Ethnic inequalities and trends in stunting prevalence among Guatemalan children: an analysis using national health surveys 1995\u20132014

Cesar Victora,Aluisio J D Barros,Giovanna Gatica-Domínguez

doi:10.1186/s12939-019-1016-0

Cesar Victora, Aluisio J D Barros + Show 1 more

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https://doi.org/10.1186/s12939-019-1016-0

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Abstract

BackgroundGuatemala has the highest prevalence of stunting among under-five children in Latin America. We aimed to compare indigenous and non-indigenous under-five child populations in relation to stunting, as well as to explore the intersectionality of ethnicity by wealth and by place of residence. We also studied how the ethnic inequalities changed over time, using five ENSMI surveys from 1995 to 2014.MethodsFive national health surveys carried out between 1995 and 2014 were analysed. World Health Organization (WHO) 2006 growth standards were used to calculate stunting prevalence. Self-reported ethnicity was classified as indigenous or nonindigenous. Wealth was measured through an asset-based index, and households were classified into quintiles (for analyses of the whole populations) or tertiles (for analyses of intersectionality with ethnicity). Area of residence was recorded as urban or rural, according to country definition.ResultsOverall stunting prevalence declined by 9.8 percentage points (95% CI −16.4 to − 3.3) from 1995 to 2014. The slope index for absolute inequalities in stunting - which corresponds to the difference in prevalence between the wealthiest and poorest households - ranged from − 52.9 to − 60.4 percentage points, with no significant change over time. Children in rural areas were consistently more stunted than those in urban areas, but rural indigenous children were significantly worse than any other group. Indigenous children in the poorest tertile of family wealth consistently presented the highest stunting prevalence, compared to all other groups. Time trends in stunting were assessed through the average annual absolute change (AAAC). The fastest decline was observed among indigenous children from the middle wealth tertile (AAAC = − 1.21 percentage points per year (pp/y); 95% CI − 1.45 to − 0.96) followed by nonindigenous children also from the middle tertile (AAAC = − 0.80 pp./y; 95% CI − 0.99 to − 0.60). Stunting prevalence in the two poorest tertiles of indigenous children in 2015 was similar to what nonindigenous children presented in 1995, 20 years earlier. In the wealthiest tertile, indigenous children were far worse off than nonindigenous children 20 years earlier.ConclusionsIn terms of stunting prevalence, poor and rural indigenous children are twenty years behind nonindigenous children with similar characteristics.

Highlights

Guatemala has the highest prevalence of stunting among under-five children in Latin America
The proportion of indigenous children living in rural areas was 80.9% in 1995, decreasing slightly to 74.4% in 2014 (Fig. 1a), whereas the proportions of rural nonindigenous children were lower: 59.2% in 1995 and 55.8% in 2014 (Fig. 1b)
Indigenous children were always poorer than nonindigenous children (Fig. 1c–d) there were slight increases in the proportion of indigenous children in the wealthiest quintiles over time whereas the proportion in the poorest quintiles remained unchanged

Summary

Introduction

Guatemala has the highest prevalence of stunting among under-five children in Latin America. Guatemala is a multicultural and multilingual country with a population of nearly 17 million people [8] that presents the sixth highest stunting prevalence in the world, and the highest in Latin America [6]. Guatemala is one of the countries from Latin America with the highest levels of income inequality, where indigenous and rural populations live under multidimensional poverty, suffering from inadequate access to basic sanitation services, low education, as well as lack of productive assets and formal employment [11]. Indigenous people still live in social exclusion partly due to the language in which public services are provided and partly because the national budget allocation does not take their needs into account, resulting in smaller proportional allocations to areas with large indigenous populations [12]

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