Introduction
Methods
Data
Survey year | |||||
---|---|---|---|---|---|
1996 | 2001 | 2006 | 2011 | 2016 | |
Total households (N) | 8082 | 8602 | 8707 | 10,826 | 11,490 |
Response rate (%) | 99.6 | 99.6 | 99.6 | 99.4 | 98.5 |
Total childrena (N) | 3734 | 6367 | 5417 | 2430 | 2446 |
Total childrenb (weighted N) | 3703 | 6442 | 5258 | 2485 | 2421 |
Total childrenc (weighted N) | 2967 | NA | NA | NA | 1588 |
Time of field work | Jan-Jun 1996 | Jan-Jun 2001 | Feb-Aug 2006 | Jan-Jun 2011 | Jun 2016 – Jan 2017 |
Outcome variable
Conceptual framework
Predictors of socioeconomic inequalities
Measurement of socioeconomic inequalities
Decomposition of inequalities
Results
Socioeconomic inequalities
Stunting (95% confidence intervals) | Absolute decline in stunting (percent points) | Percentage decline in stunting (%) | |||||||
---|---|---|---|---|---|---|---|---|---|
Average decline per year | Total decline | Average decline per year | Total decline | ||||||
1996 | 2001 | 2006 | 2011 | 2016 | 1996–2016 | 1996–2016 | 1996–2016 | 1996–2016 | |
First quintile (poorest) | 64.5 (61.4 to 67.7) | 67.6 (65.2 to 70.1) | 61.6 (58.7 to 64.5) | 56 (51.7 to 60.2) | 49.2 (44.8 to 53.6) | 0.8 | 15.3 | 1.3 | 23.7 |
Second quintile | 61 (57.3 to 64.7) | 61.3 (58.4 to 64.1) | 54.9 (51.3 to 58.4) | 45.7 (40.4 to 51.0) | 38.7 (34.0 to 43.3) | 1.1 | 22.3 | 2.2 | 36.6 |
Third quintile | 58.1 (54.3 to 62.0) | 54.3 (51.3 to 57.3) | 50.4 (46.6 to 54.1) | 34.5 (29.4 to 39.7) | 35.7 (31.1 to 40.3) | 1.1 | 22.4 | 2.4 | 38.6 |
Fourth quintile | 52.2 (48.4 to 55.9) | 53.1 (50.0 to 56.1) | 39.8 (36.1 to 43.4) | 30.5 (24.7 to 36.3) | 32.4 (27.5 to 37.4) | 1.0 | 19.8 | 2.4 | 37.9 |
Fifth quintile (richest) | 39.8 (35.5 to 44.0) | 42.1 (38.9 to 45.4) | 30.9 (26.9 to 35.1) | 25.8 (20.1 to 31.5) | 16.5 (11.7 to 21.3) | 1.2 | 23.3 | 4.3 | 58.5 |
Total stunting | 56.6 (54.9 to 58.2) | 57.2 (55.9 to 58.5) | 49.3 (47.7 to 50.9) | 40.5 (38.1 to 42.9) | 35.8 (33.7 to 38.0) | 1.0 | 20.8 | 2.3 | 36.7 |
Ratio of first to fifth quintile stunting | 1.6 | 1.6 | 2.0 | 2.2 | 3.0 | ||||
Difference in first and fifth quintile stunting | 24.7 | 25.5 | 30.7 | 30.2 | 32.7 | ||||
Concentration index (95% confidence intervals) | −0.078 (− 0.094 to − 0.061) | − 0.083(− 0.095 to − 0.070) | − 0.125(− 0.143 to − 0.108) | − 0.164 (− 0.194 to − 0.134) | − 0.147(− 0.179 to − 0.114) | ||||
Standard error of concentration index | 0.008 | 0.006 | 0.009 | 0.015 | 0.017 | ||||
Normalized concentration indexa | − 0.178 | − 0.193 | − 0.247 | − 0.276 | − 0.228 | ||||
Weighted N | 3703 | 6442 | 5258 | 2485 | 2421 |
Marginal effects of predictors
Variables | Marginal effect | Weighted mean (1996: Meanstunted = 0.553; 2016: Meanstunted = 0.337) | Concentration Index (C) (1996: Cstunted = − 0.082;2016: Cstunted = − 0.138) | Absolute contribution | Percentage contribution (%) | Change | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1996 | P value | 2016 | P value | 1996 | 2016 | 1996 | 2016 | 1996 | 2016 | 1996 | 2016 | ||
Mother’s education | |||||||||||||
Primary | −0.030 | 0.331 | − 0.048 | 0.173 | 0.113 | 0.186 | 0.157 | −0.179 | − 0.0010 | 0.0048 | 1.2 | −3.7 | −4.9 |
Secondary and above |
−0.085*
|
0.020
| −0.023 | 0.558 | 0.099 | 0.480 | 0.575 | 0.191 | −0.0087 | −0.0062 | 11.0 | 4.7 | −6.3 |
Sub-total |
−0.0097
|
− 0.0014
|
12.2
|
1.1
|
− 11.1
| ||||||||
Husband/Partner’s education | |||||||||||||
Primary | −0.035 | 0.143 | 0.015 | 0.725 | 0.244 | 0.231 | −0.070 | −0.257 | 0.0011 | −0.0027 | −1.4 | 2.1 | 3.5 |
Secondary and above | −0.035 | 0.172 | 0.039 | 0.418 | 0.389 | 0.624 | 0.243 | 0.153 | −0.0059 | 0.0110 | 7.4 | 0.8 | −6.6 |
Sub-total |
−0.0048
|
0.0083
|
6.1
|
2.9
|
−3.2
| ||||||||
Maternal short stature (< 145 cm) |
0.137*
|
< 0.001
|
0.253*
|
< 0.001
| 0.150 | 0.114 | −0.007 | − 0.089 | − 0.0002 | − 0.0077 | 0.3 | 5.9 | 5.6 |
Mother’s BMI | |||||||||||||
Normal (18.5 to < 25) | −0.018 | 0.446 |
−0.069*
|
0.042
| 0.711 | 0.634 | −0.006 | −0.046 | 0.0001 | 0.0060 | −0.2 | −4.6 | −4.4 |
Overweight/Obese (≥25) | −0.065 | 0.344 |
−0.148*
|
0.003
| 0.018 | 0.176 | 0.350 | 0.285 | −0.0007 | −0.0221 | 0.9 | 16.9 | 16.0 |
Sub-total |
−0.0006
|
−0.0161
|
0.7
|
12.3
|
11.6
| ||||||||
Antenatal care visits | −0.002 | 0.930 | −0.040 | 0.532 | 0.438 | 0.943 | 0.172 | 0.023 | −0.0002 | −0.0025 | 0.3 | 1.9 | 1.6 |
Delivery in health facility | −0.046 | 0.157 | −0.007 | 0.806 | 0.082 | 0.573 | 0.573 | 0.179 | −0.0039 | −0.0021 | 4.8 | 1.6 | −3.2 |
Children aged 25–59 months |
0.172*
|
< 0.001
|
0.109*
|
< 0.001
| 0.272 | 0.502 | 0.005 | 0.019 | 0.0004 | 0.0031 | −0.5 | −2.4 | −1.9 |
Birth order | |||||||||||||
2nd - 4th |
0.076*
|
0.001
|
0.070*
|
0.021
| 0.525 | 0.574 | 0.006 | −0.009 | 0.0005 | −0.0011 | − 0.6 | 0.8 | 1.4 |
5 or more |
0.109*
|
< 0.001
|
0.130*
|
0.007
| 0.254 | 0.093 | −0.154 | − 0.281 | − 0.0077 | −0.0101 | 9.7 | 7.7 | −2.0 |
Sub-total |
−0.0072
|
−0.0112
|
9.1
|
8.6
|
−0.5
| ||||||||
Breast fed children | −0.189 | 0.511 | −0.186 | 0.150 | 0.998 | 0.993 | −0.001 | −0.0004 | 0.0002 | 0.0002 | −0.2 | −0.2 | 0.0 |
Perceived size of baby at birth | |||||||||||||
Average |
0.052*
|
0.014
| 0.032 | 0.311 | 0.431 | 0.672 | 0.021 | 0.020 | 0.0008 | 0.0013 | −1.1 | −1.0 | 0.1 |
Small |
0.156*
|
< 0.001
|
0.084*
|
0.039
| 0.259 | 0.164 | −0.080 | −0.113 | −0.0058 | −0.0047 | 7.3 | 3.6 | −3.7 |
Sub-total |
−0.0050
|
−0.0034
|
6.2
|
2.6
|
−3.6
| ||||||||
Caste/Ethnicity | |||||||||||||
Janajati |
−0.144*
|
< 0.001
| −0.046 | 0.253 | 0.308 | 0.301 | −0.013 | −0.064 | 0.0010 | 0.0026 | −1.3 | −2.0 | −0.7 |
Other terai caste | −0.071 | 0.068 | −0.007 | 0.880 | 0.124 | 0.174 | −0.020 | 0.165 | 0.0003 | −0.0006 | −0.4 | 0.5 | 0.9 |
Muslim | −0.083 | 0.076 | −0.0002 | 0.998 | 0.058 | 0.059 | 0.068 | 0.185 | −0.0006 | 0.0000 | 0.7 | 0.0 | −0.7 |
Newar |
−0.199*
|
< 0.001
| −0.046 | 0.665 | 0.050 | 0.035 | 0.490 | 0.151 | −0.0089 | −0.0007 | 11.1 | 0.6 | −10.5 |
Brahmin/Chhetri |
−0.103*
|
0.002
| −0.015 | 0.714 | 0.296 | 0.286 | 0.029 | −0.025 | −0.0016 | 0.0003 | 2.0 | −0.2 | −2.2 |
Sub-total |
−0.0098
|
0.0016
|
12.1
|
−1.2
|
−13.3
| ||||||||
Wealth quintile | |||||||||||||
Second | −0.040 | 0.110 | −0.061 | 0.133 | 0.213 | 0.218 | −0.291 | −0.377 | 0.0044 | 0.0150 | −5.6 | −11.5 | −5.9 |
Third | −0.040 | 0.137 |
−0.124*
|
0.002
| 0.194 | 0.215 | 0.116 | 0.057 | −0.0016 | −0.0045 | 2.0 | 3.5 | 1.5 |
Fourth |
−0.101*
|
< 0.001
|
−0.098*
|
0.015
| 0.197 | 0.220 | 0.507 | 0.492 | −0.0182 | −0.0316 | 22.8 | 24.2 | 1.4 |
Fifth (Richest) |
−0.145*
|
0.001
|
−0.200*
|
< 0.001
| 0.148 | 0.144 | 0.852 | 0.856 | −0.0330 | −0.0732 | 41.4 | 56.1 | 14.7 |
Sub-total |
−0.0484
|
−0.0943
|
60.7
|
72.3
|
11.6
| ||||||||
Open Defecation | −0.039 | 0.253 | 0.050 | 0.222 | 0.812 | 0.199 | −0.165 | −0.171 | 0.0095 | −0.0050 | −11.9 | 3.9 | 15.8 |
Total sum contribution | −0.0797 | −0.1305 | |||||||||||
Residual (Unexplained) | −0.0021 | −0.0076 |