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Accepted manuscript

Stunting and inequality in Sri Lanka compared to other Low- and middle-income South Asian countries

Published online by Cambridge University Press:  19 March 2025

Damith Chandrasenage Open the ORCID record for Damith Chandrasenage [Opens in a new window] ,
William Johnson  and
Paula Griffiths
Damith Chandrasenage*
Affiliation:
School of Sport, Exercise and Health Sciences, Loughborough University, UK. Department of Social Statistics, Faculty of Social Sciences, University of Kelaniya, Sri Lanka.
William Johnson
Affiliation:
School of Sport, Exercise and Health Sciences, Loughborough University, UK.
Paula Griffiths
Affiliation:
School of Sport, Exercise and Health Sciences, Loughborough University, UK.
*
Corresponding author: Damith Chandrasenage, Email: damith.chandrasenage@york.ac.uk
Rights & Permissions [Opens in a new window]

Abstract

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Objective:

This study investigates and measures whether the association of childhood stunting with household socioeconomic position (SEP) differs in Sri Lanka compared to other South Asian countries.

Design:

Secondary analysis of data of children from the latest available DHS data (survey years, 2016-2018). The exposures (SEP) were maternal education and wealth. The outcome was stunting. Binary logistic regression models incorporated SEP, Country, and SEP-by-Country interaction terms.

Setting:

A nationally representative sample of children from Bangladesh, India, Nepal, Pakistan and Sri Lanka.

Participants:

Mothers/caregivers of children under 36 months (133,491).

Results:

The prevalence of stunting in Sri Lanka of 19% was much lower than that observed for all the other low to low-middle income South Asian countries (37% in Bangladesh, 36% in India, 31% in Nepal, 30% in Pakistan). The association of SEP with odds of stunting was similar in Sri Lanka compared to other South Asian countries. The only exception was weaker associations of wealth with stunting in Sri Lanka compared to Bangladesh. For example, in Sri Lanka, the poorest group had 2.75 (2.06, 3.67) times higher odds of stunting compared to the richest group, but in Bangladesh, this estimate was 4.20 (3.24, 5.44); the difference between these two estimates being 0.65 (0.44, 0.96) on the odds ratio scale.

Conclusions:

The lower prevalence of stunting in Sri Lanka is unlikely to be due to less inequality. It is more likely that the lower prevalence of stunting in Sri Lanka is related to there being fewer mothers belonging to the lowest SEP groups.

Keywords

stuntingsocioeconomic positionSouth AsiaSri Lanka
Type
Research Paper
Information
Public Health Nutrition , Accepted manuscript , pp. 1 - 16
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society