Understanding the health and nutritional status of children in Pakistan: A study of the interaction of socioeconomic and environmental factors

Purpose – The main purpose of this paper is to increase the level of knowledge pertaining to nutritional status of preschoolers and to identify/quantifying the relative importance of various socioeconomic and environmental factors which may have significant role in determining nutritional status of preschoolers in Pakistan. Design/methodology/approach – Household food availability, childcare practices, and child health status being focused as proximate determinants of child nutritional status pose problems for the simple regression analysis. An ordinary least squares (OLS) estimation of the regression with nutrition as an outcome and these three proximate variables as determinants could be biased for two reasons. First, there may be unobserved variables that are relegated to the error term but are correlated with the variables included on the right side. Second, explanatory variables may exit that are endogenous or codetermined with the outcome variable and hence are correlated with the error term. The approach to address these problems is to use instrumental variables (IV) approach. The credibility of the IV approach will rest on the ability to find variables that are correlated with the suspected endogenous explanatory variables but that do not affect the outcome variable (other than through the explanatory variable being instrumented). Findings – The results from empirical analysis shows that factors on the maternal and household level are more important determinants of child nutritional status. Food availability, childcare practices and child health (diarrhea) are significantly related to child nutritional status. Household size has negative and significant impact on child nutritional status. Household income has an important and significant impact on child nutritional status. Childcare practices are negatively and significantly related to child nutritional status. This may suggest that as childcare practices improve, they may complement the need for other sources of improved energy for preschooler's nutritional status. The findings suggest that women's education plays a very important role in improving children's nutritional status and that the nutrition status among children depends on both better sanitary conditions and on dietary intake. Research limitations/implications – Owing to data limitation present analysis employed child calorie adequacy ratio (CCAR) as a proxy of child nutritional status. For that to estimate, commonly used measures are nutrient intake, caloric adequacy ratio and relative caloric allocation. Practical implications – A key message of this research is that significant achievement could be made toward reducing malnutrition through actions in sectors that have not been the traditional focus of nutritional interventions like improved hygiene conditions. Originality/value – This could be the first ever effort in describing child nutritional status with the help relative more robust analytical technique for Pakistan.