Abstract
SummaryBackgroundUrban living affects children's nutrition and growth, which are determinants of their survival, cognitive development, and lifelong health. Little is known about urban–rural differences in children's height and weight, and how these differences have changed over time. We aimed to investigate trends in children's height and weight in rural and urban settings in low-income and middle-income countries, and to assess changes in the urban–rural differentials in height and weight over time.MethodsWe used comprehensive population-based data and a Bayesian hierarchical mixture model to estimate trends in children's height-for-age and weight-for-age Z scores by rural and urban place of residence, and changes in urban–rural differentials in height and weight Z scores, for 141 low-income and middle-income countries between 1985 and 2011. We also estimated the contribution of changes in rural and urban height and weight, and that of urbanisation, to the regional trends in these outcomes.FindingsUrban children are taller and heavier than their rural counterparts in almost all low-income and middle-income countries. The urban–rural differential is largest in Andean and central Latin America (eg, Peru, Honduras, Bolivia, and Guatemala); in some African countries such as Niger, Burundi, and Burkina Faso; and in Vietnam and China. It is smallest in southern and tropical Latin America (eg, Chile and Brazil). Urban children in China, Chile, and Jamaica are the tallest in low-income and middle-income countries, and children in rural areas of Burundi, Guatemala, and Niger the shortest, with the tallest and shortest more than 10 cm apart at age 5 years. The heaviest children live in cities in Georgia, Chile, and China, and the most underweight in rural areas of Timor-Leste, India, Niger, and Bangladesh. Between 1985 and 2011, the urban advantage in height fell in southern and tropical Latin America and south Asia, but changed little or not at all in most other regions. The urban–rural weight differential also decreased in southern and tropical Latin America, but increased in east and southeast Asia and worldwide, because weight gain of urban children outpaced that of rural children.InterpretationFurther improvement of child nutrition will require improved access to a stable and affordable food supply and health care for both rural and urban children, and closing of the the urban–rural gap in nutritional status.FundingBill & Melinda Gates Foundation, Grand Challenges Canada, UK Medical Research Council.
Highlights
Restricted growth in young children is a risk factor for mortality from infectious diseases and for poor physical and cognitive development throughout life.[1,2,3,4] Analyses of trends in children’s growth have been done at the regional or at most the national level.[5]
National measurement is suitable for monitoring progress towards the Millennium Development Goals (MDGs), which are based on countries as reporting units.[5]
Little is known about the differences between the nutritional status of urban and rural children, and especially about how these differences have changed over time
Summary
Restricted growth in young children is a risk factor for mortality from infectious diseases and for poor physical and cognitive development throughout life.[1,2,3,4] Analyses of trends in children’s growth (and those of other global health indicators) have been done at the regional or at most the national level.[5]. In such an urbanising world, stratified rural and urban information is needed to formulate policies and programmes that improve nutrition, since the optimum (or even feasible) strategies are different for rural and urban populations, which differ in their local infrastructure, living environment, quantity and types of food available, source of income, and health-care access and quality
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