Changes in inequality of childhood morbidity in Bangladesh 1993-2014: A decomposition analysis

Abstract

Introduction Child health remains an important public health concern at the global level, with preventable diseases such as diarrheal disease, acute respiratory infection (ARI) and fever posing a large public health burden in low- and middle-income countries including Bangladesh. Improvements in socio-economic conditions have tended to benefit advantaged groups in societies, which has resulted in widespread inequalities in health outcomes. This study examined how socioeconomic inequality is associated with childhood morbidity in Bangladesh, and identified the factors affecting three illnesses: diarrhea, ARI and fever. Materials and methods A total of 43,860 sample observations from the Bangladesh Demographic and Health Survey, spanning a 22-year period (1993–2014), were analysed. Concentration curve and concentration index methods were used to evaluate changes in the degree of household wealth-related inequalities and related trends in childhood morbidity. Regression-based decomposition analyses were used to attribute the inequality disparities to individual determinants for the three selected causes of childhood morbidity. Results The overall magnitude of inequality in relation to childhood morbidity has been declining slowly over the 22-year period. The magnitude of socio-economic inequality as a cause of childhood morbidity varied during the period. Decomposition analyses attributed the inequalities to poor maternal education attainment, inadequate pre-delivery care, adverse chronic undernutrition status and low immunisation coverage. Conclusions High rates of childhood morbidity were observed, although these have declined over time. Socio-economic inequality is strongly associated with childhood morbidity. Socio-economically disadvantaged communities need to be assisted and interventions should emphasise improvements of, and easier access to, health care services. These will be key to improving the health status of children in Bangladesh and should reduce economic inequality through improved health over time.

Inequality of childhood undernutrition in Bangladesh: A decomposition approach

“…However, affluent households were benefited more from the economic growth compared with poor households . Indeed, children from disadvantaged socioeconomic households bear the greatest burden of childhood morbidity, which is directly linked with childhood undernutrition . Therefore, policy should prioritize the mitigation of the unequal wealth distribution by focusing on effective financial mechanisms, voucher scheme, social safety net programs, and creating income opportunities, which might contribute to reducing income‐related inequalities so as to reduce childhood undernutrition in all strata of society.…”

“…Indeed, interventions promoting behavior change could be an effective strategy for tackling inequality in childhood undernutrition by targeting poorer households and uneducated mothers . Similarly, mass‐media exposure is an important source of knowledge for avoiding childhood undernutrition and has an important role to inform mothers better about adverse child health outcomes . Therefore, the in‐depth attention of policy makers is needed to increase the accessibility of mass medias and to design and roll out nutrition education programs to increase nutritional knowledge and awareness among unprivileged mothers in the community.…”

“…53 Similarly, mass-media exposure is an important source of knowledge for avoiding childhood undernutrition and has an important role to inform mothers better about adverse child health outcomes. 48,54 Therefore, the in-depth attention of policy makers is needed to increase the accessibility of mass medias and to design and roll out nutrition education programs to increase nutritional knowledge and awareness among unprivileged mothers in the community. The latest Bangladesh National Nutrition Policy emphasizes improving health equity for the poor and geographically marginalized populations through identifying its various underlying causes.…”

Inequalities in health care utilization for common illnesses among under five children in Bangladesh

“…diarrhea and ARI. Besides, a study by Mahumud et al (2019) attempted to explore the inequality of childhood morbidity in Bangladesh. However, the study did not capture the inequality in treatment use [23].…”

“…Besides, a study by Mahumud et al (2019) attempted to explore the inequality of childhood morbidity in Bangladesh. However, the study did not capture the inequality in treatment use [23]. Contingent upon this backdrop, the objective of this study is to find out the determining factors which influence equitable health care utilization among children with fever, cough, and diarrhea in Bangladesh so as to provide information for future planning, policy making, and appropriate interventions in reducing the level of under-five morbidity and mortality in Bangladesh.…”