Public Health Nutrition: 13(10), 1498–1504 doi:10.1017/S1368980010001758 Association between socio-economic status and childhood undernutrition in Bangladesh; a comparison of possession score and poverty index Masuda Mohsena*, CG Nicholas Mascie-Taylor and Rie Goto Department of Biological Anthropology, University of Cambridge, Pembroke Street, Cambridge CB2 3RA, UK Submitted 14 December 2009: Accepted 10 May 2010: First published online 25 June 2010 Abstract Objective: To determine how much of the variation in nutritional status of Ban- gladeshi children under 5 years old can be attributed to the socio-economic status of the family. Design: Nutritional status used reference Z-scores of weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ). A ‘possession score’ was generated based on ownership of a radio, television, bicycle, motorcycle and telephone, and the availability of electricity, with categories of 0 to 41 posses- sions. A five-point (quintile) ‘poverty index’ was created using principal com- ponent analysis. Setting: The Bangladesh Demographic and Health Survey 2004 was the source of data. Subjects: A sample of 4891 children aged ,5 years was obtained. Results: Some 57?8 % of the sample was either stunted, wasted or underweight (7?7% were stunted, wasted and underweight). Of those stunted (48?4 %), 25?7 % were also underweight. Underweight and wasting prevalences were 40?7% and 14?3 %, respectively. Mean WAZ, HAZ and WHZ did not differ by sex. Children of mothers with no education or no possessions were, on average, about 1 SD more underweight and stunted than those with higher educated mothers or with 41 possessions. The possession score provided much greater discrimination of undernutrition than the poverty index. Nearly 50 % of children from households with no possessions were stunted, wasted or underweight (only 27 % in the poorest quintile), compared with only 3–6 % of children from households with 41 possessions (over 13 % in the richest quintile). Conclusions: Maternal education and possession score were the main predictors of a child’s nutritional status. Possession score was a much better indicator of under- nutrition than the poverty index. Keywords Childhood undernutrition Possession score Poverty index Childhood malnutrition is currently the leading cause of the global burden of disease in low- and middle-income countries. Recent estimates published in the Lancet (1) suggest that malnutrition is the underlying cause of 3?5 million deaths and 35 % of the disease burden in children under 5 years of age. The fraction of total global health loss attributable to undernutrition was 9?5 % in 2000 and 14?9 % in high-mortality developing regions (2) . Ending malnutrition is an agenda of the current millennium, particularly for the developing world (3) . Lowering mor- tality and malnutrition rates among children, along with reducing the gender disparities in both these measures, have been identified as key Millennium Development Goals (MDG) for Bangladesh (4) . Socio-economic status (SES) has long been identified as a leading predictive variable of an individual’s health in the epidemiological, economic and sociological litera- ture (5,6) . However, international agencies have recently downplayed the importance of SES as a marker of mal- nutrition. For example, Helen Keller International (7) reported that the highest and lowest SES quintile in Bangladesh differed only by 15 % in the prevalence of stunting and Semba et al. (8) reported only 17?9 % higher prevalence of stunting among the poorest quintile com- pared with richest quintile. These findings suggest less importance of using SES to derive health policy recom- mendations. It is well acknowledged that there is no international consensus on assessing SES. Income and household expenditures are the most commonly used measures of SES (9) . Given the difficulties in obtaining income or expenditure in developing countries, a poverty index or *Corresponding author: Email mm669@cam.ac.uk r The Authors 2010 Downloaded from https://www.cambridge.org/core. 13 Dec 2021 at 16:48:44, subject to the Cambridge Core terms of use.