Abstract
BackgroundPakistan ranks third lowest on a global gender index (2013) and 13th highest on the prevalence of underweight among under-five children (2010). Through this population-based study, we examined gender differentials in the prevalence of stunting, wasting and under-weight defined by World Health Organization (WHO) Growth Standard among rural pre-school Pakistani children.MethodsWe performed secondary analysis of data collected through a cross-sectional survey of Thatta district during 1992-93. Prevalence ratios were calculated for 1051 children aged 0-35 months from 95 randomly selected villages of rural Pakistan using a clustered adjusted log binomial model. Level 1 variables included child and household characteristics and level 2 included village characteristics.ResultsBased on the new WHO growth reference, a major proportion of children were stunted (52.9 %), wasted (22.9 %) and under-weight (46.5 %). In a two-level model, compared to boys, girls had significantly greater risk of stunting [Prevalence Ratio (PR) (95 % C.I.) = 1.18 (1.03, 1.36)] and under-weight [P.R. (95 % C.I.) 1.14 (1.03, 1.26)], after adjustment of maternal literacy and village variables. Risk of wasting did not differ with gender [P.R. (95 % C.I.) = 1.04 (0.99, 1.15)]. Mothers of stunted and underweight children were respectively, 21 and 20 % more likely to be illiterate than those of normally nourished children. Sick children were at 16 % greater risk of wasting than those not reported ill.ConclusionGreater prevalence of stunting and under-weight among girls suggests adoption of a gender sensitive approach in nutritional intervention programmes. Prompt management of childhood illnesses may reduce prevalence of wasting. Better literacy among rural mothers may reduce prevalence of stunting and under-weight. Whether gender differences in nutrition status are an underlying pathway for excessive girl mortality in rural Thatta needs further examination.
Highlights
Pakistan ranks third lowest on a global gender index (2013) and 13th highest on the prevalence of underweight among under-five children (2010)
Girl disadvantge in nutritional status is reported in eight urban squatter settlements of Karachi [12], boy disadvantage in 300 rural and urban communities included in the Pakistan Integrated Household Survey (PIHS) (1991) [13] and no gender difference in four rural districts of Sindh [14]
We primarily aimed to examine the association of gender separately with stunting, wasting and under-weight among pre-school rural Pakistani children in specific conceptual and analytical frameworks
Summary
Pakistan ranks third lowest on a global gender index (2013) and 13th highest on the prevalence of underweight among under-five children (2010). Girl disadvantge in nutritional status is reported in eight urban squatter settlements of Karachi [12], boy disadvantage in 300 rural and urban communities included in the Pakistan Integrated Household Survey (PIHS) (1991) [13] and no gender difference in four rural districts of Sindh [14] These findings did not account for contextual community level factors in analysis. The new WHO growth reference released in April 2006 is recommended for use in preference to the NCHS reference to assess children regardless of ethnicity, socio-economic status and type of feeding [17] It gives greater prevalence of stunting throughout childhood, of wasting during infancy and of under-weight during first half of infancy [18, 19]. Gender differential in nutritional status of pre-school rural Pakistani children has not been assessed based on new World Health Organization (WHO) growth reference
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