Undernutrition inequality between Dalits and non-Dalits in Nepal – A decomposition analysis

Abstract

BackgroundAlthough Nepal has made substantial progress in child health over the years, there are concerns about whether marginalized (Dalits) groups have made meaningful gains in child health. In this study, we sought to understand undernutrition inequalities between Dalits and non-Dalits in Nepal, the factors associated with such differences, and how these inequalities have changed over time. MethodsWe use Blinder-Oaxaca decomposition techniques to decompose the average difference in Height-for-Age (HAZ), Weight-for-Age (WAZ), Weight-for-Height (WHZ) z-scores between Dalit and non-Dalit groups to estimate the amount of the inequality associated with different characteristics. We use data on children below the age of 5 from the Demographic and Health Survey for Nepal for 2006, 2011, and 2016. For descriptive purposes, we also estimate the prevalence of severe forms of undernutrition defined as stunting, underweight, and wasting for the Dalit and non-Dalit groups over time. ResultsWe saw declines in the prevalence of undernutrition for both Dalits and Non-Dalits over time. From 2006 to 2016, we saw declines in stunting (57–40 %), underweight (48–31 %), and wasting (16–12 %) for the Dalit group and stunting (48–36 %), underweight (37–27 %), and wasting (12–10 %) for the non-Dalit group. In 2006, when compared to Dalits, Non-Dalits had higher Z-scores for Height-for-Age (0.26), Weight-for-Age (0.31) and Weight-for-Height (0.21) and these differences were statistically different from zero (p < 0.05).In 2016, when compared to Dalits, Non-Dalits had higher Z-scores for Height-for-Age (0.09), Weight-for-Age (0.14) and Weight-for-Height (0.13) but these differences were not statistically different from zero (p > 0.1). ConclusionsOur findings show that stunting, underweight, and wasting prevalence declined in both Dalit and non-Dalit groups between 2006 and 2016. In addition, undernutrition inequality between the Dalit group and non-Dalit group also declined substantially from 2006 to 2016 such that by 2016, the difference in undernutrition was no longer statistically significant for all three outcomes. The combination of socioeconomic gains and equity-focused health policy appears to have been transformative in Nepal.