Why Is Child Malnutrition Lower in Urban Than in Rural Areas? Evidence from 36 Developing Countries

Abstract

hile ample evidence documents that urban children generally have better nutritional status than their rural counterparts, recent research suggests that urban malnutrition is on the rise. The environment, choices, and opportunities of urbanites differ greatly from those of rural dwellers-from employment conditions to social and family networks to access to health care and other services. Given these differences, understanding the relative importance of the various determinants of child malnutrition in urban and rural areas-and especially whether they differis key to designing context-relevant, effective program and policy responses for stemming malnutrition. Purpose of This Paper This study uses Demographic and Health Survey data from 36 developing countries to address the question of whether the socioeconomic determinants of child nutritional status differ across urban and rural areas. The purpose is to answer the broader question of why child malnutrition rates are lower in urban areas. The socioeconomic determinants examined are women's education, women's status, access to safe water and sanitation, and household economic status. The Data The research employs data from 36 of the most recent Demographic and Health Surveys conducted between 1990 and 1998 in South Asia, Sub-Saharan Africa (SSA), and Latin America and the Caribbean (LAC). The countries were chosen based on the availability of data on child nutritional status. The sample analyzed for this paper includes 129,351 children under age 3 and 117,007 women of childbearing age, usually their mothers. The DHS data sets are from nationally representative surveys of households. Due to similar survey instruments and data collection methodologies, the data are largely comparable across countries. The determinants of child nutritional status examined in the present research are all closely related to at least one of the three underlying determinants of child nutritional status-household food security, care for women and children, and quality of the health environment. These determinants are fundamental to a child's dietary intakes and health status, which are more immediately related to nutritional status. This study further divides these underlying determinants into two groups: "proximal" (mother's nutritional status, prenatal and birthing care for mothers, and caring practices for children), and "socioeconomic" (maternal education, women's status, access to safe water, access to sanitary toilet facilities, and economic status).

Malnutrition in the Health District of Abong Mbang, Cameroon.

“…On the other hand some rural health areas like Akok Maka and Mindourou showed very low or no case of malnutrition for the time duration of the study. The result of this study in terms of geographical distribution is in contrary to the research of Smith et al in the year 2004 which showed that malnutrition affects most the rural setting than the urban setting (6). This difference could be due to the problem of reporting since most health facilities don't effectively have trained personnel in the detection and management of malnourished children; as noted from the incomplete nature of some of the forwarded monthly reports.…”

Malnutricion infantil e inseguridad alimentaria como expresión de las condiciones socio-económicas familiares en Villaguay, Argentina (2010-2012). Un enfoque biocultural

“…En general, en la literatura se argumenta que el ámbito urbano posee mejores condiciones ambientales y sanitarias que el rural (Comisión Económica para América Latina y el Caribe [CEPAL], 2008;Smith, Ruel y Ndiaye, 2005). Sin embargo, estos planteos desestiman las grandes disparidades internas que pueden existir dentro de las ciudades, debidas principalmente a la desigual distribución de variables socioeconómicas influyentes (CEPAL, 2008).…”

Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries

“…In modern developing countries, there is active debate about what defines "urbanness" (Dorélien et al 2013;Hugo et al 2003) and when and why urban advantages in infant and child health exist (Fink et al 2014;Günther and Harttgen 2012;Jankowska et al 2013;Montgomery and Hewett 2005;Smith et al 2005; Van de Poel et al 2007). Bocquier et al (2011) pointed out that urban advantages depend on the services and economic opportunities that a city provides, whereas Sastry (1996) noted that the effects of community-level variables on child health often depend on context-that is, that when exploring the effects of place on health, interactions are often important.…”