A Decomposition Analysis of Inequality in Malnutrition among under Five Children in Iran: Findings from Multiple Indicator Demographic and Health Survey, 2010

  • Abdollah ALMASIAN KIA Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
  • Sahar GOODARZI Department of Health Economics, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
  • Heshmatollah ASADI Department of Public Health, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
  • Ardeshir KHOSRAVI Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
  • Aziz REZAPOUR Mail Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
Keywords:
Malnutrition, Inequality, Socioeconomic factors, Decomposition, Iran

Abstract

Background: Nutritional status at the early stages of children’s lives is essential for growth and development not only in infancy but also in adult life. This study aimed to measure the inequality in malnutrition among under-five children in Iran and explore the impact of socioeconomic factors on this inequality using a regression-based decomposition approach.

Methods: Data were extracted from Iran's Multiple-Indicator Demographic and Health Survey 2010. The concentration index of stunting, underweight, and wasting were applied in order to measure the magnitude of socioeconomic inequality in child malnutrition. Moreover, the concentration indices were decomposed to understand the contribution of socioeconomic variables in childhood malnutrition inequality.

Results: The obtained concentration indices of stunting, underweight, and wasting were respectively -0.177, -0.092, and -0.031. Socioeconomic inequality in stunting and underweight was statistically significant, however this socioeconomic gradient was not observed in wasting. More than 50% of the inequality in stunting and about 63% of the inequality in underweight were influenced by socioeconomic status. Furthermore, maternal education was associated with 19% and 22% of inequality in stunting and underweight respectively.

Conclusion: The average reduction of malnutrition indices at the national level hides the burden of malnutrition among children in poor families. If government and policymakers seek to solve this problem, they have to take direct and targeted actions to eliminate the existing inequalities in the socioeconomic determinants associated with malnutrition.

 

References

1. Black RE, Allen LH, Bhutta ZA et al (2008). Maternal and child undernutrition: global and regional exposures and health consequences. Lancet, 371(9608):243-60.
2. UNICEF-WHO-The World Bank Group (2016). Joint child malnutrition estimates - levels and trends. www.who.int/nutrition/publications/undernutrition/en/
3. Mazumdar S (2010). Determinants of inequality in child malnutrition in India: the poverty-undernutrition linkage. Asian Population Studies, 6(3):307-33.
4. Van de Poel E, Hosseinpoor AR, Jehu-Appiah C et al (2007). Malnutrition and the disproportional burden on the poor: the case of Ghana. Int J Equity Health, 6:21.
5. Chalasani S (2012). Understanding wealth-based inequalities in child health in India: a decomposition approach. Soc Sci Med,75(12):2160-9.
6. Jayawardena P (2012). Socio-Economic Determinants and Inequalities in Childhood Malnutrition in Sri Lanka. Well-Being and Social Policy Journal, 8(1):1-22.
7. Prakash M, Jain K (2016). Inequalities among malnourished children in India: A decomposition analysis from 1992-2006. Int J Soc Econ, 43(6):643-659.
8. Ahmed S, Hasan MM, Ahmed W, Chowdhury MAH (2013). Socio-economic Inequity of Malnutrition among under-five Children and Women at Reproductive Age in Bangladesh. J Nutr Health, 1:13-7.
9. Kien VD, Lee H-Y, Nam Y-S et al (2016). Trends in socioeconomic inequalities in child malnutrition in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2000–2011. Glob Health Action, 9:29263.
10. Hosseinpoor AR, Van Doorslaer E, Speybroeck N et al (2006). Decomposing socioeconomic inequality in infant mortality in Iran. Int J Epidemiol, 35(5):1211-9.
11. Morasae EK, Forouzan AS, Majdzadeh R et al (2012). Understanding determinants of socioeconomic inequality in mental health in Iran's capital, Tehran: a concentration index decomposition approach. Int J Equity Health,11:18.
12. Mohammadbeigi A, Hassanzadeh J, Eshrati B, Rezaianzadeh A (2013). Decomposition of inequity determinants of healthcare utilization, Iran. Public Health, 127(7):661-7.
13. Amini Rarani M, Rashidian A, Khosravi A et al (2016). Changes in socio-economic inequality in neonatal mortality in Iran between 1995-2000 and 2005-2010: an Oaxaca decomposition analysis. Int J Health Policy Manag, 6(4):219-218.
14. Rashidian A, Khosravi A, Arab M et al (2012). Tehran: National Institute of Health Research and Deputy for Health, Ministry of Health and Medical Educa-tion; IrMIDHS-I.R. Iran Multiple. Indica-tor and Demographic Health Survey 2010: Questionnaires, Guides and Proto-cols.
15. WHO Multicentre Growth Reference Study Group (2006). WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl, 450:76-85.
16. WHO Working Group (1986). Use and interpretation of anthropometric indicators of nutritional status. WHO Working Group. Bull World Health Organ, 64(6), 929-41.
17. Vyas S, Kumaranayake L (2006). Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan, 21(6):459-68.
18. Kakwani N, Wagstaff A, Van Doorslaer E (1997). Socioeconomic inequalities in health: measurement, computation, and statistical inference. J Econom, 77(1):87-103.
19. O’donnell O, Van Doorslaer E, Wagstaff A, Lindelow M (2008). Analyzing health equity using household survey data. Washington DC, World Bank.
20. Wagstaff A, Van Doorslaer E, Watanabe N (2003). On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econom, 112(1):207-23.
21. Correia LL, Campos JS, Andrade FMdO et al (2014). Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil. Rev Saude Publica, 48(1):19-28.
22. Mushtaq MU, Gull S, Khurshid U et al (2011). Prevalence and socio-demographic correlates of stunting and thinness among Pakistani primary school children. BMC Public Health,11:790.
23. Uthman OA (2009). Using extended concentration and achievement indices to study socioeconomic inequality in chronic childhood malnutrition: the case of Nigeria. Int J Equity Health, 8:22.
24. Mehryar, A (2004). Primary health care and the rural poor in the Islamic Republic of Iran. Washington, DC: World Bank.
25. Ghodsi D, Omidvar N, Rashidian A et al (2017). Key Informants’ Perceptions on the Implementation of a National Program for Improving Nutritional Status of Children in Iran. Food Nutr Bull, 38(1):78-91.
26. Sheikholeslam R, Naghavi M, Abdollahi Z et al (2008). Current status and the 10 years trend in the malnutrition indexes of children under 5 years in Iran. Iran J Epi-demiol, 4 (1) :21-28.
27. Salvucci V (2016). Determinants and Trends of Socioeconomic Inequality in Child Malnutrition: The Case of Mozambique, 1996–2011. J Int Dev, 28(6):857–875.
28. Miah R, Apanga P, Abdul-Haq Z (2016). Risk Factors for Undernutrition in Children under Five Years Old: Evidence from the 2011 Ghana Multiple Indicator Cluster Survey. J AIDS Clin Res, 7:585.
29. Marianne F, Danny L, Quentin W, Tito Y (2003). Achieving the Millennium Development Goals: The role of infrastructure (English). Policy, Research working paper series; no. WPS 3163. Washington, DC: World Bank.
30. Dollar D, Kraay A (2002). Growth is Good for the Poor. J Econ Growth, 7(3):195-225.
31. Wagstaff A; Anabe N (2000). Socioeconomic in-equalities in child malnutrition in the developing world (English). Policy, Research working paper; no. WPS 2434. Washington, DC: World Bank Group.
32. Novignon J, Aboagye E, Agyemang OS, Aryeetey G (2015). Socioeconomic-related inequalities in child malnutrition: evidence from the Ghana multiple indicator cluster survey. Health Econ Rev, 5:34.
33. Singh L, Rai RK, Singh PK (2012). Assessing the utilization of maternal and child health care among married adolescent women: evidence from India. J Biosoc Sci, 44(1):1-26.
34. Van de Poel E, O’Donnell O, Van Doorslaer E (2007). Are urban children really healthier? Evidence from 47 developing countries.Soc Sci Med, 65(10):1986-2003.
35. Smith LC, Ruel MT, Ndiaye A (2005). Why is child malnutrition lower in urban than in rural areas? Evidence from 36 developing countries. World Dev, 33(8):1285-1305.
Published
2019-04-17
How to Cite
1.
ALMASIAN KIA A, GOODARZI S, ASADI H, KHOSRAVI A, REZAPOUR A. A Decomposition Analysis of Inequality in Malnutrition among under Five Children in Iran: Findings from Multiple Indicator Demographic and Health Survey, 2010. Iran J Public Health. 48(4):748-757.
Section
Original Article(s)