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Using Cholesky Decomposition to Explore Individual Differences in Longitudinal Relations between Reading Skills

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Published on: September 17, 2019

Disentangling disparities in children's development.

Nicolás Acosta-González¹, Carolina Pérez², Silvio Guerra²

¹Facultad de Economía y Gestión Empresarial, Pontificia Universidad Católica del Ecuador, Quito, Ecuador. hnacosta@puce.edu.ec.

Journal of Public Health Policy

|July 1, 2026

Summary

Deep-rooted inequalities in birth location, income, and maternal education limit children's access to essential early development services. Children with chronic malnutrition face significant disparities, especially in water and sanitation access, highlighting the need for equitable public health policies.

Keywords:

Chronic malnutrition Disentangling Healthcare Sanitation Water

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Area of Science:

Public Health
Developmental Pediatrics
Health Equity

Background:

Childhood development is significantly impacted by socioeconomic and geographic inequalities.
Access to essential services like healthcare, water, and sanitation is crucial for early development.
Existing research indicates disparities in service access but lacks granular analysis of factors contributing to inequity.

Purpose of the Study:

To assess disparities in access to essential services for early development in Ecuador.
To identify key drivers of inequality in healthcare, water, and sanitation access.
To inform the development of equitable public health policies.

Main Methods:

Utilized data from the National Survey on Childhood Malnutrition (ENDI).
Employed the Human Opportunity Index (HOI) to measure disparities.
Applied Shapley decomposition to identify predictors of inequality.

Main Results:

While overall service access is high, significant inequalities exist, particularly for children with chronic malnutrition (stunting).
The largest equity gaps are observed in access to safely managed drinking water and sanitation.
Geographic location emerged as the primary predictor of inequality, followed by economic status and maternal education.

Conclusions:

Deep-rooted inequalities significantly restrict access to essential services for early development.
Addressing disparities in water and sanitation is critical for improving child health outcomes.
Findings offer transferable insights for designing equitable public health interventions globally.