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Time trends in socio-economic inequalities in stunting prevalence: analyses of repeated national surveys

  • María Clara Restrepo-Méndez (a1), Aluísio JD Barros (a1), Robert E Black (a2) and Cesar G Victora (a1)
Abstract
Abstract Objective

Much is known about national trends in child undernutrition, but there is little information on how socio-economic inequalities are evolving over time. We aimed to assess socio-economic inequalities in stunting prevalence over time.

Design

We selected nationally representative surveys carried out since the mid-1990s for which information was available on asset indices and on child anthropometry. We identified twenty-five countries that had at least two surveys over an interval of 10 years or more, totalling eighty-seven surveys. Stunting prevalence was calculated according to wealth quintiles. Absolute and relative inequalities were calculated and time trends were obtained by regression.

<span class='italic'>Setting</span>

Nationally representative household surveys from twenty-five low- and middle-income countries.

Subjects

Children <5 years of age.

Results

National prevalence declined significantly in twenty-two of the twenty-five countries. In eighteen out of twenty-five countries, relative reductions were higher among the rich than among the poor. Overall, there was no indication that inequalities improved. Striking examples are Nepal, with a 17·0 percentage points decline in stunting per decade, but where inequalities increased sharply; and Brazil, where stunting fell by 6·7 percentage points and inequalities were all but eliminated.

Conclusions

Global progress in reducing stunting has not been accompanied by improved equity, but countries varied markedly in how successful they were in reducing prevalence among the poorest children. It is important to document how some countries were able to reduce inequalities, so that these lessons can be used to foster global progress, particularly in light of the increased importance of within-country inequalities in the post-2015 agenda.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
* Corresponding author: Email mcm.restrepo@gmail.com
References
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1. J Waage , R Banerji , O Campbell et al. (2010) The Millennium Development Goals: a cross-sectoral analysis and principles for goal setting after 2015 Lancet and London International Development Centre Commission. Lancet 376, 9911023.

5. RE Black , CG Victora , SP Walker et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382, 427451.

7. CJ Paciorek , GA Stevens , MM Finucane et al. on behalf of the Nutrition Impact Model Study Group (Child Growth) (2013) Children’s height and weight in rural and urban populations in low-income and middle-income countries: a systematic analysis of population-representative data. Lancet Glob Health 1, 300309.

11. AJ Barros & CG Victora (2013) Measuring Coverage in MNCH: determining and interpreting inequalities in coverage of maternal, newborn, and child health interventions. PLoS Med 10, e1001390.

12. AJ Barros , C Ronsmans , H Axelson et al. (2012) Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries. Lancet 379, 12251233.

14. CG Victora , M de Onis , PC Hallal et al. (2010) Worldwide timing of growth faltering: revisiting implications for interventions using the World Health Organization growth standards. Pediatrics 125, e473e480.

15. GA Stevens , MM Finucane , CJ Paciorek et al. (2012) Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data. Lancet 380, 824834.

16. CA Monteiro , MH Benicio , W Conde et al. (2010) Narrowing socioeconomic inequality in child stunting: the Brazilian experience, 1974–2007. Bull World Health Organ 88, 305311.

17. CG Victora , EM Aquino , M do Carmo Leal et al. (2011) Maternal and child health in Brazil: progress and challenges. Lancet 377, 18631876.

19. J Bryce , K Gilroy , G Jones et al. (2010) The Accelerated Child Survival and Development programme in west Africa: a retrospective evaluation. Lancet 375, 572582.

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Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
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