The importance of reducing childhood undernutrition has been enshrined in the United Nations’ Millennium Development Goals. This study explores the relationship between alternative indicators of poverty and childhood undernutrition in developing countries within the context of a multi-national cohort study (Young Lives). Approximately 2000 children in each of four countries – Ethiopia, India (Andhra Pradesh), Peru and Vietnam – had their heights measured and were weighed when they were aged between 6 and 17 months (survey one) and again between 4.5 and 5.5 years (survey two). The anthropometric outcomes of stunted, underweight and wasted were calculated using World Health Organization 2006 reference standards. Maximum-likelihood probit estimation was employed to model the relationship within each country and survey between alternative measures of living standards (principally a wealth index developed using principal components analysis) and each anthropometric outcome. An extensive set of covariates was incorporated into the models to remove as much individual heterogeneity as possible. The fully adjusted models revealed a negative and statistically significant coefficient on wealth for all outcomes in all countries, with the exception of the outcome of wasted in India (Andhra Pradesh) and Vietnam (survey one) and the outcome of underweight in Vietnam (surveys one and two). In survey one, the partial effects of wealth on the probabilities of stunting, being underweight and wasting was to reduce them by between 1.4 and 5.1 percentage points, 1.0 and 6.4 percentage points, and 0.3 and 4.5 percentage points, respectively, with each unit (10%) increase in wealth. The partial effects of wealth on the probabilities of anthropometric outcomes were larger in the survey two models. In both surveys, children residing in the lowest wealth quintile households had significantly increased probabilities of being stunted in all four study countries and of being underweight in Ethiopia, India (Andhra Pradesh) and Peru in comparison to children residing in the highest wealth quintile households. Random effects probit models confirmed the statistical significance of increased wealth in reducing the probability of being stunted and underweight across all four study countries. We conclude that, although multi-faceted, childhood undernutrition in developing countries is strongly rooted in poverty.
Childhood malnutrition has been defined as a pathological state resulting from inadequate nutrition, including undernutrition due to insufficient intake of energy and other nutrients, overnutrition due to excessive consumption of energy and other nutrients, and deficiency diseases due to insufficient intake of one or more specific nutrients such as vitamins or minerals (Ge & Chang, 2001). Childhood undernutrition remains highly prevalent in developing countries with 178 million children less than 5 years of age estimated to be stunted, 112 million estimated to be underweight and 55 million estimated to be wasted in 2005 (Black et al., 2008). Undernutrition is considered to be the underlying cause of more than one third of childhood deaths globally (Black, Morris, & Bryce, 2003). It is also considered to compromise physical and intellectual development during childhood, educational attainment, and health and labour market outcomes during adulthood (Alderman et al., 2003, Manary and Sandige, 2008, UNSCN, 2004 and Victora et al., 2008). The importance of reducing childhood undernutrition has been enshrined in the United Nations’ Millennium Development Goals (MDGs), a set of global time-bound and quantified targets for improving the social and economic conditions of the world’s poorest (UN Millennium Project, 2005). MDG1, for example, set a target to reduce by half the prevalence of underweight children under-five years of age by 2015. MDG4 set a target to reduce by two-thirds the mortality rate among children under-five years of age by the same date, implicitly recognising the role of undernutrition as an underlying cause of many of these deaths. Progress towards achieving these goals has been variable. Notable progress towards reducing underweight prevalence, among children under-five years of age, has been made in Eastern Asia, whilst the majority of countries making the least progress in this area are in sub-Saharan Africa (UN Millennium Project, 2008 and UN Millennium Project, 2009). Similarly, many countries, particularly in sub-Saharan Africa and Southern Asia, have made little or no progress towards reducing childhood deaths, among children under-five years of age (Countdown Coverage Writing Group, 2008 and UN Millennium Project, 2009). Moreover, the recent worldwide economic and food crises have endangered, and even threatened the reversal of, the limited progress that has been made in these areas (UN Millennium Project, 2009).
