Econometric Analysis of Malnutrition Severity Among Under Five Children in Bangladesh

Transcription

1 Dhaka Univ. J. Sci. 62(1): 1-6, 2014 (January) Economtric Analysis of Malnutrition Svrity Among Undr Fiv Childrn in Bangladsh *Author for Corrspondnc. -mail: Khnd. Md. Mostafa Kamal 1* and Naimul Islam 2 1 Dpartmnt of Statistics, Biostatistics and Informatics, Dhaka Univrsity, Dhaka-1000, Bangladsh 2 Essntial Halth Car; Halth, Nutrition and Population program, BRAC, Dhaka, Bangladsh (Rcivd: 7 April 2012; Accptd: 22 August 2013) Abstract Th nutritional status of undr-fiv childrn is on of th snsitiv indicators of a country's halth status. This study invstigatd diffrntial impact of som dmographic, socioconomic and halth rlatd factors on nutritional status among undr-fiv childrn in Bangladsh basd on Bangladsh Dmographic and Halth Survy 2007 (BDHS 2007) data. Th main contributing factors of malnutrition among undr-fiv childrn is linkd to th family's conomic condition, parnt's ducation, sourcs of drinking watr, typ of toilt facility, child's birth intrval, child's birth ordr, mass mdia xposur, having diarrhoa or Acut Rspiratory Infctions (ARI) rcntly, housing condition and plac of rsidnc. An ordrd probit analysis of th ffcts of slctd socioconomic and dmographic factors on malnutrition indicats that th strongst prdictors of nutritional status of childrn in Bangladsh ar gndr of child, parnt's ducation, family's conomic condition and houshold standard of living. Ky words: Stunting (hight for ag), wasting (wight for hight) undrwight (wight for ag), undr fiv childrn, Ordrd probit. I. Introduction Malnutrition is th condition that rsults from taking an unbalancd dit in which crtain nutrints ar lacking, in xcss (too high an intak), or in th wrong proportions. Approximatly half of th 10.4 million childrn of our country who di ach yar ar malnourishd. Th World Halth Organization (WHO) cits malnutrition as th gratst singl thrat to th world's public halth. A numbr of diffrnt nutritional disordrs may aris, dpnding on which nutrints ar undr or ovr abundant in th dit. According to th Unitd Nations Rports on th Right to Food for 2000 to March 2008, mortality du to malnutrition accountd for 58% of th total mortality in 2006: In th world, approximatly 62 million popl, all causs of dath combind, di ach yar. On in twlv popl worldwid is malnourishd. In 2006, mor than 36 million did of hungr or disass du to dficincis in micronutrints. Kabirullah t al 1 showd that 14% of th childrn agd undr 4 months had normal body wight which dcrass to about 5% at th ag of 5 yars. Among thm 31% of th childrn suffrd from third dgr malnutrition and thy grw up as shortr and thinnr. Thy also found that with th incras of ag, th wight-for-ag and wight-forhight dcrasd. Bairagi and Chowdhury 2 invstigat that th importanc of family incom in rlation to som othr socio dmographic factors, that might affct th nutritional status of childrn in rural Bangladsh. H obsrvd that th sasonal factors, family incom, mothr's ducation sx and birth ordr of childrn ar th important dtrminant of malnutrition. Haqu t al. 3 showd that programs on nutritional awarnss aird through mass mdia had influnc on th lvl of awarnss of th rspondnts. Mozumdr t al. 4 showd that childrn in familis with short subsqunt birth intrvals ar significantly mor likly to b modrat-to-svrly or svrly malnourishd than thos childrn in familis having longr intrvals bfor th birth of anothr child in th family. A numbr of variabls rlatd to infant and child malnutrition including low ditary intak, low birth wight, family siz, lack of parntal ducation, faulty infant fding practics, incidnc of diarrhoa and dlayd waning. 5,6,7,8 Inadquat nutrition of th mothr may also b rsponsibl for malnutrition in brast-fd infants and young childrn. 9 Rahman and Chowdhury 10 and Chaudhuri 11 showd that th MCH program, is statistically significant for long-trm halth (masurd in hight-for-ag) as wll as short-trm halth (masurd in wight-for-ag), but not on acut growth disturbancs (masurd in wightfor-hight). Furthrmor, a probit modl stimation was prformd by using a discrt dpndnt variabl indicating stunting (low hight-for-ag), wasting (low wight-forhight) and bing undrwight (low wight-for-ag) among childrn to captur th program ffct on xtrm halth outcoms. Isanaka S, Villamor E, Shphrd S, Grais RF of WHO 12 rvald how program nrollmnt and infant halth outcoms would hav changd if th 2006 World Halth Organization growth standards had bn usd to idntify svrly malnourishd childrn in a Médcins Sans Frontièrs fding program lik Nigr. Th prvalnc of malnutrition in Bangladsh is amongst th highst in th world. Millions of childrn suffr from on or mor forms of malnutrition, including: low birth wight, stunting, undrwight, vitamin A dficincy, iodin dficincy disordrs and anmia. From th abov discussion it is clar that thr is no plac for nglignc of th svrity issu of child malnutrition in Bangladsh. But almost all th prvious studis ar basd on bivariat and logistic approach. Through this study th currnt stat and prvalnc of child malnutrition in Bangladsh was analyzd by using ordrd probit approach. Th main objctiv of th study is to undrstand & idntify th factors affcting th svrity of malnutrition in Bangladsh. For this purpos, thr typs of malnutrition svrity analyss hav bn incorporatd, such as: Undrwight, Stunting & Wasting. Indpndnt variabls ar catgorizd into Child Charactristics, Houshold Charactristics, Socioconomic Charactristics and Mothr s Autonomy. In ordr to rach th objctiv, data from Bangladsh Dmographic and Halth Survy (BDHS) 13 has bn usd.

2 2 Khnd. Md. Mostafa Kamal and Naimul Islam II. Mthodology Ordrd Probit Modl: Though multinomial Logit (MNL) modl is th most widly usd modl du to its simpl mathmatical structur and asy to stimat, it imposs a rstriction random rror trms sinc th dpndnt variabl is of ordinal in natur. Also Multinomial and nstd Logit modl cannot handl ordinal dpndnt variabl. Consquntly, thr will b loss of fficincy du to information bing ignord. On way to dal with this problm is to us ordrd probit modl instad of multinomial Logit and nstd Logit modl. Th ordrd probit modl discrns unqual diffrncs btwn ordinal 14,15 catgoris in th dpndnt variabl. Th gnral form of th modl, y * = β + ε Whr, * is a row vctor of i x i obsrvd non-random xplanatory variabls; β is a vctor of unknown paramtr; is th random rror trm; which is assumd to b normally distributd. According to Long, 16 th ordrd probit modl can b drivd from a masurmnt modl in which a latnt variabl i ranging from to + is mappd to an obsrvd ordinal variabl y. Th obsrvd and codd discrt variabl is dtrmind * from y m, if τ y < τ from m = 1 to M, whr i = m 1 th thrshold valus τ ' s ar unknown paramtrs to b stimatd. Th xtrm catgoris, 1 and M, ar dfind by opn-ndd intrvals with - and = +. Th mapping from th latnt variabl to th obsrvd catgoris is illustratd in Figur blow: τ 1 τ 2 τ i τ m m 1 2 M y i * y i Fig.1. Mapping of latnt variabl to obsrvd variabl Howvr, O Donnll and Connor 17, Kocklman t al. 18 hav rcognizd that th discrt masur of svrity is ordinal in natur and hav applid th ordrd probit or ordrd logit modls to svrity studis. Th diffrnc btwn th two modls lis in th assumption of rrors. Thy hav furthr indicatd that th rsults from th ordrd probit and ordrd Logit ar similar. Howvr, ordrd probit modl is prfrabl bcaus th assumption that th distribution of rrors is normally distributd is mor likly to b valid. Sinc svrity of malnutrition is ncssarily ordrd (mild, modrat & svr), ordrd probit modl is appropriat for Tabl 1. Goodnss of Fit Statistics Thrs hold * y Wight for Ag, (Hight for Ag ), {Wight for hight} y malnutrition svrity studis; thrfor it has bn chosn for our study. This modl rquirs no assumptions rgarding th ordinarily of th dpndnt variabl, i.., svrity scor. Furthr, ordrd probit modl can account for mor than two stats of svrity of malnutrition which Logit and probit modl cannot do. It can account for both th catgorical and th ordinal natur of dpndnt variabl (svrity of malnutrition). In addition, ordrd probit modl is not associatd with undsirabl proprtis such as lack of a closd form that likly to b found in multinomial Logit modl and multinomial probit modl. Whn th xpctd valu of svrity is intrprtd as probability in ordrd probit modl, th rangs could not b outsid btwn 0 and 1 lik multipl linar rgrssion modl. Z - Scor or Standard Dviation Systm: Hight and wight ar compard with th NCHS rfrnc standard and ar xprssd as prcntag dviations or as standard dviation scors (Z scors) of th rfrnc mdians. Th distributions of hight-for-ag and wight-for-ag Z scors ar vry clos to standardizd Gaussian (Normal) distribution bcaus th population has a normal distribution with man of 0 and standard dviation of 1.Th mathmatical xprssions is Z Obsrvd valu Mdian = Standard dviation scors ar :. According to WHO th usd Z- Z-scor Malnutrition Cod Z-scors -2SD Mild 1-2SD > Z-scors -3SD Modrat 2-3SD > Z-scors Svr 3 III. Rsult and Discussion Bivariat analysis: It was rvald from BDHS 2007 that, among th 4,125 childrn, 40%, 19% and 40% wr undrwight, wasting and stunt rspctivly (according to 5 moduls dsignd by th WHO in 2008). From th data, 14.8%, 3.2% & 15% of th cass wr classifid as svr malnutrition in trms of undrwight, wasting and stunt rspctivly and 25.1%, 16% &24.2% as modrat malnutrition rspctivly. Modl Evaluation: To confirm suitability of th fittd modl, th goodnss of fit indx has bn usd. Although ths valus smd low in our study, thy ar comparabl with thos in othr malnutrition svrity studis whr ordrd probit modl was mployd. 14,15,16,18 Th following modl rsult is justifid to xplain variations in malnutrition svrity. Goodnss of Fit Log Liklihood 2.5 (4.9) {0.3}.186 Intrcpt (-2 log liklihood) 3.4 (4.1) {0.9}.157 Final (-2 log liklihood) Numbr of obsrvation

3 Economtric Analysis of Malnutrition Svrity Among Undr Fiv Childrn in Bangladsh 3 Child Charactristics: Th ngativ cofficints (-.573, -.41,-.3) indicat that svrity of malnutrition is smallr in mal childrn compard with fmal child. Th rlativ svr undrwight malnutrition probability of mal child is Tabl 1 also show that a highr risk of svrity is associatd with not rcivd BCG vaccination. Th svr undrwight malnutrition risk is 39% highr than rfrnc group (i.. who rcivd BCG vaccination) and th prcntag is incrasd for stunting & wasting. Th rsult shows that a highr svrity risk is associatd with th childrn with diarrhoa whr th chanc of a svr Tabl 2. Ordr Probit Modl Analysis Rsults( Child Charactristics) Wight for Ag Hight for Ag Wight for Hight undrwight malnutrition is 24% smallr for th childrn who had not. For stunting & wasting, th prcntag is 21% & 13% smallr rspctivly. Hr th stimatd valu of th cofficint of currnt ag of child is.081 i.. 8% avrag incras in undrwight malnutrition whn child ag incrass by on month. Similarly, th prcntag is incrasd for stunting & wasting. Th rsults also show that a highr undrwight malnutrition svrity risk is associatd with 3rd & 4th birth ordr. It may happn from th fact that th first baby of any family gts som xtra facilitis than th othr babis of th family (Chaudhuri A.2004). Wight for Ag Hight for Ag Wight for Hight Cofficints Sx of child fmal =1 Mild Modrat Svr Mild Modrat Svr Mild Modrat Svr mal= ** -.41** -.306** Currnt ag of child.081** 0109** -.108** Birth ordr numbr ( Birth ordr 1 =1) Birth ordr 2 = * Birth ordr 3 =3.173* * Birth ordr 4 = Birth ordr 5 = Currntly brast fding (No=1) Ys= Rcivd BCG ( Ys=1) No=0.297**.177*.406** Rcivd DPT 3( Ys=1) No= Rcivd POLIO 3 ( Ys=1) No= Rcivd MEASLES (Ys=1) No= ** Had diarrha rcntly ( Ys=1) No= ** -.154* **significant at 1% lvl * significanc at 5% lvl Houshold Charactristics: Th rsults in Tabl2 show that, a highr child malnutrition svrity risk is associatd with th rfrnc group (i.. Sylht). Th rlativ svr malnutrition probabilitis of Khulna is 0.64 indicating that th chanc of a svr malnutrition is 36% smallr than Sylht and th rlativ svr malnutrition probabilitis of Khulna is smallr than othr division. Similarly, th ngativ cofficint indicats; Chittagong, Dhaka, Khulna and Rajshahi hav smallr risk of undrwight malnutrition svrity than Sylht. Tabl 2 also shows that th risk of modrat & svr undrwight malnutrition is smallr for primary ducation group, scondary ducation group and highr ducation group compard with th No ducation.

4 4 Khnd. Md. Mostafa Kamal and Naimul Islam Tabl 3. Ordr Probit Modl Analysis Rsults (Houshold Charactristics) Wight for Ag Cofficints Hight for Ag Wight for Hight Wight for Ag Hight for Ag Wight for Hight Typ of plac of rsidnc (1 = Rural) Mild Modrat Svr Mild Modrat Svr Mild Modrat Svr 2 = Urban Division (1 = Sylht) 2 = Chittagong = Dhaka * = Khulna -.174* -.221** = Rajshahi -.142* -.193** -.222** = Barisal Fathr's ducation lvl (0 = "No ducation") 1 = "Primary" -.051* = "Scondary" ** = "Highr" -.213* -.371** Fathr's occupation (1 = "Unmployd") 2 = "agricultural sctor" = "Businss & profssional " 4 = "workr" = "othrs" Fathr s ag * -.007** Rligion (1 = othr rligion) 2 = Islam **significant at 1% lvl * significanc at 5% lvl Economic Charactristics: Th rsults in Tabl 3 show that, undrwight child malnutrition svrity is smallr for flush toilt & pit toilt ovr th othr facilitis of toilt in th hous of child. Th chanc of svr malnutrition of th Tabl 4. Ordr Probit Modl Analysis Rsults (Economic Charactristics) Wight for Ag Cofficints Hight for Ag Wight for Hight flush toilt usrs is 47% smallr than th rfrnc catgory. Th rsults in Tabl 3 also show that malnutrition svrity of childrn is smallr for having lctricity. Wight for Ag Hight for Ag Wight for Hight Sourc of drinking watr (0=othr) Mild Modrat Svr Mild Modra t Svr Mild Modrat Svr 1 = "tub wll" = "pipd watr" Typ of toilt facility (0=othr) 1 = Flush Toilt -.173* -.17* -.04* 2 = Pit Toilt **.07 Has lctricity (0 = No) 1 = Ys -.012* Rading nwspapr or magazin(0 = No) 1 = Ys -.023* Frquncy of listning to radio(0 = No) 1 = Ys.117* Frquncy of watching tlvision (0 = No) = Ys -.023* Walth indx(5 = "Richst") 1 = "Poorst" * = "Poorr" = "Middl" = "Richr" Rading nwspapr or magazin(0 = No)

5 Khnd. Md. Mostafa Kamal and Naimul Islam 5 Similarly watching tlvision and rading nwspapr group has smallr risk of undrwight malnutrition than thos who do not. According to th rsults of walth indx, Poor family has highr risk of child undrwight malnutrition than rich family. Hr, th group of using tub wll watr or pipd watr also has risk of undrwight malnutrition. Mothr s Charactristics: In Mothr s ducation, th risk of modrat & svr undrwight malnutrition in chioldrn of ducatd group is smallr for primary ducation group. Tabl 5. Ordr Probit Modl Analysis Rsult (Mothr s Charactristics/Autonomy) Wight for Ag Hight for Ag Wight for Hight Hr, th rlativ svr malnutrition probability of highr ducation group is 0.26 indicating that th chanc of a svr malnutrition is 74% smallr in childrn group whos mothr ar ducatd compard to thos with no ducation. Similarly, th prcntag of stunting and wasting lvl is smallr for th highr ducation group. Th risk of svrity of malnutrition dcrass if th mothr s hight & wight incrass which is du to gntic rason. Wight for Ag Hight for Ag Wight for Hight Cofficints to rf. cas Mild Modrat Svr Mild Modr at Curr. ag of Mothr Mothr's wight -.029** -.021** -.013** Mothr 's hight -.015** -.026** Mothr s occupation(1= "mployd") Svr Mild Modrat 0= Unmployd * Highst ducational lvl (0 = "No ducation") 1 = "Primary" = "Scondary" = "Highr" -.23* Svr **significant at 1% lvl IV. Conclusion * significanc at 5% lvl All anthropomtric indicators stimatd for childrn with 0-59 months indicat high prvalnc of malnutrition in Bangladsh. Gndr discrimination is found in this study. Birth ordr of childrn appars to b an important indicator of malnutrition. First births ar lss likly to b malnourishd than th childrn with highr birth ordr. Birth intrval also shows significant association with child nutritional status. Th ducational lvl of parnts is also rlatd to th prvalnc of malnutrition among childrn. Mothr's ducation smd to b dirctly rlatd to rduc th risk of malnutrition of a child. Fathr s ducation is also vry important to rduc th malnutrition svrity. Lik mothr's working status, fathr's working status has significant influnc rducing child malnutrition svrity. Sourc of drinking watr ar also associatd with th nutritional status of childrn. It is indirctly rlatd with sanitation facilitis and diffrnt disass lik diarrhoa. It is found that th familis having th Elctricity, TV, radio, nwspapr tc facilitis ar lss likly to hav malnourishd childrn than th familis not having th abov facilitis. Rciving BCG, DPT, POLIO and MEASLES show ffct on rducing th malnutrition. Walth indx of houshold is th important socioconomic factor that affcts th svrity of malnutrition. Othr factors such as housing condition, sourcs of drinking watr, typ of toilt facility, having lctricity, mass mdia xposur tc. ar dpndnt on walth indx. In summary, th prsnt rsarch work has idntifid th factors affcting th svrity of malnutrition of Bangladsh using ordrd probit modl. This work suggsts that svral factors play major rols in affcting th svrity of malnutrition. Th findings of this study giv a basis for dvloping ffctiv countrmasurs to improv nutritional status in undr fiv childrn. Rfrncs 1. Kabirullah, M., Socioconomic Factors Influncing th Nutritional Status of Pr-school Childrn in Rural Villag in Bangladsh.Bangladsh Journal of Child Halth; 14(4), Bairagi, R. and Mridul K. Chowdhury, Socioconomic and Anthropomtric Status, and Mortality of Young Childrn in Rural Bangladsh, Intrnational Journal of Epidmiology 23(6), Haqu, A., A. Karim, A. K. M. A. Chowdhury, and M. Kabir, Nutritional status and ag at scondary strility in rural Bangladsh, Journal of Biosocial Scinc 17(4), Mozumdr, A.B.M., Barkt-E-Khuda, T. K. Thomas, A. Lvin and S. Ahmd, 2000.Th Effct of Birth Intrval on Malnutrition in Bangladshi Infants and Young Childrn. Journal ofbiosocial scinc.32, Chowdhury, A.Y. and A. Bhuiyan, Effcts in Nutritional Status of Rural Bangladshi Childrn, pr and post monsoon flooding. Journal of biosocial scinc; 25(3), Islam, S. t. al., Impact of Socioconomic Condition & Matrnal Education on Nutritional Status of Childrn. Dhaka Shishu Hospital Journal: 1-6.

6 6 Economtric Analysis of Malnutrition Svrity Among Undr Fiv Childrn in Bangladsh 7. Islam, S. t.al., Managmnt of svr malnutrition: mortality among childrn tratd by th adaptd WHO protocol and cathch-up growth on indiginus dit and nutrition. ICDDRB publications. 8. Rayhan, M.I. and M. Skandr. H. Khan, Factors Causing Malnutrition among undr Fiv Childrn in Bangladsh, Pakistan Journal of Nutrition 5 (6), Rahaman, M., N. Alam, B. Wojtyniak, and Mohammd, Anthropomtric Indicators and Risk of Dath, Amrican Journal of Clinical Nutrition 49(5), Rahman, A. and S. Chowdhury, Dtrminants of Chronic Malnutrition among Pr-school Childrn in Bangladsh, Journal of Biosocial Scinc 39(2), Chaudhuri, A., Sibling Rivalry and Birth Ordr Effcts on th Nutritional Status of Childrn in Rural Bangladsh, San Francisco Stat Univrsity. 12. WHO,1986. Us and Intrprtation of Anthropomtric Indicators of Nutritional Status, Bulltin of th World Halth Organization 64(6), BDHS, Bangladsh Dmographic and Halth Survy , Dhaka: NIPORT and Mitra & Associats. 14. McKlvy, W. and T.A. Zavoina, Statistical Modl for Analysis of Ordinal Lvl Dpndnt Variabls.Journalof Mathmatical Sociology, Grn, W. H., Economtric Analysis (fifth dition).prntic Hall, Nw Jrsy. 16. Long, S. J., Rgrssion Modls for Catgorical and Limitd Dpndnt Variabls. Advancd Quantitativ Tchniqus in th Social Scincs (7), O Donnl, C.J. and D.H.Connor, Prdicting th Svrity of Motor Vhicl Accidnt Injuris Using Modls of Ordrd Multipl Choic. Analysis and Prvntion, 28(6), Kocklman, K.M. and Y.J. Kwon, Drivr Injury Svrity: An Application of Ordrd Probit Modls. Analysis and Prvntion, 34(3),