Residence-based disparities of composite index of anthropometric failures in East African under five children;
Aznamariam Ayres1, Yawkal Tsega2, Abel Endawkie3
1Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia. aznamariamayres@gmail.com.
Insights
Rural children under-5 face higher rates of anthropometric failure due to disparities in wealth, education, and maternal factors. Addressing these inequalities is crucial for reducing child undernutrition in East Africa.
Area of Science:
- Global Health
- Pediatric Nutrition
- Socioeconomic Determinants of Health
Background:
- Undernutrition, specifically the composite index of anthropometric failure (CIAF), remains a significant global public health challenge.
- Rural children under-five disproportionately experience higher rates of CIAF compared to their urban counterparts.
- Identifying key contributors to these disparities is essential for targeted interventions.
Purpose of the Study:
- To analyze residence-based differences in CIAF among children under-five in five East African countries.
- To determine the factors contributing to the disparity in CIAF between rural and urban children.
Main Methods:
- Utilized nationally representative demographic and health survey data from Ethiopia, Kenya, Rwanda, Uganda, and Tanzania.
- Employed Blinder-Oaxaca decomposition analysis to assess the effects of covariates and coefficients on CIAF disparities.
- Conducted country-specific analyses for robust findings.
Main Results:
- Reported CIAF prevalence ranging from 22.04% to 40.69% across the studied East African nations.
- Revealed significant residence-based CIAF differences, with rural-urban gaps ranging from 11.38% to 27%.
- Found that 100% of the rural-urban CIAF disparity is attributable to endowment characteristics, including wealth, maternal education, child age, birth type, sex, and birth interval.
Conclusions:
- High residence-based CIAF differences persist in East Africa, primarily driven by household, maternal, and child characteristics.
- Rural children are disproportionately disadvantaged by these characteristics, highlighting systemic inequalities.
- Interventions should focus on improving household wealth, maternal education, and specific child care practices to reduce CIAF and associated inequalities.
Background:
Undernutrition remains a global challenge and public health concern, despite the presence of policies, programs and interventions. There is substantial evidence that the majority of the rural children under-5 years old have composite index of anthropometric failure than the urban counter parts. Hence, identifying the main contributors of these disparities will help health policy makers, program designers and implementers for the reduction of composite index of anthropometric failures in children under-5 years old in the study areas.
Methods:
The most recent and nationally representative samples of demographic and health surveys of five East African countries data were used for the current study. To appreciate the residence-based differences of composite index of anthropometric failure in under-5 children, the Blinder-Oaxaca decomposition analysis and its extensions were employed to determine the effects of covariates and coefficients. The country specific survey data analysis was performed.
Results:
The current study revealed that the burden of composite index of anthropometric failure (CIAF) in under-5 children were 40.69%, 22.04%, 34.06%, 31.99%, and 33.27% in Ethiopia, Kenya, Rwanda, Uganda, and Tanzania respectively. The residence-based differences in CIAF were 25.49%, 11.38%, 27%, 22.15%, and 20.55% in Ethiopia, Kenya, Rwanda, Uganda, and Tanzania respectively. Results of the Blinder-Oaxaca decomposition analysis and its extensions revealed that 100% of the rural-urban children under-5 composite index of anthropometric failure disparity was explained by endowment characteristics (covariate effect). Wealth index, mother's education, age of child, type of birth, sex of child and birth interval inequality between rural and urban households explains most of the composite index of anthropometric failure disparity in children under-5 years old.
Conclusions:
The residence-based CIAF differences were high in all study countries. The rural-urban CIAF gap is ascribed by household, maternal and child characteristics. This result implies that rural children under-5 is disproportionally disadvantaged with respect to characteristics than their consequences. Through identification of the underlying factors behind the rural-urban CIAF disparities, the result of this study is important in planning effective intervention measures aiming at reducing residence-based inequalities and the population health outcomes. Therefore, should be given for rural children to reduce CIAF by improving house hold wealth index, women education and attentions to older children, and female children.
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