Association between economic growth and early childhood undernutrition: evidence from 121 Demographic and Health Surveys from 36 low-income and middle-income countries

TitleAssociation between economic growth and early childhood undernutrition: evidence from 121 Demographic and Health Surveys from 36 low-income and middle-income countries
Publication TypeJournal Article
AuthorsVollmer, S., K. Harttgen, M. A. Subramanyam, J. Finlay, S. Klasen, and S. V. Subramanian
BACKGROUND: Economic growth is widely regarded as a necessary, and often sufficient, condition for the improvement of population health. We aimed to assess whether macroeconomic growth was associated with reductions in early childhood undernutrition in low-income and middle-income countries. METHODS: We analysed data from 121 Demographic and Health Surveys from 36 countries done between Jan 1, 1990, and Dec 31, 2011. The sample consisted of nationally representative cross-sectional surveys of children aged 0-35 months, and the outcome variables were stunting, underweight, and wasting. The main independent variable was per-head gross domestic product (GDP) in constant prices and adjusted for purchasing power parity. We used logistic regression models to estimate the association between changes in per-head GDP and changes in child undernutrition outcomes. Models were adjusted for country fixed effects, survey-year fixed effects, clustering, and demographic and socioeconomic covariates for the child, mother, and household. FINDINGS: Sample sizes were 462,854 for stunting, 485,152 for underweight, and 459,538 for wasting. Overall, 35.6% (95% CI 35.4-35.9) of young children were stunted (ranging from 8.7% [7.6-9.7] in Jordan to 51.1% [49.1-53.1] in Niger), 22.7% (22.5-22.9) were underweight (ranging from 1.8% [1.3-2.3] in Jordan to 41.7% [41.1-42.3] in India), and 12.8% (12.6-12.9) were wasted (ranging from 1.2% [0.6-1.8] in Peru to 28.8% [27.5-30.0] in Burkina Faso). At the country level, no association was seen between average changes in the prevalence of child undernutrition outcomes and average growth of per-head GDP. In models adjusted only for country and survey-year fixed effects, a 5% increase in per-head GDP was associated with an odds ratio (OR) of 0.993 (95% CI 0.989-0.995) for stunting, 0.986 (0.982-0.990) for underweight, and 0.984 (0.981-0.986) for wasting. ORs after adjustment for the full set of covariates were 0.996 (0.993-1.000) for stunting, 0.989 (0.985-0.992) for underweight, and 0.983 (0.979-0.986) for wasting. These findings were consistent across various subsamples and for alternative variable specifications. Notably, no association was seen between per-head GDP and undernutrition in young children from the poorest household wealth quintile. ORs for the poorest wealth quintile were 0.997 (0.990-1.004) for stunting, 0.999 (0.991-1.008) for underweight, and 0.991 (0.978-1.004) for wasting. INTERPRETATION: A quantitatively very small to null association was seen between increases in per-head GDP and reductions in early childhood undernutrition, emphasising the need for direct health investments to improve the nutritional status of children in low-income and middle-income countries. FUNDING: None.
Title Association between economic growth and early childhood undernutrition: evidence from 121 Demographic and Health Surveys from 36 low-income and middle-income countries
Publication Title Lancet Glob Health
Publication Type Journal Article
Published Year 2014
Authors S. Vollmer; K. Harttgen; M.A. Subramanyam; J. Finlay; S. Klasen; S.V. Subramanian
Accession Number 25103063
Number 4
ISBN Number 2214-109X (Electronic)<br/>2214-109X (Linking)
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