Trends in socioeconomic inequalities in stunting prevalence in Latin America and the Caribbean countries: differences between quintiles and deciles

Maria Del Pilar Flores-Quispe,Leonardo Z Ferreira,Maria Fátima S Maia,María Clara Restrepo-Méndez,Fernando C Wehrmeister

doi:10.1186/s12939-019-1046-7

Abstract

BackgroundWith the adoption of the Sustainable Development Goals (SDGs), there is a renewed commitment of tackling the varied challenges of undernutrition, particularly stunting (SDG 2.2). Health equity is also a priority in the SDG agenda and there is an urgent need for disaggregated analyses to identify disadvantaged subgroups. We compared time trends in socioeconomic inequalities obtained through stratification by wealth quintiles and deciles for stunting prevalence.MethodsWe used 37 representative Demographic and Health Surveys and Multiple Indicator Cluster surveys from nine Latin American and Caribbean (LAC) countries conducted between 1996 and 2016. Stunting in children under-5 years was assessed according to the 2006 WHO Child Growth Standards and stratified by wealth quintiles and deciles. Within-country socioeconomic inequalities were measured through concentration index (CIX) and slope index of inequality (SII). We used variance-weighted least squares regression to estimate annual changes.ResultsEight out of nine countries showed a statistical evidence of reduction in stunting prevalence over time. Differences between extreme deciles were larger than between quintiles in most of countries and at every point in time. However, when using summary measures of inequality, there were no differences in the estimates of SII with the use of deciles and quintiles. In absolute terms, there was a reduction in socioeconomic inequalities in Peru, Honduras, Dominican Republic, Belize, Suriname and Colombia. In relative terms, there was an increase in socioeconomic inequalities in Peru, Bolivia, Haiti, Honduras and Guatemala.ConclusionsLAC countries have made substantial progress in terms of reducing stunting,. Nevertheless, renewed actions are needed to improve equity. Particularly in those countries were absolute and relative inequalities did not change over time such Bolivia and Guatemala. Finer breakdowns in wealth distribution are expected to elucidate more differences between subgroups; however, this approach is relevant to cast light on those subgroups that are still lagging behind within populations and inform equity-oriented health programs and practices.

Highlights

The proportion of children under 5 years of age who are stunted is an indicator for the Sustainable Development Goals 2 (SDG 2.2) [1]
Study design and data sources We carried out cross-sectional analyses that relied on data from the Demographic and Health Surveys (DHS)
The Guatemala 2008 Reproductive Health Survey (RHS) [18] was used and variables were derived according to DHS and Multiple Indicator Cluster Surveys (MICS) standards

Summary

Introduction

The proportion of children under 5 years of age who are stunted is an indicator for the Sustainable Development Goals 2 (SDG 2.2) [1]. There have been estimates of trends in national prevalence of stunting, underweight, and wasting by country and by region showing an important reduction in these conditions in children under 5 years in the last decade [5]. The complex interrelation of social, economic, and political determinants of undernutrition results in substantial inequalities between population subgroups [9]. This is especially observed in Latin American countries where health inequalities are still treated as a major concern [10]. We compared time trends in socioeconomic inequalities obtained through stratification by wealth quintiles and deciles for stunting prevalence

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Discussion

Conclusion