Explaining urban-rural disparity in prevalence of stunting and wealth related inequality in Ethiopia: A decomposition analysis

Abstract

Background: Stunting is a global health concern. It has consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Ethiopia although the prevalence is still high varying across socioeconomic determinants and geographical location with a larger burden among the disadvantaged group and the rural areas. The objective of the study was to explain the rural-urban disparity in the prevalence of stunting and explore the level and determinants of wealth related inequality in stunting in Ethiopia. Method: Data were drawn from the 2016 Ethiopian Demographic and Health Survey. The dependent variables were stunting and wealth related inequality in stunting. A multivariate decomposition analysis was employed to decompose the urban-rural disparity in the prevalence of stunting into meaningful components. A concentration index was used to quantify the magnitude of inequalities in stunting and multilevel linear regression model was used to identify determinants of socioeconomic inequality in stunting. STATA version 14 software was used for data management and analysis. Result: Differences in observed characteristics of children, maternal characteristics, their household and environment explained 82.8% of the gap in the prevalence of stunting between rural and urban areas. A further decomposition of the gap in stunting showed that differences in maternal characteristics contributed to 36.7% of the gap in stunting, variation in household characteristics explained 31.7% of the gap and 13.6% of the gap in stunting was due to differences in child characteristics in the two areas. The study also found a significant propoor wealth related absolute inequality in stunting (-0.133). Age of child, maternal education level, maternal age and place of residence were found to be significantly associated with socioeconomic inequality in stunting. Conclusion: Rural-urban disparities in child stunting need to focus principally on bridging gaps in socio-economic situations of rural and urban women and households and improving the quality of rural infrastructure. Health policy makers should work together across sectors and develop strategies for effective inter sectoral actions to adequately address the social determinants of inequity and reduce inequalities in stunting. Rural-urban disparities in child stunting need to focus principally on bridging gaps in socio-economic situations of rural and urban women and households and improving the quality of rural infrastructure. Health policy makers should work together across sectors and develop strategies for effective inter sectoral actions to adequately address the social determinants of inequity and reduce inequalities in stunting.