Stunting and inequality in Sri Lanka compared to other Low- and middle-income South Asian countries.

Abstract

Objective: This study investigates and measures whether the association of childhood stunting with household socioeconomic position (SEP) differs in Sri Lanka compared to other South Asian countries.

Design: Secondary analysis of data of children from the latest available DHS data (survey years, 2016-2018). The exposures (SEP) were maternal education and wealth. The outcome was stunting. Binary logistic regression models incorporated SEP, Country, and SEP-by-Country interaction terms.

Setting: A nationally representative sample of children from Bangladesh, India, Nepal, Pakistan and Sri Lanka.

Participants: Mothers/caregivers of children under 36 months (133,491).

Results: The prevalence of stunting in Sri Lanka of 19% was much lower than that observed for all the other low to low-middle income South Asian countries (37% in Bangladesh, 36% in India, 31% in Nepal, 30% in Pakistan). The association of SEP with odds of stunting was similar in Sri Lanka compared to other South Asian countries. The only exception was weaker associations of wealth with stunting in Sri Lanka compared to Bangladesh. For example, in Sri Lanka, the poorest group had 2.75 (2.06, 3.67) times higher odds of stunting compared to the richest group, but in Bangladesh, this estimate was 4.20 (3.24, 5.44); the difference between these two estimates being 0.65 (0.44, 0.96) on the odds ratio scale.

Conclusions: The lower prevalence of stunting in Sri Lanka is unlikely to be due to less inequality. It is more likely that the lower prevalence of stunting in Sri Lanka is related to there being fewer mothers belonging to the lowest SEP groups.