title: Time trends in socio-economic inequalities in stunting prevalence: analyses of repeated national surveys.
abstract: OBJECTIVE
  Much is known about national trends in child undernutrition, but there is little information on how socio-economic inequalities are evolving over time. We aimed to assess socio-economic inequalities in stunting prevalence over time.
  
  
  METHODS
  We selected nationally representative surveys carried out since the mid-1990s for which information was available on asset indices and on child anthropometry. We identified twenty-five countries that had at least two surveys over an interval of 10 years or more, totalling eighty-seven surveys. Stunting prevalence was calculated according to wealth quintiles. Absolute and relative inequalities were calculated and time trends were obtained by regression. Setting Nationally representative household surveys from twenty-five low- and middle-income countries.
  
  
  METHODS
  Children <5 years of age.
  
  
  RESULTS
  National prevalence declined significantly in twenty-two of the twenty-five countries. In eighteen out of twenty-five countries, relative reductions were higher among the rich than among the poor. Overall, there was no indication that inequalities improved. Striking examples are Nepal, with a 17·0 percentage points decline in stunting per decade, but where inequalities increased sharply; and Brazil, where stunting fell by 6·7 percentage points and inequalities were all but eliminated.
  
  
  CONCLUSIONS
  Global progress in reducing stunting has not been accompanied by improved equity, but countries varied markedly in how successful they were in reducing prevalence among the poorest children. It is important to document how some countries were able to reduce inequalities, so that these lessons can be used to foster global progress, particularly in light of the increased importance of within-country inequalities in the post-2015 agenda.
authors.affiliation: 1International Center for Equity in Health,Federal University of Pelotas,Rua Marechal Deodoro 1160,3° Piso,96020-220 Pelotas,Brazil.
authors.forename: María Clara
authors.initials: MC
authors.lastname: Restrepo-Méndez
authors.affiliation: 1International Center for Equity in Health,Federal University of Pelotas,Rua Marechal Deodoro 1160,3° Piso,96020-220 Pelotas,Brazil.
authors.forename: Aluísio J D
authors.initials: AJ
authors.lastname: Barros
authors.affiliation: 2Institute for International Programs,Bloomberg School of Public Health,Johns Hopkins University,Baltimore,MD,USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.affiliation: 1International Center for Equity in Health,Federal University of Pelotas,Rua Marechal Deodoro 1160,3° Piso,96020-220 Pelotas,Brazil.
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
mesh_terms: D001827:Body Height; D001835:Body Weight; D002675:Child, Preschool; D005191:Family Characteristics; D006130:Growth Disorders / Q000453:epidemiology*; D006306:Health Surveys / Q000639:trends*; D006801:Humans; D016014:Linear Models; D015995:Prevalence; D012959:Socioeconomic Factors
keywords: Child; Malnutrition; Nutritional status; Socio-economic factors; Stunting