in the study allows the covariate and coefficient effects to vary across entire distribution of child nutrition outcomes. This is particularly useful in providing specific insights into factors influencing rural-urban disparities at the lower tails of child HAZ score distributions. It also helps assess the importance of individual determinants and how they vary across the distribution of HAZ scores.ResultsThere are no fundamental differences in the characteristics that determine child nutrition outcomes in urban and rural areas. Differences in the levels of a limited number of socio-economic characteristics – maternal education, spouse’s education and the wealth index (incorporating household asset ownership and access to drinking water and sanitation) contribute a major share of rural-urban disparities in the lowest quantiles of child nutrition outcomes. Differences in the strength of association between socio-economic characteristics and child nutrition outcomes account for less than a quarter of rural-urban disparities at the lower end of the HAZ score distribution.ConclusionsPublic health interventions aimed at overcoming rural-urban disparities in child nutrition outcomes need to focus principally on bridging gaps in socio-economic endowments of rural and urban households and improving the quality of rural infrastructure. Improving child nutrition outcomes in developing countries does not call for fundamentally different approaches to public health interventions in rural and urban areas.

Different forms of malnutrition among under five children in Bangladesh: a cross sectional study on prevalence and determinants

“…Although many of the previous studies identified that rural children are more vulnerable to be malnourished [32][33][34], this study found that children living in urban area are more vulnerable to be stunted in Bangladesh. The urban population in last few decades has changed a lot due to migration of rural people to urban area for work and other opportunities.…”

“…In developing countries, the rural-urban disparities in child nutrition outcomes remained persistent since long [32][33][34] presumably due to the difference in economic levels and poor accessibility to health facilities, education and other factors. Although many of the previous studies identified that rural children are more vulnerable to be malnourished [32][33][34], this study found that children living in urban area are more vulnerable to be stunted in Bangladesh.…”

Food and nutrition security trends and challenges in the Ganges Brahmaputra Meghna (GBM) delta

“…Significant relationships between wealth and stunting have been reported in numerous studies (e.g. Hong and Mishra, 2006;Johnson and Brown, 2014;Srinivasan et al, 2013). Wealthier households are likely to have greater access to food or may be less reliant on rice alone.…”

Malnutrisi Akut Berat dan Determinannya pada Balita di Wilayah Rural dan Urban

“…20 Beberapa penelitian menyatakan bahwa sebagian besar balita malnutrisi tidak mendapatkan ASI eksklusif. 10,21 Angka cakupan ASI eksklusif terus mengalami penurunan dan pemberian susu formula pada bayi semakin meningkat meskipun para tenaga kesehatan telah bekerja sama untuk meningkatkan pemberian ASI eksklusif. 22 Hal ini yang merupakan salah satu faktor pemicu kejadian malnutrisi pada balita.…”

“…7,8,9 Penelitian yang dilakukan pada balita malnutrisi di Bangladesh dan Nepal menyatakan terdapat perbedaan karakteristik antara responden perkotaan dan pedesaan yaitu perbedaan dalam skor-z, jenis kelamin, vaksinasi pada anak, pendidikan orang tua, tingkat kesejahteraan, rasio ketergantungan dan jumlah anak yang berusia kurang dari lima tahun. 10 Faktor-faktor lain selain faktor kesehatan, tetapi juga merupakan masalah utama gizi buruk adalah stigma masyarakat, sosial budaya, kemiskinan, pendidikan rendah, ketersediaan pangan dan kesempatan kerja sebagai dampak urbanisasi. 11,12 Penelitian ini bertujuan untuk mengidentifikasi kejadian malnutrisi akut berat dan determinannya pada balita di wilayah perkotaan dan perdesaan di Yogyakarta.…”