Socioeconomic gradients in early childhood health: evidence from Bangladesh and Nepal

Abstract

BackgroundA large literature has developed researching the origins of socioeconomic gradients in child health in developed countries. Particularly, this research examines the age at which these gradient effects emerge and how they change across different stages of childhood. However, similar research on developing countries is limited.MethodsThis paper examines the socioeconomic gradients in early childhood health in two developing countries, Bangladesh and Nepal using the 2011 Demographic and Health Surveys. The paper separately studies two measures of household socioeconomic status: household wealth and maternal educational attainment. Two anthropometric measures of early childhood health, height-for-age and weight-for-age Z scores for 0–59 months of children, are used for our empirical exercise. The paper uses both non-parametric and multivariate ordinary least squares approaches to examine at what age socioeconomic disparities in health emerge, and investigates if these disparities increase with age in early childhood.ResultsThe paper provides significant evidence of age-specific socioeconomic gradients in early childhood health in both countries. Health disparities in household wealth exist in both countries. This disparity emerges in the first 11 months of life, and is particularly severe for children from the poorest quintile. On the other hand, while the emergence of maternal education gradients during the first 11 months is sensitive to the choice of childhood health measure, the study finds the children of mothers with higher education to enjoy significantly higher health outcomes in comparison to those with lower education. However, controlling for father’s education weakens the effects of maternal education on child health in both countries. Further, the paper does not find statistically significant evidence where socioeconomic gradients in health increase with age in early childhood.ConclusionsOur study concludes that socioeconomic disparities in health outcomes exist even in very early childhood in Bangladesh and Nepal. This has important implications for targeted policy interventions in the form of food security and nutrition supplement programs, free provision of health care, and maternal education in both countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0364-2) contains supplementary material, which is available to authorized users.

How socioeconomic status moderates the stunting-age relationship in low-income and middle-income countries

“…Surprisingly, despite the importance of the socioeconomic environment, the moderating effect of income or household socioeconomic status (SES) for the age pattern of stunting or, alternatively, height-for-age z-scores (HAZ) has not been systematically described. Existing studies are largely limited to rough split-sample analyses and only a small set of countries 12–21. While Alderman and Headey22 make use of a much larger data set, consisting of Demographic and Health Surveys (DHS) implemented in 57 countries, to describe various determinants of HAZ in children below the age of 5 years, they limit their focus to seven age groups and only base their analysis on SES terciles rather than quartiles.…”

Socio-economic risk factors for early childhood underweight in Bangladesh

“…Even though Bangladesh has one of the highest prevalence of underweight in the world, few studies have identified the socioeconomic factors responsible for child underweight [ 24 – 30 ]. Most of the studies conducted in Bangladesh suggested that maternal education is a strong and significant predictor for child underweight [ 24 , 28 , 29 , 31 , 32 ]. A recent study by Devkota et al [ 28 ] established a positive association of WAZ (weight-for-age z score) with the level of maternal education.…”

“…Most of the studies conducted in Bangladesh suggested that maternal education is a strong and significant predictor for child underweight [ 24 , 28 , 29 , 31 , 32 ]. A recent study by Devkota et al [ 28 ] established a positive association of WAZ (weight-for-age z score) with the level of maternal education. Mohsena et al [ 24 ] explored the Bangladesh Demographic and Health Survey (2004) Data and found that higher levels of maternal education are associated with lower risk of underweight.…”

“…Children coming from poor families are more likely to be underweight compared with children coming from wealthier families [ 4 ]. Despite the fact that Bangladesh has managed to achieve an enormous economic growth in the last 20 years along with massive improvements in educational achievement, still a large proportion of its population, nearly 43.3%, are living under the poverty line of 1.25 dollar per day [ 28 ]. Having such a large proportion of the population living in poverty, hence unable to afford nutritious food or access improved health care facilities, makes the task of reducing the country’s prevalence of underweight children extremely difficult.…”

“…Having such a large proportion of the population living in poverty, hence unable to afford nutritious food or access improved health care facilities, makes the task of reducing the country’s prevalence of underweight children extremely difficult. Indeed, a number of studies conducted in Bangladesh suggested household socioeconomic status as a significant determinant of child underweight, reporting that children from relatively higher socioeconomic condition had lower likelihood of being underweight [ 28 , 33 ]. A study in Bangladesh carried out by Alom et al [ 29 ] reported that children who came from the richest wealth index had 44% lower odds of being underweight compared with children from the poorest wealth index.…”