Revisiting swimming against tide; inequalities in child malnutrition in Nepal

Abstract Background Child stunting, child underweight, and child wasting in Nepal decreased from 48%, 47%, and 11% to 25%, 19%, and 9%, respectively, between 1996 and 2022. Despite an overall reduction in prevalence rates, economically poor and geographically backward regions in Nepal have not seen equivalent improvement in child undernutrition similar to their richer and developed regions, leading to increased differences in undernutrition prevalence across the wealth quintiles. This study aimed to assess time trends in the average and inequality of child nutritional status by household wealth across Nepal's geographical spaces from 1996 to 2022. Methods This study utilized data from four rounds (1996, 2006, 2016, and 2022) of the Nepal Demographics and Health Survey (NDHS). The nutritional status of children below three years of age, measured by stunting, wasting, and underweight, served as the main dependent variable. Household wealth status, determined by binary responses regarding possession of household assets, acted as a proxy for economic status. The study employed point prevalence for average, Concentration Index (CI), Poorest-Richest-Ratio (P-R-R), and Poorer-Richer-Ratio (Pr-Rr-R) to analyze trends in child nutritional status by wealth quintiles. Results From 1996 to 2022, Nepal exhibited an increasing Concentration Index and an upward trend in P-R-R measures of inequality in child stunting. The P-R-R increased from 1.77 in 1996 to 2.51 in 2022, However, results show a concurrent decrease in Pr-Rr-R from 1.19 to 1.18, assessing the prevalence of stunting among children. In the prevalence of child underweight, the P-R-R and Pr-Rr-R were 1.88 and 1.19 in 1996, decreasing to 1.47 and 1.10, respectively, in 2022. Conclusion The results indicated that inequalities in child nutrition across wealth status show an increase in stunting but marginal decline in underweight and wasting. Therefore, the study underscores the need for inclusive policy and program interventions to achieve equitable improvement in child stunting in Nepal, ensuring that progress extends to children in the poorest wealth quintile households. However, the progress is equitable in child underweight and wasting.