@article {5436, title = {Association between economic growth and early childhood undernutrition: evidence from 121 Demographic and Health Surveys from 36 low-income and middle-income countries}, journal = {Lancet Glob Health}, volume = {2}, number = {4}, year = {2014}, note = {Vollmer, Sebastian
Harttgen, Kenneth
Subramanyam, Malavika A
Finlay, Jocelyn
Klasen, Stephan
Subramanian, S V
eng
Research Support, Non-U.S. Gov{\textquoteright}t
England
2014/08/12 06:00
Lancet Glob Health. 2014 Apr;2(4):e225-34. doi: 10.1016/S2214-109X(14)70025-7. Epub 2014 Mar 27.}, month = {Apr}, pages = {e225-34}, abstract = {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.}, keywords = {*Body Height, *Body Weight, *Developing Countries, *Economic Development, *Gross Domestic Product, *Income, Child Nutrition Disorders/*economics/epidemiology/pathology, Child, Preschool, Demography, Female, Growth Disorders/economics/epidemiology, Health Surveys, Humans, Infant, Infant, Newborn, Logistic Models, Male, Odds Ratio, Poverty, Prevalence, Thinness/economics/epidemiology, Wasting Syndrome/economics/epidemiology}, isbn = {2214-109X (Electronic)
2214-109X (Linking)}, author = {Vollmer, S. and Harttgen, K. and Subramanyam, M. A. and Finlay, J. and Klasen, S. and Subramanian, S. V.} }