Peer-reviewed article
Stunting and inequality in Sri Lanka compared with other low- and middle-income South Asian countries.
Chandrasenage D, Johnson W, Griffiths PL ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study compared childhood stunting rates and their relationship to household wealth and maternal education across five South Asian countries using Demographic and Health Survey data. Sri Lanka had a much lower stunting prevalence (19%) than Bangladesh, India, Nepal, and Pakistan (30-37%). The association between poverty and stunting was similar across countries, except that wealth showed a weaker link to stunting in Sri Lanka than Bangladesh. The researchers concluded that Sri Lanka's lower stunting rates are likely due to fewer families in the poorest groups rather than less economic inequality.
Key points
- Sri Lanka's stunting prevalence of 19% was substantially lower than all other South Asian countries studied (30-37%)
- Poorest children in Sri Lanka had 2.75 times higher odds of stunting compared with richest children
- Poorest children in Bangladesh had 4.20 times higher odds of stunting compared with richest children
- The association between socio-economic position and stunting was largely similar across countries
- Lower stunting in Sri Lanka appears linked to fewer mothers in the lowest socio-economic groups, not reduced inequality
Limitations
This is a secondary analysis of cross-sectional survey data from 2016-2018, which cannot establish causation. The study measures association only and cannot explain the mechanisms behind why Sri Lanka has fewer families in the poorest groups or what policies or circumstances enabled this difference.
Abstract
Objective This study investigates and measures whether the association of childhood stunting with household socio-economic position (SEP) differs in Sri Lanka compared with other South Asian countries. Design Secondary analysis of data of children from the latest available Demographic and Health Surveys 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 and 30 % in Pakistan). The association of SEP with odds of stunting was similar in Sri Lanka compared with other South Asian countries. The only exception was weaker associations of wealth with stunting in Sri Lanka compared with Bangladesh. For example, in Sri Lanka, the poorest group had 2·75 (2·06, 3·67) times higher odds of stunting compared with 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 OR 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.