Geospatial inequalities in women's malnutrition in Pakistan.

Abstract

Background: In developing countries, regional disparities in maternal malnutrition are a major deterrent to development. Inadequate nutrition and poor health among women not only affect their quality of life but also the well-being of their children, risking the future generation of the country. This study examines the spatial distribution of malnutrition at the extreme quantiles of Body Mass Index-severe thinness and underweight at the lower quantile and over-weight and obese at the upper quantile- and associated risk factors among women in Pakistan using Bayesian additive quantile regression.

Methods: A sample of 5,252 of the currently non-pregnant and non-lactating married women aged 15-49 was taken from Pakistan Demographic and Health Survey 2017-18. The response variable was the women's nutritional status measured in body mass index (weight in kilograms/height in meters squared) of women. Following WHO guidelines, we used four indicators of BMI, as follows: severe thinness (BMI < 16 kg/m2); underweight (BMI < 18.5 kg/m2); Overweight (BMI > 24 kg/m2); and obese (BMI >  = 30 kg/m2). A set of explanatory variables comprising women's characteristics and household related variables were used to assess their association with the likelihood of various forms of malnutrition. The structured Bayesian Geo-additive Quantile regression approach was employed to examine the association of the explanatory variables with the entire conditional distribution of the response variable.

Results: The sizable regional variation was found in malnutrition among reproductive age women. Women living in urban areas are more likely to become overweight (mean: 0.3; 95% CI: 0.06, 0.58) than their rural counterparts. Working women are less prone to obesity (mean: -0.51; 95% CI: -0.79, -0.23). Women with unimproved toilet are more likely to become overweight (mean: 0.7; 95%CI: 0.34., 1.04) and obese (mean: 0.90; 95%CI: 0.48, 1.33).

Conclusions: Findings underscore the need for targeted interventions to address the complex and varied challenges posed by women's malnutrition.