Urban-rural disparities in child linear growth: a decomposition analysis of digital, physical, and socioeconomic environments in seven least-developed countries

Le résumé fourni par la source

Background: Child linear growth lags behind in rural areas compared to urban areas in least developed countries (LDCs). The extent to which household environments - digital, physical, and socioeconomic - are associated with this urban-rural gap remains unclear. We quantified how these household environments contribute to the urban-rural difference in linear growth among children. Methods: We pooled cross-sectional data from the demographic and health surveys conducted between 2015 and 2024 in seven LDCs. The analysis included children aged 0-59 months. Child linear growth was measured using the height-for-age Z-score (HAZ), computed from standard anthropometric measurements using the World Health Organization Child Growth Standards. We estimated the urban-rural difference in HAZ using hierarchical regression models and decomposed the mean gap into contributions from household digital, physical, and socioeconomic environments using Blinder-Oaxaca decomposition. Results: The pooled sample included 59 219 children (28.0% urban and 72.0% rural). The urban-rural difference in HAZ decreased from -0.29 (95% confidence interval (CI) = -0.32, -0.27) to -0.02 (95% CI = -0.05, 0.01) after adjustment for demographic characteristics and household environments. Blinder-Oaxaca decomposition indicated that over 95% of the pooled urban-rural HAZ gap was explained by measured household characteristics. The largest contributions were from household wealth (richest vs. poorest percentage explained = 38.8%), maternal education (secondary or higher vs. none = 19.6%), digital access (17.4%), and daily maternal Internet use (10.2%). Physical-environment indicators were smaller and less consistent across countries, although improved sanitation contributed positively in the pooled analysis (percentage explained = 10.4%). Conclusions: The urban-rural disparity in child linear growth is largely explained by unequal distributions of socioeconomic, digital, and physical household resources.

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