The consequences
of childhood malnutrition throughout the globe are widespread and devastating.
The burden and costs that it places both on individuals and on society are
enormous, making it imperative that actions be taken to reduce the high numbers
of malnourished children. 167 million children under five years old were
underweight in developing countries in 1995, with South Asia having the highest
prevalence at 50 percent of the developing-country total (Gabriele &
Schettino, 2008). Child stunting (low length-for-age) and wasting (low
weight-for-height), as well as overnutrition, are all public health problems
faced by developing countries. These factors vary greatly among rural and urban
areas as a direct result of a multitude of complex factors related to
socioeconomic status (Gabriele & Schettino, 2008). Moreover, rapid
urbanization has created a larger heterogeneity of poverty and malnutrition
(Ortiz et al., 2013). The need for effective interventions and policies adapted
to rural and urban areas has thus increased drastically, necessitating a deeper
understanding of the factors affecting the distribution of childhood
malnutrition in rural and urban areas.

Little evidence of
the factors that play into the urban-rural difference can be found, and much is
lacking on the association these factors have with malnutrition. An analysis
and comparison of the key determinants of malnutrition among children of urban
and rural areas in Ecuador will thus be undertaken in order to determine
appropriate strategies to address this issue.

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A study by Smith
et al. (2005) found that child nutritional status was significantly better in
urban areas. The authors believe that urban malnutrition is lower due to
favorable socioeconomic conditions leading to better-caring practices for
children. But while food insecurity and malnutrition differ greatly, the nature
of the determinants and the magnitudes of their effects were found to be nearly
the same among rural and urban regions (Garrett & Ruel, 1999).
Specifically, income, food prices, maternal education, and demographics, such
as household size, affected malnutrition in both rural and urban areas (Garrett
& Ruel, 1999).

Research completed
in different areas of Kenya determined that geographic variability between
urban and rural centers was evident, with underweight children “tending to
cluster in rural areas” (Pawloski et al., 2012). Herrador et al. (2014)
noted that stunting was significantly higher in rural areas of Ethiopia, due to
the number of children living in the house, years of schooling of the caretaker,
consumption of food from animal sources, and literacy of head of household.
Similarly, the urban-rural gap could be traced back to parental education and
better household economic status of urban children in Malawi, and poor
household wealth, family size, and sub-optimal feeding practices after birth in
Eastern Uganda (Engebretsen et al.; 2008, Mussa, 2014). The findings from each
of these studies imply that in order to reduce the gap between malnutrition in
rural and urban areas, a focus should be placed on improving the socioeconomic
status in rural areas.

Despite evidence
of this geographical difference, child growth and nutrition in rural South
Africa was found to be “shifting towards an urban-like profile,” but
persisting prevalence of rural malnutrition suggests there have been
“inadequate interventions to address food insecurity and
undernutrition” (Kimani-Murage et al., 2010). Key areas for intervention
to reduce malnutrition in rural and urban areas must be identified, and
administrators “need not abandon the conceptual frameworks and toolkits
they have developed for rural areas but can bring them along as they move to
work in the city” (Garrett & Ruel, 1999). Both of these sources
suggest both the continued use of intervention in rural areas as well as further
implementation of policies in the growing urban population.

Fifty percent of
child mortality results from undernourishment, which is a direct result of
socioeconomic status (Victora et al., 2003). Anyamele (2009) looked at the
different socioeconomic determinants of child mortality in sub-Saharan Africa.
The study examined differences between urban and rural areas, finding that
wealth and literacy were both significant factors explaining child mortality,
thus contributing to child malnutrition.

Considering this,
Fotso et al. (2006) extensively explored the difference in malnutrition based
on geographical location, finding that urban-rural differentials can be mainly
explained by socioeconomic status; these socioeconomic inequalities are more
pronounced in urban regions.

Moreover, Fotso
(2007) examined correlations between socioeconomic status and malnutrition in
urban and rural sub-Saharan African regions. Factors affecting the distribution
of malnutrition were documented, showing immense socioeconomic and cultural
diversity between the countries. In order to determine whether the rural-urban
difference in stunting could be explained by socioeconomic factors; maternal
education, household wealth, and community socioeconomic status were examined.
Results indicated that rates of malnutrition declined with increasing
socioeconomic status and that malnutrition was lower in urban than rural areas.
Additionally, urban-rural stunting differences were abolished when
socioeconomic status was controlled.

An analytical
paper will be composed using the data from Demographic and Health Surveys of
countries in the sub-Saharan region of Africa. In the report, factors affecting
the difference in malnutrition in urban and rural areas of sub-Saharan Africa
will be discussed and compared to current data on malnutrition and its
determinants. In other words, the rates of child malnutrition will be compared
to the statistics of specific urban-rural differentials of malnutrition that
have been found following a review of the literature. Determinants will include
community socioeconomic status, household wealth, mother’s education, and
father’s education. Statistics regarding the socioeconomic determinants of
malnutrition will be sourced from the United Nations Development Programme (UNDP)
Human Development Report 2002, as well as the United Nation’s Department of
Economic and Social Affair’s report World Urbanization Prospects: The 2003
Revision. I will use the World Health Organization Joint Child Malnutrition
Estimates 2017 for data on current malnutrition rates.

Through a
comparison of current data and recent literature, it is the purpose of this
paper to improve the understanding of determinants of child malnutrition and to
further our knowledge on the strength of association of specific determinants
with undernutrition in urban and rural areas. An analysis of the determinants
that contribute to the urban-rural gap will be undertaken in order adequately
address malnutrition in rural and urban sub-Saharan Africa.


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