ArticleJournal of global health2026
Urban-rural disparities in child linear growth: a decomposition analysis of digital, physical, and socioeconomic environments in seven least-developed countries.
Article in Journal of global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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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