The Equity Gap of Nutritional Health Outcomes of Children Under Five in Three South Asian Countries Since the Advent of the MDGs 公开
Teachout, Emily (2017)
Abstract
The Equity Gap of Nutritional Health Outcomes of Children Under Five in Three South Asian Countries since the advent of the MDGs
By Emily Teachout
Background:
Over the past decade, there has been an increased focus at a global level on improving the nutrition of children under 5. Progress toward this goal has been monitored since the MDGs in 2000. However, a well-documented criticism of the MDGs is its lack of focus on health equity. The SDGs have been applauded for their renewed focus toward improving equity. Still, neither set of UN development goals have nutritional health indicators stratified by wealth. South Asia experienced a large decrease in undernutrition in children under 5 from 2000-2015. However, we know very little about the regional trends in health equity for children from the poorest households over the period of the Millennium Development Goals.
Methods and Findings:
We conducted a secondary data analysis using 6 DHS surveys from three countries in South Asia: Pakistan (1991 and 2013), Bangladesh (1999 and 2014), and Nepal (2001 and 2011). Survey weights were applied to the data sets to produce population level estimates. We used a variety of methods to explore the changes in the distribution of the prevalence and the odds ratios of stunting across wealth quintiles for children under five. We conducted multivariate logistic regression using SAS 9.2 to produce odds ratios of stunting and wasting by wealth quintile for each survey separately using SAS-callable SUDAAN. We found that across all surveys, the changes in prevalence of stunting at a national population level masked sluggish improvements for children from the poorest 40% of households.
Conclusion:
The poor are being left behind as the South Asia region makes large progress toward the reduction of undernutrition. There is an urgent need for improved targeting of public health resources to the most vulnerable and hard to reach children. Further, there is a need for the UN development goals to include indicators that stratify by economic status so that countries are held accountable for more than an overall prevalence reduction.
Table of Contents
Table of Contents
Distribution Agreement
Approval Sheet
Abstract
Acknowledgements
List of Tables and Figures
Chapter 1: Introduction
Purpose of this Study
Significance Statement
Definition of Terms
Chapter 2: Literature Review
The Global Move Toward Better Nutritional Health Outcomes
Comparing Indicators from MDGs and SDGs
Indicators of Malnutrition: Stunting and Wasting
Measures of Socioeconomic Status
The Wealth Index
Stunting and Wasting: Relative vs. Absolute Measures of Wealth
Introduction to Measurements of Inequities in Health Outcomes
Concentration Curve and Concentration Index
Simple Proportions
Other Proposed Methods for Dichotomous Variables
Previous Studies that have Explored the Equity Gap in Nutritional Health Outcomes Since the MDGs
Study #1: Wagstaff, 2014
Study #2: Bredenkamp, Buisman, & Van de Poel, 2014
Study #3: Greffeuille et al., 2016
Study #4: Pathak & Singh, 2011
Overall Trends in Nutritional Health for South Asia and Identified Regional Challenges
Nepal
Pakistan
Bangladesh
Equity of Program Coverage and Targeting of MCNH Interventions
Chapter 3: Manuscript
Abstract
Keywords
Introduction
Methods
Results
Discussion
Conclusion
Appendix A: Extended Tables and Figures
Table 1A. Cross-tabulations Full Table: Bangladesh
Table 1B. Odds Ratios Full Table: Bangladesh
Table 1C. Stunting Contingency Table: Bangladesh
Table 1D. Wasting Contingency Table: Bangladesh
Table 1E. Combined Undernourished Contingency Table: Bangladesh
Table 2A. Cross-tabulations Full Table: Pakistan
Table 2B. Odds Ratios Full Table: Pakistan
Table 2C. Stunting Contingency Table: Pakistan
Table 2D. Wasting Contingency Table: Pakistan
Table 2E. Combined Undernourished Contingency Table: Pakistan
Table 3A. Cross-tabulations Full Table: Nepal
Table 3B. Odds Ratios Full Table: Nepal
Table 3C. Stunting Contingency Table: Nepal
Table 3D. Wasting Contingency Table: Nepal
Table 3E. Combined Undernourished Contingency Table: Nepal
About this Master's Thesis
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