Contribution of sociodemographic determinants in explaining the nutritional gap between the richest-poorest women of Bangladesh: A decomposition approach

Abstract

Background Malnutrition among women disproportionately exists across socioeconomic classes of Bangladesh. According to our knowledge, studies which attempted to identify determinants and their contributions to explain BMI-based nutritional gap between the poorest and the richest categories of Wealth Index are still scarce. Objectives To identify the nutritional gap of women between the richest-poorest classes in Bangladesh, and to determine how much of this gap are attributed to differences in predictors and differences in coefficients. Study population Reproductive-aged (15-49 years) women of Bangladesh. Methods and procedures We utilized the latest round (2017-2018) data of the Bangladesh Demographic and Health Survey (BDHS). Body mass index (BMI) has been used to measure the nutritional status of women. The kernel density was used to visualize the nutritional gap. The Oaxaca-Blinder (OB) decomposition method was used to ascertain influential determinants and their contributions to the existing gap between the richest-poorest classes of women. Results We analyzed the data of 18, 682 reproductive-aged women. There was a significant mean BMI gap of 4.1 unit (95% CI: 3.90-4.35) between the poorest-richest (25.6 vs 21.5) women. The overall prevalence of underweight, overweight and obese were 11.8%, 33.8% and 15.4%, respectively. The richest women were less underweight (7.5%) but more overweight (23.7%) and obese (42.2%). In contrast, the poorest women were more underweight (32.0%) but less overweight (13.9%) and obese (7.0%). According to results of OB decomposition method, all predictors combinedly can explain 1.62 units (95% CI: 1.31-1.93) of the total mean BMI gap (equivalent to 40%). Some of the major predictors were women years of education (0.45 units, 95% CI: 0.27-0.64), spouse years of education (0.16 units, 95% CI: -0.02-0.34), current working status (0.17 units, 95% CI: 0.10-0.34), access to Television (0.50 units, 95% CI: 0.28-0.72), and place of residence (0.37 units, 95% CI: 0.22-0.72). The unexplained part of the poorest-richest gap was 2.51 units (95% CI: 2.13-2.89), which means that this particular gap will remain unchanged even though the mean difference of the predictors was diminished. Conclusions A large part of the nutritional gap (approximately 60%) between the poorest and richest classes of women are found to be unchanged by the predictors of the study. Therefore, further predictors should be identified to minimize such gap. Moreover, policy makers and relevant stakeholders should implement feasible strategies to minimize the existing differences in the major predictors.