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Socioeconomic Inequalities Persist Despite Declining Stunting Prevalence in Low- and Middle-Income Countries
BACKGROUND: Global stunting prevalence has been nearly halved between 1990 and 2016, but it remains unclear whether this decline has benefited poor and rural populations within low- and middle-income countries (LMICs). OBJECTIVE: We assessed time trends in stunting among children <5 y of age (und...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6084584/ https://www.ncbi.nlm.nih.gov/pubmed/29490104 http://dx.doi.org/10.1093/jn/nxx050 |
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author | da Silva, Inácio Crochemore M França, Giovanny V Barros, Aluisio JD Amouzou, Agbessi Krasevec, Julia Victora, Cesar G |
author_facet | da Silva, Inácio Crochemore M França, Giovanny V Barros, Aluisio JD Amouzou, Agbessi Krasevec, Julia Victora, Cesar G |
author_sort | da Silva, Inácio Crochemore M |
collection | PubMed |
description | BACKGROUND: Global stunting prevalence has been nearly halved between 1990 and 2016, but it remains unclear whether this decline has benefited poor and rural populations within low- and middle-income countries (LMICs). OBJECTIVE: We assessed time trends in stunting among children <5 y of age (under-5) according to household wealth and place of residence in 67 LMICs. METHODS: Stunting prevalence was analyzed in 217 nationally representative Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 67 countries with ≥2 surveys between 1993 and 2014. National estimates were stratified by wealth and area of residence, comparing the poorest 40% with the wealthiest 60%, and those residing in urban and rural areas. Time trends were calculated for LMICs by using multilevel regression models weighted by under-5 population, with stratification by wealth and by residence. Trends in absolute (slope index of inequality; SII) and relative (concentration index; CIX) inequalities were calculated. RESULTS: Mean prevalences in 1993 were 53.7% in low-income and 48.2% in middle-income countries, with annual average linear declines of 0.76 and 0.72 percentage points (pp), respectively. Although similar slopes of declines were observed for the poorest 40% and wealthiest 60% groups in all countries (0.78 and 0.74 pp, respectively), absolute and relative inequalities increased over time in low-income countries (SII increased from –19.3% in 1993 to –23.7% in 2014 and CIX increased from –6.2% to –10.8% in the same period). In middle-income countries, socioeconomic inequalities remained stable. Overall, stunting prevalence decreased more rapidly among rural than for urban children (0.78 and 0.55 pp, respectively). CONCLUSIONS: The prevalence of stunting is decreasing. Poor-rich gaps are stable in middle-income countries and slightly increasing in low-income countries. Rural-urban inequalities are decreasing over time. |
format | Online Article Text |
id | pubmed-6084584 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-60845842018-08-14 Socioeconomic Inequalities Persist Despite Declining Stunting Prevalence in Low- and Middle-Income Countries da Silva, Inácio Crochemore M França, Giovanny V Barros, Aluisio JD Amouzou, Agbessi Krasevec, Julia Victora, Cesar G J Nutr Community and International Nutrition BACKGROUND: Global stunting prevalence has been nearly halved between 1990 and 2016, but it remains unclear whether this decline has benefited poor and rural populations within low- and middle-income countries (LMICs). OBJECTIVE: We assessed time trends in stunting among children <5 y of age (under-5) according to household wealth and place of residence in 67 LMICs. METHODS: Stunting prevalence was analyzed in 217 nationally representative Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 67 countries with ≥2 surveys between 1993 and 2014. National estimates were stratified by wealth and area of residence, comparing the poorest 40% with the wealthiest 60%, and those residing in urban and rural areas. Time trends were calculated for LMICs by using multilevel regression models weighted by under-5 population, with stratification by wealth and by residence. Trends in absolute (slope index of inequality; SII) and relative (concentration index; CIX) inequalities were calculated. RESULTS: Mean prevalences in 1993 were 53.7% in low-income and 48.2% in middle-income countries, with annual average linear declines of 0.76 and 0.72 percentage points (pp), respectively. Although similar slopes of declines were observed for the poorest 40% and wealthiest 60% groups in all countries (0.78 and 0.74 pp, respectively), absolute and relative inequalities increased over time in low-income countries (SII increased from –19.3% in 1993 to –23.7% in 2014 and CIX increased from –6.2% to –10.8% in the same period). In middle-income countries, socioeconomic inequalities remained stable. Overall, stunting prevalence decreased more rapidly among rural than for urban children (0.78 and 0.55 pp, respectively). CONCLUSIONS: The prevalence of stunting is decreasing. Poor-rich gaps are stable in middle-income countries and slightly increasing in low-income countries. Rural-urban inequalities are decreasing over time. Oxford University Press 2018-02 2018-02-27 /pmc/articles/PMC6084584/ /pubmed/29490104 http://dx.doi.org/10.1093/jn/nxx050 Text en © 2018 American Society for Nutrition. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited |
spellingShingle | Community and International Nutrition da Silva, Inácio Crochemore M França, Giovanny V Barros, Aluisio JD Amouzou, Agbessi Krasevec, Julia Victora, Cesar G Socioeconomic Inequalities Persist Despite Declining Stunting Prevalence in Low- and Middle-Income Countries |
title | Socioeconomic Inequalities Persist Despite Declining Stunting Prevalence in Low- and Middle-Income Countries |
title_full | Socioeconomic Inequalities Persist Despite Declining Stunting Prevalence in Low- and Middle-Income Countries |
title_fullStr | Socioeconomic Inequalities Persist Despite Declining Stunting Prevalence in Low- and Middle-Income Countries |
title_full_unstemmed | Socioeconomic Inequalities Persist Despite Declining Stunting Prevalence in Low- and Middle-Income Countries |
title_short | Socioeconomic Inequalities Persist Despite Declining Stunting Prevalence in Low- and Middle-Income Countries |
title_sort | socioeconomic inequalities persist despite declining stunting prevalence in low- and middle-income countries |
topic | Community and International Nutrition |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6084584/ https://www.ncbi.nlm.nih.gov/pubmed/29490104 http://dx.doi.org/10.1093/jn/nxx050 |
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