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Epidemiology

Rural–urban differences in socioeconomic inequality trends for double burden of malnutrition in Thailand 2005–2016

European Journal of Clinical Nutrition volume 74, pages 500–508 (2020)Cite this article

Subjects

Abstract

Background/Objectives

This study determined time trends in the prevalence of malnutrition and its socioeconomic inequality among children under five at a national level and by urbanity in Thailand.

Subjects/Methods

This study compared malnutrition prevalence and inequality among children under five by wealth index score and urbanity using three Multiple Indicator Cluster Surveys for 2005–06, 2012, and 2015–16. The magnitude of inequality was measured on absolute (slope index of inequality) and relative scales (relative index of inequality).

Results

National prevalence of stunting decreased substantially (16% in 2005–06 and 2012 and 10% in 2015–16), whereas overweight prevalence did not meaningfully change. Inequalities in stunting and overweight by wealth decreased over time nationally on both absolute and relative scales (p-trend < 0.001). Similar decreasing patterns in inequalities were seen in both rural and urban areas, though substantial inequalities persisted. Poor children remained stunted (11.6% in the rural poor and 14.8% in the urban poor), wasted (6.6% in the rural poor), and, strikingly, also overweight (from 5.5% in 2005–06 to 9% in 2015–16 for the rural poor and 8% over time for the urban poor).

Conclusion

Despite favorable time trends in socioeconomic inequality, this study showed the existence of a double burden of malnutrition (under-nutrition and overweight) in young Thai children with persistent inequalities at the national level. Different patterns of this double burden were seen between urban and rural areas. Public health policies should target both under-nutrition and overweight and consider urbanity in this rapidly developing society.

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References

  1. United Nations Children’s Fund (UNICEF), World Health Organization, International Bank for Reconstruction and Development/The World Bank. Levels and trends in child malnutrition: key findings of the 2019 Edition of the Joint Child Malnutrition Estimates. Geneva: World Health Organization; 2019 Licence: CC BY-NC-SA 3.0 IGO.

  2. Paciorek CJ, Stevens GA, Finucane MM, Ezzati M, Nutrition Impact Model Study Group. Children’s height and weight in rural and urban populations in low-income and middle-income countries: a systematic analysis of population-representative data. Lancet Glob Health. 2013;1:e300–9. https://doi.org/10.1016/S2214-109X(13)70109-8

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mberu BU, Haregu TN, Kyobutungi C, Ezeh AC. Health and health-related indicators in slum, rural, and urban communities: a comparative analysis. Glob Health Action. 2016;9:33163. https://doi.org/10.3402/gha.v9.33163

    Article  PubMed  Google Scholar 

  4. WHO. World health statistics 2016: monitoring health for the SDGs. Geneva: WHO; 2016.

    Google Scholar 

  5. Gwatkin DR. Health inequalities and the health of the poor: what do we know? What can we do? Bull World Health Organ. 2000;78:3–18.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. da Silva ICM, França GV, Barros AJD, Amouzou A, Krasevec J, Victora CG. Socioeconomic inequalities persist despite declining stunting prevalence in low- and middle-income countries. J Nutr. 2018;148:254–8. https://doi.org/10.1093/jn/nxx050

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bredenkamp C, Buisman LR, Van de Poel E. Persistent inequalities in child undernutrition: evidence from 80 countries, from 1990 to today. Int J Epidemiol. 2014;43:1328–35. https://doi.org/10.1093/ije/dyu075

    Article  PubMed  PubMed Central  Google Scholar 

  8. Van de Poel E, Hosseinpoor AR, Speybroeck N, Van Ourti T, Vega J. Socioeconomic inequality in malnutrition in developing countries. Bull World Health Organ. 2008;86:282–91.

    Article  Google Scholar 

  9. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427–51. https://doi.org/10.1016/S0140-6736(13)60937-X

    Article  PubMed  Google Scholar 

  10. Garcia V. Children malnutrition and horizontal inequalities in sub-saharan Africa: a focus on contrasting domestic trajectories. United Nations Development Programme; 2012.

  11. Neuman M, Kawachi I, Gortmaker S, Subramanian SV. Urban-rural differences in BMI in low- and middle-income countries: the role of socioeconomic status. Am J Clin Nutr. 2013;97:428–36. https://doi.org/10.3945/ajcn.112.045997

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Smith LC, Ruel MT, Ndiaye A. Why is child malnutrition lower in urban than in rural areas? Evidence from 36 developing countries. World Dev. 2005;33:1285–305.

    Article  Google Scholar 

  13. Fox K, Heaton TB. Child nutritional status by rural/urban residence: a cross-national analysis. J Rural Health. 2012;28:380–91.

    Article  Google Scholar 

  14. Srinivasan CS, Zanello G, Shankar B. Rural-urban disparities in child nutrition in Bangladesh and Nepal. BMC Public Health. 2013;13:581. https://doi.org/10.1186/1471-2458-13-581

    Article  PubMed  PubMed Central  Google Scholar 

  15. UN. World urbanization prospects: the 2014 revision, highlights (ST/ESA/SER.A/352). New York: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat; 2014.

    Google Scholar 

  16. Winichagoon P. Thailand nutrition in transition: situation and challenges of maternal and child nutrition. Asia Pac J Clin Nutr. 2013;22:6–15.

    PubMed  Google Scholar 

  17. Food and Agriculture Organization of the United Nations. Thailand—food and nutrition security profiles. Food and Agriculture Organization of the United Nations; 2014.

  18. Aekplakorn W, Mo-Suwan L. Prevalence of obesity in Thailand. Obes Rev. 2009;10:589–92. https://doi.org/10.1111/j.1467-789X.2009.00626.x

    Article  CAS  PubMed  Google Scholar 

  19. Yamborisut U, Mo-Suwan L. Prevalence of childhood and adolescent obesity in Thailand: a review. J Med Assoc Thai. 2014;97:44–51.

    PubMed  Google Scholar 

  20. International Food Policy Research Institute. Global nutrition report: governance International Food Policy Research Institute; 2014.

  21. International Food Policy Research Institute. 2017 global food policy report. Washington, DC: International Food Policy Research Institute; 2017.

    Google Scholar 

  22. Thailand National Statistical Office and UNICEF. Thailand Multiple Indicator Cluster Survey (MICS) 2012, final report. Bangkok, Thailand: Thailand National Statistical Office and United Nations Children’s Fund; 2012.

    Google Scholar 

  23. Thailand National Statistical Office. Thailand Multiple Indicator Cluster Survey (MICS) 2016, final report. Bangkok, Thailand: Thailand National Statistical Office; 2016.

  24. Thailand National Statistical Office. Thailand Multiple Indicator Cluster Survey (MICS) December 2005–February 2006, final report. Bangkok, Thailand: Thailand National Statistical Office; 2006.

  25. WHO. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva, Switzerland: WHO; 2006.

    Google Scholar 

  26. Houweling TA, Kunst AE, Mackenbach JP. Measuring health inequality among children in developing countries: does the choice of the indicator of economic status matter? Int J Equity Health. 2003;2:8. https://doi.org/10.1186/1475-9276-2-8

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gwatkin DR, Rutstein S, Johnson K, Pande R, Wagstaff. A. Socio-economic differences in health, nutrition, and population. Washington, DC: World Bank, HNP/Poverty Thematic Group; 2001.

    Google Scholar 

  28. Mackenbach JP, Kunst AE. Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997;44:757–71. https://doi.org/10.1016/S0277-9536(96)00073-1

    Article  CAS  PubMed  Google Scholar 

  29. Moreno-Betancur M, Latouche A, Menvielle G, Kunst AE, Rey G. Relative index of inequality and slope index of inequality: a structured regression framework for estimation. Epidemiology. 2015;26:518–27. https://doi.org/10.1097/EDE.0000000000000311

    Article  PubMed  Google Scholar 

  30. Regidor E. Measures of health inequalities: part 2. J Epidemiol Community Health. 2004;58:900. https://doi.org/10.1136/jech.2004.023036

    Article  PubMed  PubMed Central  Google Scholar 

  31. Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358:2468–81. https://doi.org/10.1056/NEJMsa0707519

    Article  CAS  PubMed  Google Scholar 

  32. Khang YH, Lynch JW, Yun S, Lee SI. Trends in socioeconomic health inequalities in Korea: use of mortality and morbidity measures. J Epidemiol Community Health. 2004;58:308–14. https://doi.org/10.1136/jech.2003.012989

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Espelt A, Kunst AE, Palència L, Gnavi R, Borrell C. Twenty years of socio-economic inequalities in type 2 diabetes mellitus prevalence in Spain, 1987–2006. Eur J Public Health. 2012;22:765–71. https://doi.org/10.1093/eurpub/ckr158

    Article  PubMed  Google Scholar 

  34. Spiegelman D, Hertzmark E, Easy SAS. calculations for risk or prevalence ratios and differences. Am J Epidemiol. 2005;162:199–200. https://doi.org/10.1093/aje/kwi188

    Article  PubMed  Google Scholar 

  35. Monteiro CA, Benicio MH, Conde WL, Konno S, Lovadino AL, Barros AJ, et al. Narrowing socioeconomic inequality in child stunting: the Brazilian experience, 1974–2007. Bull World Health Organ. 2010;88:305–11. https://doi.org/10.2471/BLT.09.069195

    Article  PubMed  Google Scholar 

  36. Greffeuille V, Sophonneary P, Laillou A, Gauthier L, Hong R, Hong R, et al. Persistent inequalities in child undernutrition in Cambodia from 2000 until today. Nutrients. 2016;8:297. https://doi.org/10.3390/nu8050297

    Article  CAS  PubMed Central  Google Scholar 

  37. Kien VD, Lee HY, Nam YS, Oh J, Giang KB, Minh HV. Trends in socioeconomic inequalities in child malnutrition in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2000–11. Glob Health Action. 2016;9:29263. https://doi.org/10.3402/gha.v9.29263

    Article  PubMed  Google Scholar 

  38. Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: Lessons from Thailand. Adv Health Econ Health Serv Res. 2009;21:57–81.

    Article  Google Scholar 

  39. Kongsri S, Limwattananon S, Sirilak S, Prakongsai P, Tangcharoensathien V. Equity of access to and utilization of reproductive health services in Thailand: national reproductive health survey data, 2006 and 2009. Reprod Health Matters. 2011;19:86–97. https://doi.org/10.1016/S0968-8080(11)37569-6

    Article  PubMed  Google Scholar 

  40. Kelly M, Seubsman S, Banwell C, Dixon J, Sleigh A. Thailand’s food retail transition: supermarket and fresh market effects on diet quality and health. Br Food J. 2014;116:1180–93. https://doi.org/10.1108/BFJ-08-2013-0210

    Article  Google Scholar 

  41. Hong SA, Sriburapapirom S, Thamma-aphiphol K, Jalayondeja C, Tiraphat S. Overweight and obesity among primary schoolchildren in Nakhon Pathom, Thailand: comparison of Thai, international obesity task force and WHO Growth references. Southeast Asian J Trop Med Public Health. 2017;48:902–11.

    Google Scholar 

  42. Jaacks LM, Vandevijvere S, Pan A, McGowan CJ, Wallace C, Imamura F, et al. The obesity transition: stages of the global epidemic. Lancet Diabetes Endocrinol. 2019;7:231–40. https://doi.org/10.1016/S2213-8587(19)30026-9

    Article  PubMed  Google Scholar 

  43. Gordon-Larsen P, Wang H, Popkin BM. Overweight dynamics in Chinese children and adults. Obes Rev. 2014;15(Suppl 1):37–48. https://doi.org/10.1111/obr.12121

    Article  PubMed  PubMed Central  Google Scholar 

  44. Victora CG, Vaughan JP, Barros FC, Silva AC, Tomasi E. Explaining trends in inequities: evidence from Brazilian child health studies. Lancet. 2000;356:1093–8. https://doi.org/10.1016/S0140-6736(00)02741-0

    Article  CAS  PubMed  Google Scholar 

  45. Popkin BM. Urbanization, lifestyle changes and the nutrition transition. World Dev. 1999;27:1905–16.

    Article  Google Scholar 

  46. Kim R, Kawachi I, Coull BA, Subramanian SV. Contribution of socioeconomic factors to the variation in body-mass index in 58 low-income and middle-income countries: an econometric analysis of multilevel data. Lancet Glob Health. 2018;6:e777–86. https://doi.org/10.1016/S2214-109X(18)30232-8

    Article  PubMed  Google Scholar 

  47. Gale EL, Saunders MA. The 2011 Thailand flood: climate causes and return periods. Weather. 2013;68. https://doi.org/10.1002/wea.2133

  48. Soekirman. Food and nutrition security and the economic crisis in Indonesia. Asia Pac J Clin Nutr. 2001;10(Suppl):S57–61.

    Article  Google Scholar 

  49. Shrimpton R, Rokx C. The double burden of malnutrition: a review of global evidence. The International Bank for reconstruction and development. Washington DC: The World Bank; 2012.

  50. Background of Child Support Grant [Internet]. Bangkok, Thailand: Child Support Grant, Department of Children and Youth; 2018. [updated 2018; cited 2019 June 20] Available from: https://csg.dcy.go.th/en/about/background

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Acknowledgements

The authors would like to thank the Thailand National Statistical Office (NSO) and the UNICEF Thailand country office for permission to use the publicly available data from the three MICS rounds for the present study.

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Authors and Affiliations

  1. ASEAN Institute for Health Development, Mahidol University, Phutthamonthon District, Nakhon Pathom, 73170, Thailand

    Seo Ah Hong

  2. Institute for Health and Society, Hanyang University, Seoul, 04763, Republic of Korea

    Seo Ah Hong

  3. Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon District, Nakhon Pathom, 73170, Thailand

    Pattanee Winichagoon

  4. Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea

    Young-Ho Khang

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SAH designed the research, performed the analysis, interpreted the results, and drafted the manuscript. PW and Y-HK interpreted the results, and revised the manuscript. All authors read and approved the manuscript.

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Correspondence to Seo Ah Hong.

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Hong, S.A., Winichagoon, P. & Khang, YH. Rural–urban differences in socioeconomic inequality trends for double burden of malnutrition in Thailand 2005–2016. Eur J Clin Nutr 74, 500–508 (2020). https://doi.org/10.1038/s41430-019-0510-1

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