Wealth inequalities in nutritional status among the tribal under-5 children in India: A temporal trend analysis using NFHS data of Jharkhand and Odisha states - 2006-21

Background

Undernutrition remains a major public health concern in India, especially among children belonging to the Scheduled Tribes (ST). In this study, we analyse wealth inequalities in nutritional outcomes within ST communities in two tribal-dominated states of India, namely, Odisha and Jharkhand. The study also compares the trends in nutrition outcomes between ST and Non-ST children in these states.

Methods

We have conducted a trend analysis of the prevalence and inequalities in the nutritional indicators among ST children under age five using unit-level data of the National Family Health Survey (NFHS) [NFHS-3(2005-06),4 (2015-16) and 5(2019-2021)]. Wealth-related inequalities were analysed using the Slope Index of Inequality (SII), which measures absolute inequality, and the relative Concentration Index (CIX), which measures relative inequality. We have also analysed the correlation between Antenatal Care (ANC) visits and nutritional indicators using the Pearson Correlation test.

Results

The trend analysis shows that the prevalence of undernutrition remains higher among ST children in India as compared to Non-ST children between NFHS-3 (2005-06) and NFHS-5 (2019-2020) in Jharkhand and Odisha. The SII and CIX values show that statistically significant inequalities in stunting and underweight exist among children belonging to various wealth quintiles within the ST category in both states. Wasting is found to be significantly prevalent across all wealth quintiles. Also, we found a negative association between ANC visits and all three nutritional indicators.

Interpretation

Our study highlights the importance of monitoring both the absolute and relative wealth inequalities in nutritional outcomes. This is due to the fact that while inequalities across groups may reduce, the prevalence of poor nutritional outcomes may increase among certain groups. Such observations, therefore, will enable policymakers to focus further on those groups and devise appropriate interventions.

Decomposition analysis of the compositional and contextual factors associated with poor-non-poor inequality in diarrhoea among under-five children in low- and middle-income countries

OBJECTIVES

The aim of the study was to assess the magnitude of wealth inequalities in the development of diarrhoea among under-five children in low- and middle-income countries (LMICs) and to identify and quantify contextual and compositional factors' contribution to the inequalities.

DESIGN

This is a cross-sectional study.

METHODS

We used cross-sectional data from 57 Demographic and Health Surveys conducted between 2010 and 2018 in LMICs. Descriptive statistics were used to understand the gap in having diarrhoea between the children from poor and non-poor households and across the selected covariates using Fairlie decomposition techniques with multivariable binary logistic regressions at P = 0.05.

RESULTS

Of the 57 countries, we found a statistically significant pro-poor odds ratio in only 29 countries, 7 countries showed pro-non-poor inequality and others showed no statistically significant inequality. Among the countries with statistically significant pro-poor inequality, the risk difference was largest in Cameroon (94.61/1000), whereas the largest pro-non-poor risk difference in diarrhoea was widest in Timor-Leste (-41.80/1000). Important factors responsible for pro-poor inequality varied across countries. The largest contributors to the pro-poor inequalities in having diarrhoea are maternal education, access to media, neighbourhood socio-economic status, place of residence, birth order and maternal age.

CONCLUSION

Diarrhoea remains a major challenge in most LMICs, with a wide range of pro-poor inequalities. These disparities were explained by both compositional and contextual factors, which varied widely across the countries. Thus, multifaceted geographically specific economic alleviation intervention may prove to be a potent approach for addressing the poor and non-poor differentials in the risk of diarrhoea with policies tailored to country-specific risk factors. There is a need for further investigation of factors that drive pro-non-poor inequalities found in 9 of the LMICs.

Soil salinity, household wealth and food insecurity in tropical deltas: evidence from south-west coast of Bangladesh

As a creeping process, salinisation represents a significant long-term environmental risk in coastal and deltaic environments. Excess soil salinity may exacerbate existing risks of food insecurity in densely populated tropical deltas, which is likely to have a negative effect on human and ecological sustainability of these regions and beyond. This study focuses on the coastal regions of the Ganges-Brahmaputra delta in Bangladesh, and uses data from the 2010 Household Income and Expenditure Survey and the Soil Resource Development Institute to investigate the effect of soil salinity and wealth on household food security. The outcome variables are two widely used measures of food security: calorie availability and household expenditure on food items. The main explanatory variables tested include indicators of soil salinity and household-level socio-economic characteristics. The results of logistic regression show that in unadjusted models, soil salinisation has a significant negative effect on household food security. However, this impact becomes statistically insignificant when households' wealth is taken into account. The results further suggest that education and remittance flows, but not gender or working status of the household head, are significant predictors of food insecurity in the study area. The findings indicate the need to focus scholarly and policy attention on reducing wealth inequalities in tropical deltas in the context of the global sustainable deltas initiative and the proposed Sustainable Development Goals.