Economic inequality and undernutrition in women: multilevel analysis of individual, household, and community levels in Cambodia

BACKGROUND: Many people in developing countries are still struggling to emerge from the realm of extreme poverty, where economic improvements tend to benefit a small, affluent group of the population and cause growing inequality in health and nutrition that affects the most vulnerable groups of the population, including women and children. OBJECTIVE: To examine how household and community economic inequality affects nutritional status in women using information on 6,922 nonpregnant women aged 15 to 49 years included in the 2000 Cambodia Demographic and Health Survey. METHODS: Nutritional status is defined with the use of the body-mass index (BMI). BMI less than 18.5 kg/m2 is defined as undernourishment. The household wealth index was calculated from household ownership of durable assets and household characteristics. Community wealth is an average household wealth index at the community level. Household and community economic inequalities were measured by dividing the wealth index into quintiles. The effects of household and community economic inequality were estimated by multilevel analysis. RESULTS: Independently of community economic status and other risk factors, women in the poorest 20% of households are more likely to be undernourished than women in the richest 20% of households (RR = 1.63; p = .008). The results also show variation among communities in the nutritional status of women. Age, occupation, and access to safe sources of drinking water are significantly associated with women's nutritional status. CONCLUSIONS: Improving household income and creating employment opportunities for women, in particular poor women, may be a key to improving the nutritional status of women in Cambodia.