Assessing the impact of early marriage and socioeconomic determinants on under-five morbidity: a cross-country analysis in South Asia

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BACKGROUND: Early marriage and socioeconomic factors, which expose young mothers to early pregnancy under situations of adversity, are, as a result, dramatically associated with increased risk of children’s morbidity and perpetuate intergenerational cycles of poor health and disparity. Thus, this study aims to assess the association between early marriage and socioeconomic factors on children’s morbidity in South Asian countries using national survey data. MATERIALS AND METHODS: This study utilized the most recent nationally representative Demographic and Health Survey (DHS) child datasets from five South Asian countries—Bangladesh, India, Pakistan, Afghanistan, and Nepal—comprising a total sample of 286,131 children. The study’s outcome variable was the child morbidity. In addition to descriptive statistics, a two-stage binary logistic regression was used to analyze factors influencing child morbidity. RESULTS: In South Asia, Pakistan had the highest prevalence of child morbidity at 44.38%, followed by Afghanistan at 42.25%, Bangladesh at 34.20%, Nepal at 28.33%, and India with the lowest at 17.72%. Binary logistic regression revealed key factors associated with under-five morbidity in South Asia. Children born to early-married mothers in Pakistan had a significantly higher risk of morbidity (OR = 1.43, 95% CI: 1.20–1.70). Higher morbidity was also associated with maternal secondary education in Pakistan (OR = 1.88, 95% CI: 1.40–2.53), eight or more antenatal care visits in Pakistan (OR = 1.75, 95% CI: 1.17–2.63), Afghanistan (OR = 2.23, 95% CI: 1.83–2.71), and female-headed households in India and Pakistan (OR = 1.14, 95% CI: 1.05–1.24). Breastfeeding was connected to higher child morbidity in Bangladesh, India, Pakistan, and Afghanistan. In contrast, higher maternal education was associated with a significant reduction in child morbidity in both India (OR = 0.81, 95% CI: 0.70–0.93) and Afghanistan (OR = 0.57, 95% CI: 0.45–0.72). Rural residence (OR = 0.80, 95% CI: 0.73–0.87) in Afghanistan, as well as wealth status in India (OR = 0.79, 95% CI: 0.72–0.87), were protective factors. CONCLUSION: These findings highlight the urgent need to delay early marriage and address socioeconomic disparities to reduce child morbidity in South Asia. Improving maternal education, enforcing laws to delay the age at marriage, and increasing access to healthcare are crucial for enhancing child health and well-being in the region.

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