Does economic growth reduce childhood undernutrition in Ethiopia?
Summary of research1
Location: Ethiopia
What we know: Rapid economic growth in developing countries has had a mixed effect on human development; the impact on reducing childhood undernutrition is not well understood.
What this article adds: A cross-sectional study of three rounds of data from the Demographic and Health Survey (DHS) in Ethiopia (2000, 2005 and 2010) was integrated with corresponding World Bank real per capital income (PCI) to examine the association between economic growth and childhood undernutrition in Ethiopia. Household PCI improved in the two sample period intervals by 18.85% and 43.14% respectively. Strong significant associations were found between PCI and child undernutrition, as measured by stunting, underweight and wasting (P<0.0001 for all measures) in 32,610 children aged 0 to 59 months. Results suggest a strong correlation between economic development and improved anthropometric nutritional status in Ethiopia.
Policy discussions and debates over the last couple of decades have emphasised the efficiency of development policies in terms of translating economic growth into human development. However, the literature shows that rapid economic growth has brought mixed results and the effect of economic growth on improving human nutrition remains inconclusive. In some countries, rapid economic growth has accompanied increased income inequality, while in others it has brought little or no substantial improvement in poverty and nutrition outcomes (DNEAP, 2010; O’Donnella et al, 2009).
For the past decade, Ethiopia has made economic progress, with a gross domestic product (GDP) growth rate of 11% per annum. Despite this achievement, the prevalence of micronutrient deficiencies remains high and infant and young child feeding practices remain sub-optimal. This study aimed to assess the interplay between economic growth and childhood undernutrition in Ethiopia.
Three rounds of cross-sectional data from the Ethiopian Demographic and Health Survey (DHS) (2000, 2005 and 2010) were used for the study. DHS involves multi-stage cluster sampling and collects standardised data from women of reproductive age regarding their socio-demographic characteristics and maternal and child health. Child nutritional status is assessed using standard anthropometric measures. A multi-level, mixed logistic regression model was used for analysis. The dependent variables were stunting, underweight and wasting in household children. The main independent variable was World Bank real per capita income (PCI) that was adjusted for purchasing power parity.
A total of 32,610 children aged 0 to 59 months was included in the pooled analysis, with 11,095 (34.02%); 9,861 (30.24%); and 11,654 (35.74%) samples from the 2000, 2005 and 2010 surveys respectively. Overall, 11,296 children (46.7%) [46.0%-47.3%] were stunted, 8,197 (33.8%) [33.2%-34.4%] were underweight and 3,175 (13.1%) [12.7%-13.5%] were wasted.2 Among respondents, 84.4% lived in rural areas, 83.9% were male-headed households, 89.9% were married, and 24.8% were in the lowest wealth quantile at the time of the survey. More than 15.1% of families used unimproved toilet facilities, 45.6% received improved water, 53.3% of respondents did not engage in paid work, while 22.1% (7,130) and 76.6% (24,673) of husbands were employed in paid jobs and agricultural activities respectively. The relevant PCI of the country data (2000: US$515, 2005: US$612 and 2010: US$876) demonstrated an improvement in PCI of households in Ethiopia in the two sample period intervals of 18.85% and 43.14%, respectively.
Analysis showed a strong correlation between prevalence of early childhood undernutrition outcomes and PCI. The proportions of stunting (r = -0.1207, p<0.0001), wasting (r = -0.0338, p<0.0001) and underweight (r = -0.1035, p<0.0001) from all children in the household were negatively correlated with the PCI. In the final model adjustment with all the covariates, economic growth was associated with a substantial reduction in the prevalence of stunting [β = -0.0016, SE = 0.00013, p<0.0001], underweight [β = -0.0014, SE = 0.0002, p<0.0001] and wasting [β = -0.0008, SE = 0.0002, p<0.0001] in the country over a decade. Results demonstrate that economic growth was strongly (negatively) correlated with undernutrition in Ethiopia. This confirms the hypothesis that economic development is associated with improved nutritional status as measured by prevalence of underweight, wasted and stunted children.
These results contribute to empirical findings that confirm the association of household income and nutrition in sub-Saharan African countries. Families in sub-Saharan Africa spend as much as 60% of their income on food-related expenditures and an improvement in wealth condition is often translated into better access to food and healthcare services. Since most of the sampled households were engaged in agriculture and this sector makes a significant contribution to overall GDP, improvement in agricultural productivity of the country over the last decades may have played a vital role in nutrition improvement.
In order to facilitate further reductions in undernutrition and achieve the sustainable development goals, investment to boost agricultural production, stabilisation of price volatilities and implementation of policies to increase household income are crucial. Evidence also shows that nutrition interventions have assured effects on child health and development (Ruel et al, 2013). There is therefore a need to continue to focus on both nutrition-sensitive and nutrition-specific interventions that can boost child health and nutritional status.
Endnotes
1Biadgilign S, Shumetie A, Yesigat H (2016) Does Economic Growth Reduce Childhood Undernutrition in Ethiopia? PLoS ONE 11(8): e0160050. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0160050
1Defined as less than two standard deviations (-2SD) below the median height-for-age (stunting), weight-for-age (underweight) and weight-for-height (wasting), according to 2006 WHO growth standards.
References
DNEAP: Poverty and Well Being in Mozambique: The Third National Assessment. National Directorate of Poverty Analysis and Studies, Ministry of Planning and Development, Maputo, Mozambique. 2010.
O’Donnella O, Nicolásb ÁL, Doorslaerc EV: Growing richer and taller: Explaining change in the distribution of child nutritional status during Vietnam’s economic boom. Journal of Development Economics 2009, 88(1):45–58.
Ruel M, Alderman H, Group MaCNS: Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet 2013, 382(9891).