Abstract
It is widely recognized in the public health literature that healthcare and nutrition during the early childhood period have important long-term and sometimes irreversible consequences on health and wellbeing later in life. In this paper, we endeavor to investigate deeply the patterns of inequality of opportunity in health and nutrition outcomes among under-five children in Tunisia. Several tools are used to do such analysis including comparison of distributions of the considered outcomes across circumstances groups; estimation of the Human Opportunity Index; and measurement of the relative contributions of different circumstances using the Shapley decomposition. The main findings reveal reasonable and low levels of inequality in access to all basic healthcare services and nutrition except access to improved water and sanitation. Besides, parents’ education, wealth status and location of residence are found to be key factors causing low level of inequalities. Thus, it is easy to conclude that without more inclusive and pro-poor policy interventions, there are few chances for children belonging in poor families and living in marginalized rural areas to spring out of the poverty lived by their parents.
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Notes
At these years, no Demographic and Health Survey (DHS) was conducted in Tunisia, for this reason we have opted for using the MICS data in our analysis. MICS is a publicly available dataset. Data can be downloaded for free at the UNICEF’s website: http://mics.unicef.org/surveys
For more information on the MICS surveys, please visit www.childinfo.org.
A healthy pregnant woman has a blood test to rule out the possibility that her baby has certain abnormalities, such as Down’s syndrome.
See de Barros et al. (2009)
Z-scores are calculated by mean of the CSPro software using the WHO international reference population; As recommended by WHO, exact age (not completed months) are used to calculate these Z-scores.
Height-for-age (H/A) reflects cumulative linear growth. Height for age deficits indicate past or chronic inadequacies of nutrition and/or chronic or frequent illness, but cannot measure short-term changes in malnutrition. Low H/A relative to a child of the same sex and age in the reference population is referred to as “shortness.” Extreme cases of low H/A, in which shortness is interpreted as pathological, are referred to as “stunting.” H/A is used primarily as a population indicator rather than for individual growth monitoring (O’Donnell and Wagstaff 2008).
Weight-for-height (W/H) measures body weight relative to height and has the advantage of not requiring age data. Normally, W/H is used as an indicator of current nutritional status and can be useful for screening children at risk and for measuring short-term changes in nutritional status. At the other end of the spectrum, W/H can also be used to construct indicators of obesity. Low W/H relative to a child of the same sex and age in a reference population is referred to as “thinness.” Extreme cases of low W/H are commonly referred to as “wasting.” Wasting may be the consequence of starvation or severe disease (in particular, diarrhea) (O’Donnell and Wagstaff 2008).
Weight-for-age (W/A) reflects body mass relative to age. W/A is, in effect, a composite measure of height-for-age and weight-for-height, the term “underweight” is commonly used to refer to severe or pathological deficits in W/A. W/A is commonly used for monitoring growth and to assess changes in the magnitude of malnutrition over time. However, W/A confounds the effects of short- and long-term health and nutrition problems (O’Donnell and Wagstaff 2008).
The current section merely gives the basic conceptual method for computing the Human Opportunities Index as explained in the recent literature. For further details and discussion, refer to de Barros et al. (2009) which gives a more exhaustive explanation of the procedure of computing the two components of the HOI: the coverage rate and the Dissimilarity index (D-index). The methodology employed in the current exercise to calculate the HOI follows similar notations used in the recent literature.
This method of decomposition is based mainly on the concept of Shapley value in cooperative games
The composite index, Nutrition_1, is constructed by assuming that a child who haven’t a malnutrition problem should be neither stunted, nor wasted, either underweight.
The second nutrition indicator, Nutrition_2, is the defined simply by the access of the mother to blood tests during the pregnancy period.
To ensure hygiene, access to water for cleansing and hand washing at critical times is essential particularly for children.
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Amara, M., Jemmali, H. Do Tunisian Young Children Have Equal Chances in Access to Basic Services? A Special Focus on Opportunities in Healthcare and Nutrition. Child Ind Res 11, 383–403 (2018). https://doi.org/10.1007/s12187-017-9447-x
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DOI: https://doi.org/10.1007/s12187-017-9447-x