Social Determinants of nutritional outcomes in young children in Sri Lanka: Analysis of the 2016 Demographic and Health Survey
Social Determinants of nutritional outcomes in young children in Sri Lanka: Analysis of the 2016 Demographic and Health Survey
Sri Lanka has been able to achieve satisfactory progress in health and developmental goals, characterized by substantial declines in infant, child and maternal mortality rates. Despite low mortality levels, better access to healthcare, food security and economic growth, there is little improvement in child nutrition – a paradox and a critical policy challenge that remain unresolved for over the last two decades. Low Birth Weight (LBW), child stunting, wasting and underweight have remained high at constant levels for past 10 years, with increasing health inequalities across different social and ethnic groups. On the other hand, rapid socioeconomic and nutrition transitions can lead to the emergence of a double burden of malnutrition (DBM). This has not been systematically investigated at the national level. Using the data from most recent Sri Lankan Demographic and Health Survey (SDHS), this research investigates the bio-behavioural, socioeconomic and demographic factors underlying inequalities in child nutritional outcomes in Sri Lanka. Further, it examines the risk factors associated with the prevalence of DBM at the household level. The first paper investigates social inequalities underlying LBW outcomes using fixed and random intercept logistic regression models and inequality measures. The results show that LBW is linked to socioeconomic disadvantage, as it is highly concentrated among poor households and in rural and the estate sector; in particular Indian Tamils in the estate sector have the highest risk of LBW of any comparable sub-group of the population. There was substantial unobserved variation in LBW outcomes between mothers. Regression models confirmed that LBW is more closely associated with maternal biological factors, including maternal depletion, than it is with socioeconomic factors. The second paper examines the extent of inequalities in child stunting, wasting and underweight and how these are distributed across different socioeconomic groups, residential sectors and geographical regions. The results show that LBW and BMI are associated with all three outcomes. The effect of child immunisation and feeding practices was not strong for child undernutrition outcomes. Results also suggested that characteristics of the children, their mothers and the households in which they live explain most of the variance in child undernutrition. There is relatively little variation between communities that is not accounted by the composition of those communities. The third paper assesses the driving factors associated with coexistence of child stunting and maternal overweight and obesity at the same household. The results confirm that Sri Lanka is facing a DBM at the household level, with the coexistence of child stunting and maternal overweight. LBW status, maternal age, number of household members, delivery mode, wealth status, ethnicity and province are significantly associated with DBM. Overall, the survey evidence demonstrates that LBW and undernutrition among children are clearly interlinked with socioeconomic disadvantages. The findings of this study suggest that Sri Lanka is facing a dual nutrition challenge of reducing both child undernutrition and maternal overweight and obesity, which are intertwined. The study recommends that child health policies and interventions in Sri Lanka should address both under-nutrition as well as preventing obesity and obesity-related chronic disease risks of malnourished children and their mothers.
University of Southampton
Abeywickrama, Dineshika
8f6a5549-3007-4b97-92ff-2513b0e68789
September 2021
Abeywickrama, Dineshika
8f6a5549-3007-4b97-92ff-2513b0e68789
Padmadas, Sabu
64b6ab89-152b-48a3-838b-e9167964b508
Abeywickrama, Dineshika
(2021)
Social Determinants of nutritional outcomes in young children in Sri Lanka: Analysis of the 2016 Demographic and Health Survey.
University of Southampton, Doctoral Thesis, 314pp.
Record type:
Thesis
(Doctoral)
Abstract
Sri Lanka has been able to achieve satisfactory progress in health and developmental goals, characterized by substantial declines in infant, child and maternal mortality rates. Despite low mortality levels, better access to healthcare, food security and economic growth, there is little improvement in child nutrition – a paradox and a critical policy challenge that remain unresolved for over the last two decades. Low Birth Weight (LBW), child stunting, wasting and underweight have remained high at constant levels for past 10 years, with increasing health inequalities across different social and ethnic groups. On the other hand, rapid socioeconomic and nutrition transitions can lead to the emergence of a double burden of malnutrition (DBM). This has not been systematically investigated at the national level. Using the data from most recent Sri Lankan Demographic and Health Survey (SDHS), this research investigates the bio-behavioural, socioeconomic and demographic factors underlying inequalities in child nutritional outcomes in Sri Lanka. Further, it examines the risk factors associated with the prevalence of DBM at the household level. The first paper investigates social inequalities underlying LBW outcomes using fixed and random intercept logistic regression models and inequality measures. The results show that LBW is linked to socioeconomic disadvantage, as it is highly concentrated among poor households and in rural and the estate sector; in particular Indian Tamils in the estate sector have the highest risk of LBW of any comparable sub-group of the population. There was substantial unobserved variation in LBW outcomes between mothers. Regression models confirmed that LBW is more closely associated with maternal biological factors, including maternal depletion, than it is with socioeconomic factors. The second paper examines the extent of inequalities in child stunting, wasting and underweight and how these are distributed across different socioeconomic groups, residential sectors and geographical regions. The results show that LBW and BMI are associated with all three outcomes. The effect of child immunisation and feeding practices was not strong for child undernutrition outcomes. Results also suggested that characteristics of the children, their mothers and the households in which they live explain most of the variance in child undernutrition. There is relatively little variation between communities that is not accounted by the composition of those communities. The third paper assesses the driving factors associated with coexistence of child stunting and maternal overweight and obesity at the same household. The results confirm that Sri Lanka is facing a DBM at the household level, with the coexistence of child stunting and maternal overweight. LBW status, maternal age, number of household members, delivery mode, wealth status, ethnicity and province are significantly associated with DBM. Overall, the survey evidence demonstrates that LBW and undernutrition among children are clearly interlinked with socioeconomic disadvantages. The findings of this study suggest that Sri Lanka is facing a dual nutrition challenge of reducing both child undernutrition and maternal overweight and obesity, which are intertwined. The study recommends that child health policies and interventions in Sri Lanka should address both under-nutrition as well as preventing obesity and obesity-related chronic disease risks of malnourished children and their mothers.
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Published date: September 2021
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Local EPrints ID: 456993
URI: http://eprints.soton.ac.uk/id/eprint/456993
PURE UUID: 9aa68139-f545-4489-8535-fd67095a444a
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Date deposited: 19 May 2022 16:33
Last modified: 17 Mar 2024 02:57
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Author:
Dineshika Abeywickrama
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