title: Social determinants of inequalities in child undernutrition in Bangladesh: A decomposition analysis.
abstract: Socioeconomic inequalities in child undernutrition remain one of the main challenges in Bangladesh. The social determinants of health are mostly responsible for such inequalities across different population groups. However, no study has examined the relative contribution of different social determinants to the socioeconomic inequality in child undernutrition in Bangladesh. Our objective is to measure the extent of socioeconomic-related inequalities in childhood stunting and identify the key social determinants that potentially explain these inequalities in Bangladesh. We used data for children younger than 5 years of age for this analysis from 2 rounds of Bangladesh Demographic and Health Surveys conducted in 2004 and 2014. We examined the socioeconomic inequality in stunting using the concentration curve and concentration index. We then decomposed the concentration index into the contributions of individual social determinants. We found significant inequality in stunting prevalence. The negative concentration index of stunting indicated that stunting was more concentrated among the poor than among the well-off. Our results suggest that inequalities in stunting increased between 2004 and 2014. Household economic status, maternal and paternal education, health-seeking behavior of the mothers, sanitation, fertility, and maternal stature were the major contributors to the disparity in stunting prevalence in Bangladesh. Equity is a critical component of sustainable development goals. Health policymakers should work together across sectors and develop strategies for effective intersectoral actions to adequately address the social determinants of equity and reduce inequalities in stunting and other health outcomes.
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.|Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh.
authors.forename: Tanvir M
authors.identifier: 0000-0002-8996-4361
authors.initials: TM
authors.lastname: Huda
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Hayes
authors.affiliation: Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh.
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dibley
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D001827:Body Height; D002675:Child, Preschool; D004522:Educational Status; D006130:Growth Disorders / Q000453:epidemiology; D015438:Health Behavior; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D007223:Infant; D044342:Malnutrition / Q000453:epidemiology*; D008425:Maternal Behavior; D000068097:Maternal Health; D008875:Middle Aged; D011203:Poverty; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Bangladesh; decomposition; low-income countries; socioeconomic factors; stunting; undernutrition