Semiparametric Analysis of the Socio-Demographic and Spatial Determinants of Undernutrition in Two African Countries

We estimate semiparametric regression models of chronic undernutrition (stunting) using the 1992 Demographic and Health Surveys (DHS) from Tanzania and Zambia. We focus particularly on the influence of the child's age, the mother's body mass index, and spatial influences on chronic undernutrition. Conventional parametric regression models are not flexible enough to cope with possibly nonlinear effects of the continuous covariates and cannot flexibly model spatial influences. We present a Bayesian semiparametric analysis of the effects of these two covariates on chronic undernutrition. Moreover, we investigate spatial determinants of undernutrition in these two countries. Compared to previous work with a simple fixed effects approach for the influence of provinces, we model small scale district specific effects using flexible spatial priors. Inference is fully Bayesian and uses recent Markov chain Monte Carlo techniques

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 neighbouring countries in southern Africa, using the 1992 Demographic and Health Surveys. In particular, 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 geo-additive regression models to flexibly model the effects of selected socioeconomic covariates and spatial effects. Inference is fully Bayesian based on recent Markov chain Monte Carlo techniques. While the socioeconomic determinants generally confirm findings from the literature, we find distinct residual spatial patterns that are not explained by the socioeconomic determinants. In particular, there appears to be a belt transcending boundaries and running from southern Tanzania to northeastern Zambia which exhibits much worse undernutrition. These findings have important implications for planning, as well as in the search for left-out variables that might account for these residual spatial patterns

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

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

Differential pathways to adult metabolic dysfunction following poor nutrition at two critical developmental periods in sheep

Epidemiological and experimental studies suggest early nutrition has long-term effects on susceptibility to obesity, cardiovascular and metabolic diseases. Small and large animal models confirm the influence of different windows of sensitivity, from fetal to early postnatal life, on offspring phenotype. We showed previously that undernutrition in sheep either during the first month of gestation or immediately after weaning induces differential, sex-specific changes in adult metabolic and cardiovascular systems. The current study aims to determine metabolic and molecular changes that underlie differences in lipid and glucose metabolism induced by undernutrition during specific developmental periods in male and female sheep. Ewes received 100% (C) or 50% nutritional requirements (U) from 1–31 days gestation, and 100% thereafter. From weaning (12 weeks) to 25 weeks, offspring were then fed either ad libitum (CC, UC) or were undernourished (CU, UU) to reduce body weight to 85% of their individual target. From 25 weeks, all offspring were fed ad libitum. A cohort of late gestation fetuses were studied after receiving either 40% nutritional requirements (1–31 days gestation) or 50% nutritional requirements (104–127 days gestation). Post-weaning undernutrition increased in vivo insulin sensitivity, insulin receptor and glucose transporter 4 expression in muscle, and lowered hepatic methylation at the delta-like homolog 1/maternally expressed gene 3 imprinted cluster in adult females, but not males. Early gestational undernutrition induced lower hepatic expression of gluconeogenic factors in fetuses and reduced in vivo adipose tissue insulin sensitivity in adulthood. In males, undernutrition in early gestation increased adipose tissue lipid handling mechanisms (lipoprotein lipase, glucocorticoid receptor expression) and hepatic methylation within the imprinted control region of insulin-like growth factor 2 receptor in adulthood. Therefore, undernutrition during development induces changes in mechanisms of lipid and glucose metabolism which differ between tissues and sexes dependent on the period of nutritional restriction. Such changes may increase later life obesity and dyslipidaemia risk

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