Introduction
Socio-economic inequality in childhood malnutrition: Contextualizing the extent in India
Methodology
Data
Methods used
Concentration Index
Multi-level regression
Variables in the regression model
Measuring nutritional status: the dependent variable
Explanatory variables
Asset quintile as the proxy for household socio-economic status
Other explanatory variables used as controls
Results
Extent of socio-economic inequity in childhood stunting
States/Country
|
Underweight
|
Stunting
|
Wasting
| ||||||
---|---|---|---|---|---|---|---|---|---|
Rural | Urban | Total | Rural | Urban | Total | Rural | Urban | Total | |
Haryana | 41.3 | 34.6 | 39.6 | 48.1 | 38.3 | 45.7 | 19.7 | 17.3 | 19.1 |
Punjab | 26.8 | 21.4 | 24.9 | 37.5 | 35.1 | 36.7 | 9.2 | 9.2 | 9.2 |
Rajasthan | 42.5 | 30.1 | 39.9 | 46.3 | 33.9 | 43.7 | 20.3 | 20.8 | 20.4 |
Madhya Pradesh | 62.7 | 51.3 | 60 | 51.7 | 44.3 | 50 | 36 | 31.7 | 35 |
Uttar Pradesh | 44.1 | 34.8 | 42.4 | 58.4 | 50.1 | 56.8 | 15.2 | 12.9 | 14.8 |
Bihar | 57 | 47.8 | 55.9 | 56.5 | 48.4 | 55.6 | 27.4 | 25.2 | 27.1 |
Orissa | 42.3 | 29.7 | 40.7 | 46.5 | 34.9 | 45.0 | 20.5 | 13.4 | 19.5 |
West Bengal | 42.2 | 24.7 | 38.7 | 48.4 | 29.3 | 44.6 | 17.8 | 13.5 | 16.9 |
Assam | 37.7 | 26.1 | 36.4 | 47.8 | 35.6 | 46.5 | 13.6 | 14.2 | 13.7 |
Gujarat | 47.9 | 39.2 | 44.6 | 54.8 | 46.6 | 51.7 | 19.9 | 16.7 | 18.7 |
Maharashtra | 41.6 | 30.7 | 37 | 49.1 | 42.3 | 46.3 | 18.2 | 14.1 | 16.5 |
Andhra Pradesh | 34.8 | 28 | 32.5 | 45.8 | 36.7 | 42.7 | 13 | 10.7 | 12.2 |
Karnataka | 41.1 | 30.7 | 37.6 | 47.7 | 36 | 43.7 | 18.2 | 16.5 | 17.6 |
Kerala | 26.4 | 15.4 | 22.9 | 25.6 | 22.2 | 24.5 | 18.2 | 10.9 | 15.9 |
Tamilnadu | 32.1 | 27.1 | 29.8 | 31.3 | 30.5 | 30.9 | 22.6 | 21.6 | 22.2 |
All 15 states
|
44.1
|
32.2
|
41.1
|
49.7
|
39.2
|
47.04
|
19.9
|
16.6
|
19.04
|
ALL INDIA
|
45.6
|
32.7
|
42.5
|
50.7
|
39.6
|
48
|
20.7
|
16.9
|
19.8
|
States/Country
|
Concentration Index (Stunting)
| ||
---|---|---|---|
Rural | Urban | Total | |
Haryana | -0.118** | -0.257** | -0.151** |
Punjab | -0.211** | -0.259** | -0.212** |
Rajasthan | -0.069** | -0.182** | -0.106** |
Madhya Pradesh | -0.032 | -0.133** | -0.063** |
Uttar Pradesh | -0.071** | -0.153** | -0.083** |
Bihar | -0.082** | -0.131** | -0.094** |
Orissa | -0.169** | -0.267** | -0.183** |
West Bengal | -0.112** | -0.3** | -0.168** |
Assam | -0.101** | -0.253** | -0.116** |
Gujarat | -0.087** | -0.132** | -0.115** |
Maharashtra | -0.12** | -0.167** | -0.146** |
Andhra Pradesh | -0.104** | -0.134** | -0.14** |
Karnataka | -0.076** | -0.185** | -0.127** |
Kerala | -0.204** | -0.061 | -0.165** |
Tamil Nadu | -0.075 | -0.196** | -0.131** |
All 15 states
|
-0.092**
|
-0.177**
|
-0.121**
|
ALL INDIA
|
-0.098**
|
-0.169**
|
-0.126**
|
Role of household socio-economic conditions determining long-term nutritional status among children
Model parameters | OLS | Null_model | Model_Kids | Model_Mom | Model_Full | Model_Random_Slope |
---|---|---|---|---|---|---|
Exp (B) (SE) | ||||||
HH Asset Quintile | ||||||
Poorest | -0.181*** (0.026) | - | -0.296*** (0.027) | -0.180*** (0.027) | -0.183*** (0.028) | -0.185*** (0.028) |
Richest | 0.311*** (0.029) | - | 0.548*** (0.027) | 0.296*** (0.030) | 0.314*** (0.031) | 0.310*** (0.031) |
Controls
| ||||||
Individual Characteristics
| ||||||
Child_age (in months) | -0.085*** (0.002) | - | -0.091*** (0.002) | -0.088*** (0.002) | -0.089*** (0.002) | -0.089*** (0.002) |
Child_age2 | 0.001*** (0.000) | - | 0.001*** (0.000) | 0.001*** (0.000) | 0.001*** (0.000) | 0.001*** (0.000) |
Sex_male | -0.005 (0.019) | - | -0.012 (0.018) | -0.012 (0.018) | -0.012 (0.018) | -0.012 (0.018) |
Order_of_birth | -0.016*** (0.006) | - | -0.041*** (0.006) | -0.018** (0.006) | -0.016** (0.006) | -0.016** (0.006) |
Size_at_birth | 0.258*** (0.024) | - | 0.296*** (0.023) | 0.271*** (0.023) | 0.265*** (0.024) | 0.265*** (0.024) |
Suffered_recent_illness | -0.021 (0.026) | -0.018 (0.026) | -0.025 (0.026) | -0.027 (0.027) | -0.026 (0.027) | |
Recommended_feed | 0.042* (0.021) | - | 0.043* (0.021) | 0.045* (0.021) | 0.050* (0.021) | 0.050* (0.021) |
Completed_immunization | 0.007 (0.022) | - | 0.090*** (0.022) | 0.017 (0.022) | 0.014 (0.022) | 0.015 (0.022) |
Mothers' characteristics
| ||||||
Years_education | 0.034*** (0.003) | - | - | 0.036*** (0.003) | 0.032*** (0.003) | 0.031*** (0.003) |
BMI_mother | 0.026*** (0.003) | - | - | 0.029*** (0.003) | 0.025*** (0.003) | 0.026*** (0.003) |
Suffer_anemia | 0.113*** (0.025) | - | - | 0.104*** (0.026) | 0.107*** (0.026) | 0.107*** (0.026) |
Treatment_self_noprob | -0.054 (0.038) | - | - | -0.046 (0.039) | -0.050 (0.040) | -0.049 (0.040) |
Institutional_birth | 0.087*** (0.024) | - | - | 0.112*** (0.024) | 0.075** (0.025) | 0.075*** (0.025) |
Household characteristics
| ||||||
Ethnicity_SCST | -0.104*** (0.022) | - | - | - | -0.120*** (0.024) | -0.121*** (0.024) |
Rural_residence | -0.135*** (0.023) | - | - | - | -0.147*** (0.026) | -0.145*** (0.026) |
States
| ||||||
Haryana | -0.129* (0.065) | - | -0.184* (0.083) | -0.103 (0.078) | -0.122 (0.078) | -0.120 (0.078) |
Rajasthan | 0.161*** (0.060) | - | 0.093 (0.077) | 0.187** (0.072) | 0.160* (0.073) | 0.162* (0.073) |
Uttar Pradesh | -0.255*** (0.052) | - | -0.237*** (0.065) | -0.215*** (0.062) | -0.259*** (0.062) | -0.258*** (0.062) |
Bihar | -0.165*** (0.060) | - | -0.179** (0.077) | -0.115 (0.072) | -0.167* (0.073) | -0.164* (0.073) |
Assam | 0.131 (0.071) | - | 0.115 (0.082) | 0.126 (0.077) | 0.153 (0.083) | 0.153 (0.083) |
West Bengal | 0.142* (0.060) | 0.209** (0.072) | 0.186** 0.068) | 0.162* (0.070 | 0.165*** (0.070) | |
Orissa | 0.116 (0.062) | - | 0.126 (0.077) | 0.123 (0.073) | 0.127 (0.073) | 0.134 (0.074) |
Madhya Pradesh | 0.025 (0.056) | - | 0.062 (0.071) | 0.069 (0.067) | 0.032 (0.067) | 0.034 (0.067) |
Gujarat | -0.307*** (0.063) | - | -0.281*** (0.079) | -0.272*** (0.074) | -0.314*** (0.075) | -0.311*** (0.075) |
Maharashtra | -0.161*** (0.058) | - | -0.012 (0.070) | -0.101 (0.067) | -0.156* (0.068) | -0.153* (0.068) |
Andhra Pradesh | -0.013 (0.060) | - | 0.103 (0.074) | 0.041 (0.070) | -0.010 | -0.005 (0.070) |
Karnataka | -0.031 (0.063) | - | 0.074 (0.076) | 0.027 (0.073) | -0.002 | 0.001 (0.074) |
Kerala | -0.021 (0.072) | 0.229** (0.083) | 0.031 (0.079) | -0.005 | 0.000 (0.082) | |
Tamil Nadu | 0.377*** (0.062) | - | 0.54*** (0.075) | 0.405*** (0.071) | 0.385*** (0.072) | 0.385*** (0.072) |
_cons | -1.291*** (0.095) | 1.593*** (0.014) | -0.184*** (0.083) | -1.471*** (0.094) | -1.200*** (0.102) | -1.208*** (0.102) |
N
|
23099
|
24896
|
24541
|
23939
|
23099
|
23099
|
- 2 log likelihood | (R2 0.170) | -45882.64 | -43383.54 | -42042.3 | -40559.133 | -40553.034 |
X
2
statistics | 152.390 | - | 4123.31 | 4657.03 | 4575.07 | 4527.58 |
P value | 0.000 | - | 0.000 | 0.000 | 0.000 | 0.000 |
Null_model | Model_Kids | Model_Mom | Model_Full | Model_Random_Slope | |
---|---|---|---|---|---|
Random Effects
| |||||
σ
2
c
(Community - PSU)
| 0.202 | 0.091 | 0.056 | 0.055 | 0.055 |
(S.E.) | (0.014) | (0.009) | (0.008) | (0.008) | (0.008) |
Proportions of overall (null model) explained by the covariates of the model (in %) | 55.189 | 72.149 | 72.850 | 72.875 | |
σ
2
h
(Household)
| 0.346 | 0.462 | 0.436 | 0.431 | 0.366 |
(S.E.) | (0.027) | (0.025) | (0.025) | (0.025) | (0.030) |
Proportions of overall (null model) explained by the covariates of the model (in %) | -33.578 | -26.086 | -24.575 | -5.683 | |
Residual2 | 1.877 | 1.516 | 1.514 | 1.518 | 1.516 |
(S.E.) | (0.029) | (0.024) | (0.025) | (0.025) | (0.025) |
Intra-class correlation
| |||||
ρ (PSU) | 0.083* | 0.044* | 0.028* | 0.027* | 0.028* |
ρ (household) | 0.226* | 0.267* | 0.245* | 0.242* | 0.217* |
Variance Decomposition (in %)
| |||||
PSU | 36.9 | 16.4 | 11.4 | 11.3 | 13.1 |
Household | 63.1 | 83.6 | 88.6 | 88.7 | 86.9 |