Socio-economic influences on gender inequalities in child health in rural Bangladesh

Objective: To investigate gender inequalities in child growth and nutritional status in relation to socio-economic status in Bangladesh. Design: A 16-month longitudinal study of child growth measuring anthropometric and socioeconomic status. Setting: A rural area of Jamalpur district, northern Bangladesh. Subjects: 1366 children from 2 to 6 years of age, Methods: Child height and weight were measured monthly. Morbidity, food intake and health-seeking behaviours were assessed fortnightly. Multivariable analyses were performed on the growth and nutritional status of male and female children in relation to socio-economic Factors including father's occupation: parental education, birth order and family size. Results: There was no evidence of gender bias in farming and trading/employee households but landless female children had significantly poorer height-for-age (P < 0.001) and weight-for-age (P ( 0.001) than their male counterparts. During a period of natural disaster; a statistically significant interaction was observed between father's occupation and sex (P < 0.05) such that the combination of being female and being landless was more detrimental to nutritional status than either variable alone. Over the following 16-months, catch-up-growth was apparent in landless female children who grew significantly more in height-for-age (P < 0.001) and weight-for-age (P < 0.001) than their male counterparts. Conclusions: Gender inequalities in health in Bangladesh varied significantly according to occupational status, such that the effect of sex was dependent upon occupation. These effects were statistically significant during the period of natural disaster but became insignificant as local conditions improved. This demonstrates both temporal and socio-economic variation in gender inequalities in health.