Decomposing the gap in childhood undernutrition between poor and non–poor in urban India, 2005–06

Despite the growing evidence from other developing countries, intra-urban inequality in childhood undernutrition is poorly researched in India. Additionally, the factors contributing to the poor/non-poor gap in childhood undernutrition have not been explored. This study aims to quantify the contribution of factors that explain the poor/non-poor gap in underweight, stunting, and wasting among children aged less than five years in urban India.We used cross-sectional data from the third round of the National Family Health Survey conducted during 2005-06. Descriptive statistics were used to understand the gap in childhood undernutrition between the urban poor and non-poor, and across the selected covariates. Blinder-Oaxaca decomposition technique was used to explain the factors contributing to the average gap in undernutrition between poor and non-poor children in urban India.Considerable proportions of urban children were found to be underweight (33%), stunted (40%), and wasted (17%) in 2005-06. The undernutrition gap between the poor and non-poor was stark in urban India. For all the three indicators, the main contributing factors were underutilization of health care services, poor body mass index of the mothers, and lower level of parental education among those living in poverty.The findings indicate that children belonging to poor households are undernourished due to limited use of health care services, poor health of mothers, and poor educational status of their parents. Based on the findings the study suggests that improving the public services such as basic health care and the education level of the mothers among urban poor can ameliorate the negative impact of poverty on childhood undernutrition

Poverty, Undernutrition, and Child Mortality: Some Inter-Regional Puzzles and their Implications for Research and Policy

This paper examines the relationship between measures of income poverty, undernourishment, childhood undernutrition, and child mortality in developing countries. While there is, as expected, a close aggregate correlation between these measures of deprivation, the measures generate some inter-regional paradoxes. Income poverty and child mortality is highest in Africa, but childhood undernutrition is by far the highest in South Asia, while the share of people with insufficient calories (undernourishment) is highest in the Caribbean. The paper finds that standard explanations cannot account for these inter-regional paradoxes, particularly the ones related to undernourishment and childhood undernutrition. The paper suggests that measurement issues related to the way undernourishment and childhood undernutrition is measured might play a significant role in affecting these inter-regional puzzles and points to implications for research and policy.Millennium Development Goals, Undernutrition, Child Mortality, Poverty

Child undernutrition in affluent societies: what are we talking about?

In this paper we set out to explore the prevalence of child undernutrition found in community studies in affluent societies, but a preliminary literature review revealed that, in the absence of a gold standard method of diagnosis, the prevalence largely depends on the measure, threshold and the growth reference used, as well as age. We thus go on to explore describe the common clinical ‘syndromes’ of child undernutrition: wasting, stunting and failure to thrive (weight faltering) and how we have used data from two population-based cohort studies, this paper to explore how much these different ‘syndromes’ overlap and the extent to which they reflect true undernutrition. This analysis revealed that when more than one definition is applied to the same children, a majority are below the lower threshold for only one measure. However, those with both weight faltering and low BMI in infancy, go on in later childhood to show growth and body composition patterns suggestive of previous undernutrition. In older children there is even less overlap and most children with either wasting or low fat seem to be simply growing at one extreme of the normal range. We conclude that in affluent societies the diagnosis of undernutrition is only robust when it relies on a combination of both, that is decline in weight or BMI centile and wasting

Postnatal origins of undernutrition.

Obesity and nutrition-related chronic disorders are fast rising in developing countries. But undernutrition--stunting, underweight, wasting and micronutrient deficiencies--still affect millions of preschool children in both rural and urban settings increasing the risks of morbidity and mortality, impairing cognitive development, reducing productivity and increasing the risk of chronic diseases in later life. In addition undernutrition has a transgenerational effect. Here I review the evidence for a synergistic effect of inadequate nutrition (breastfeeding, complementary feeding), infection, and inappropriate mother-child interactions on growth and nutritional deficiencies. Underlying socioeconomic, environmental and genetic factors are also explored. Finally some perspectives on how urbanization and globalization may affect the prevalence and distribution of undernutrition are discussed. Fighting child under-nutrition is still an urgent necessity and a moral imperative

Investing in early childhood nutrition:

"It has long been known that good nutrition is essential to children's physical and cognitive development, but recent evidence sheds new light on the optimal timing of interventions to improve child nutrition and the long-term effects of such interventions. Recent studies have shown that undernutrition has a whole range of effects that impede not only children's nutrition and development in the short term, but also their cognitive abilities and productivity in adulthood, with measurable economic impacts. They have also shown that the window of opportunity for addressing child nutritional needs in ways that produce healthy, productive adults lasts from conception through age two. After that, the effects of undernutrition are largely irreversible. By addressing the large and severe problem of early childhood undernutrition in many poor countries, policymakers could maximize the effectiveness of investments designed to achieve overall development goals." from authors' abstractChildren, Nutrition, malnutrition, Undernutrition, Nutrition policy Developing countries,

Seasonal undernutrition in rural Ethiopia:

Marked seasonal variability of both production- and consumption is characteristic of virtually all farming systems in the developing world. This study examines the magnitude and significance of seasonal undernutrition in south central Ethiopia, southern Shewa and Zigwa Boto, a peasant association in the Gurage Zone. The study seeks to answer five questions: (1)Does seasonal energy stress affect individuals of various age groups and sexes differently? (2)Do members of the same household show divergent responses to seasonal energy stress? (3)What are the functional consequences of different levels of adult undernutrition? (4)Are the current anthropometric cut-off points for adults appropriate for rural Ethiopia? (5)What household characteristics are associated with vulnerability to seasonal undernutrition? A number of important findings emerge from this research.....The study clarifies some points of contention in the field of adult undernutrition and shows how seasonal undernutrition operates as an intermittent warning signal, reminding us not to miss opportunities to promote good nutrition throughout the life cycle.Nutrition, Ethiopia, Malnutrition., Food crops., Climate.,

Is undernutrition responsive to changes in incomes?

This paper discusses the effect that changes in individual incomes have on aggregate undernutrition. Undernutrition depends not only on nutrient intakes but on other factors, including nutrient requirements - which may differ widely amongst people. The author offers an approach to measuring the effects of shifts in budget constraints or other household parameters on undernutrition. Using household data on calorie consumption, income, prices, and other household characteristics, theaper illustrates how to: (a) estimate caloric intake functions for that data; and (b) use those functions to simulatethe effects of income changes on various measures of caloric undernutrition. The paper finds that the income elasticity of measured undernutrition is considerably higher than the income elasticity of individual caloric intakes. The reason is that the density of people tends to be high in a neighborhood of requirement norms, and intake responses tend to be highest amongst those who are least well nourished. Recent arguments that intakes are unresponsive to income changes should thus be interpreted with caution.Poverty Diagnostics,Environmental Economics&Policies,Economic Theory&Research,Inequality,Poverty Lines

Geo-additive models of Childhood Undernutrition in three Sub-Saharan African Countries

We investigate the geographical and socioeconomic determinants of childhood undernutrition in Malawi, Tanzania and Zambia, three neighboring countries in Southern Africa using the 1992 Demographic and Health Surveys. We estimate models of undernutrition jointly for the three countries to explore regional patterns of undernutrition that transcend boundaries, while allowing for country-specific interactions. We use semiparametric models to flexibly model the effects of selected so-cioeconomic covariates and spatial effects. Our spatial analysis is based on a flexible geo-additive model using the district as the geographic unit of anal-ysis, which allows to separate smooth structured spatial effects from random effect. Inference is fully Bayesian and uses recent Markov chain Monte Carlo techniques. While the socioeconomic determinants generally confirm what is known in the literature, we find distinct residual spatial patterns that are not explained by the socioeconomic determinants. In particular, there appears to be a belt run-ning from Southern Tanzania to Northeastern Zambia which exhibits much worse undernutrition, even after controlling for socioeconomic effects. These effects do transcend borders between the countries, but to a varying degree. These findings have important implications for targeting policy as well as the search for left-out variables that might account for these residual spatial patterns

The Role of Women?s Empowerment and Domestic Violence in Child Growth and Undernutrition in a Tribal and Rural Community in South India

Moderate undernutrition continues to affect 46 per cent of children under 5 years of age and 47 per cent of rural women in India. Women?s lack of empowerment is believed to be an important factor in the persistent prevalence of undernutrition. In India, women?s empowerment often varies by community, with tribes sometimes being the most progressive. This paper explores the relationship between women?s empowerment, domestic violence, maternal nutritional status, and the nutritional status and growth over six months in children aged 6 to 24 months in a rural and tribal community. This longitudinal observational study undertaken in rural Karnataka, India included tribal and rural subjects. Structured interviews with mothers were conducted and anthropometric measurements were obtained for 820 mother-child pairs, the follow-up rate after 6 months was 82 per cent. The data were analysed by multivariate regression. Some degree of undernutrition was seen in 83.5 per cent of children and 72.4 per cent of mothers in the sample, moreover the prevalence of undernutrition increased among children at follow-up. Domestic violence was experienced by 34 per cent of mothers in the sample. In multivariate analysis, biological variables explained most of the variance in nutritional status and child growth, followed by health-care seeking and women?s empowerment variables; socio-economic variables explained the least variance. Women?s empowerment variables were significantly associated with child nutrition on enrolment and child growth at follow-up. At follow-up, mother?s prior lifetime experience of physical violence significantly undermined child growth in terms of weight-for-age, and older age at marriage and high mobility of mothers predicted less stunting in their children. In addition to the known investments needed to reduce undernutrition, improving women?s nutrition, promoting gender equality, empowering women, and ending violence against women could further reduce the prevalence of undernutrition in this segment of the Indian population.child nutrition, child growth, domestic violence, nutritional status, women?s empowerment, maternal nutritional status

Reducing child undernutrition

How rapidly will child undernutrition respond to income growth? This study explores that question using household survey data from 12 countries. In addition, data on the undernutrition rates since the 1970s available from a cross-section of countries are employed in this investigation. Both forms of analysis yield similar results. Income increases at household and national levels imply similar rates of reduction in undernutrition. Using these estimates and better-than-historical income growth rates, we find that the Millennium Development Goal (MDG) of halving the levels of child underweight by 2015 is unlikely to be met through income growth alone. What is needed is a balanced strategy of income growth and investment in more direct interventions to accelerate reductions in undernutrition.Food security. ,Income Developing countries. ,Malnutrition. ,Children Nutrition. ,