title: Gendered effects of siblings on child malnutrition in South Asia: cross-sectional analysis of demographic and health surveys from Bangladesh, India, and Nepal.
abstract: This study examines the effects of number and sex of siblings on malnutrition of boys and girls under-5 in South Asia. Cross-sectional analyses were conducted on Demographic and Health Surveys data on children under-5 in Bangladesh (N = 7,861), India (N = 46,655) and Nepal (N = 2,475). Data were pooled across countries, and multinomial logistic regression was used to assess the relationship between number and sex of siblings and malnutrition outcomes (wasting, stunting, underweight; based on anthropometric data), adjusting for country and key social and maternal-child health indicators in sex stratified analyses. Number of brothers increased the odds for severe wasting [1 vs. 0 brothers adjusted odds ratio (AOR) = 1.31, 95 % CI = 1.11, 1.55; 2 vs. 0 brothers AOR = 1.36, 95 % CI = 1.07, 1.73] for girls but not boys. Having more male siblings and more female siblings increased the odds of stunting for boys and girls, but effect of 3+ sisters on severe stunting was significantly stronger for girls than boys (girls- 3+ vs. 0 sisters AOR = 2.25, 95 % CI = 1.88, 2.70; boys- 3+ vs. 0 sisters AOR = 1.37, 95 % CI = 1.13, 1.67). For underweight, three or more sisters increased the odds for severe underweight for girls (AOR = 1.27, 95 % CI = 1.04, 1.57) but not boys. Having brothers heightens girl risk for acute malnutrition (wasting), where having multiple sisters increases girl risk for chronic malnutrition (stunting/underweight). Boy malnutrition is less affected by siblings. Findings suggest that issues of son preference/daughter aversion may affect child malnutrition in South Asia.
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA, anitaraj@ucsd.edu.
authors.forename: Anita
authors.initials: A
authors.lastname: Raj
authors.forename: Lotus P
authors.initials: LP
authors.lastname: McDougal
authors.forename: Jay G
authors.initials: JG
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000328:Adult; D000886:Anthropometry; D001208:Asia / Q000453:epidemiology; D001459:Bangladesh / Q000453:epidemiology; D015362:Child Nutrition Disorders / Q000150:complications* / Q000453:epidemiology*; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006130:Growth Disorders / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D012307:Risk Factors; D017678:Sex Distribution; D035781:Siblings; D013851:Thinness / Q000150:complications / Q000453:epidemiology; D019282:Wasting Syndrome / Q000150:complications / Q000453:epidemiology; D055815:Young Adult