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      Malnutrition and the disproportional burden on the poor: the case of Ghana

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          Abstract

          Background

          Malnutrition is a major public health and development concern in the developing world and in poor communities within these regions. Understanding the nature and determinants of socioeconomic inequality in malnutrition is essential in contemplating the health of populations in developing countries and in targeting resources appropriately to raise the health of the poor and most vulnerable groups.

          Methods

          This paper uses a concentration index to summarize inequality in children's height-for-age z-scores in Ghana across the entire socioeconomic distribution and decomposes this inequality into different contributing factors. Data is used from the Ghana 2003 Demographic and Health Survey.

          Results

          The results show that malnutrition is related to poverty, maternal education, health care and family planning and regional characteristics. Socioeconomic inequality in malnutrition is mainly associated with poverty, health care use and regional disparities. Although average malnutrition is higher using the new growth standards recently released by the World Health Organization, socioeconomic inequality and the associated factors are robust to the change of reference population.

          Conclusion

          Child malnutrition in Ghana is a multisectoral problem. The factors associated with average malnutrition rates are not necessarily the same as those associated with socioeconomic inequality in malnutrition.

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          Most cited references39

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          Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India.

          Using data from India, we estimate the relationship between household wealth and children's school enrollment. We proxy wealth by constructing a linear index from asset ownership indicators, using principal-components analysis to derive weights. In Indian data this index is robust to the assets included, and produces internally coherent results. State-level results correspond well to independent data on per capita output and poverty. To validate the method and to show that the asset index predicts enrollments as accurately as expenditures, or more so, we use data sets from Indonesia, Pakistan, and Nepal that contain information on both expenditures and assets. The results show large, variable wealth gaps in children's enrollment across Indian states. On average a "rich" child is 31 percentage points more likely to be enrolled than a "poor" child, but this gap varies from only 4.6 percentage points in Kerala to 38.2 in Uttar Pradesh and 42.6 in Bihar.
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            The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality.

            When the health sector variable whose inequality is being investigated is binary, the minimum and maximum possible values of the concentration index are equal to micro-1 and 1-micro, respectively, where micro is the mean of the variable in question. Thus as the mean increases, the range of the possible values of the concentration index shrinks, tending to zero as the mean tends to one and the concentration index tends to zero. Examples are presented on levels of and inequalities in immunization across 41 developing countries, and on changes in coverage and inequalities in selected countries. Copyright (c) 2004 John Wiley & Sons, Ltd.
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              Correcting the concentration index.

              In recent years attention has been drawn to several shortcomings of the Concentration Index, a frequently used indicator of the socioeconomic inequality of health. Some modifications have been suggested, but these are only partial remedies. This paper proposes a corrected version of the Concentration Index which is superior to the original Concentration Index and its variants, in the sense that it is a rank-dependent indicator which satisfies four key requirements (transfer, level independence, cardinal invariance, and mirror). The paper also shows how the corrected Concentration Index can be decomposed and generalized.
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                Author and article information

                Journal
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central
                1475-9276
                2007
                28 November 2007
                : 6
                : 21
                Affiliations
                [1 ]Department of Applied Economics, Erasmus University Rotterdam, Burg. Oudlaan 50, 3000 DR Rotterdam, The Netherlands
                [2 ]The Faculty of Economics and Commerce, The University of Melbourne, Victoria 3010, Australia
                [3 ]Equity, Poverty and Social Determinants of Health, Evidence and Information for Policy, World Health Organization, Avenue Appia 20, CH - 1211 Geneva 27, Switzerland
                [4 ]Policy Planning Monitoring and Evaluation Division, Ghana Health Service, Private Mail Bag, Ministries, Accra, Ghana
                [5 ]Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
                Article
                1475-9276-6-21
                10.1186/1475-9276-6-21
                2245943
                18045499
                bce1359b-7366-4e20-bfb5-ba6e9bcdbd64
                Copyright © 2007 Van de Poel et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 August 2007
                : 28 November 2007
                Categories
                Research

                Health & Social care
                Health & Social care

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