Malnutrition is often caused by undernourishment, which is defined as receiving insufficient food for at least one year. In other words, undernourishment is the state of not fulfilling the energy requirements. It’s about two years that the World Bank is publishing the prevalence of undernourishment as a percentage of the total population. In addition, the Food and Agricultural Organization of the United Nations (UNFAO) publishes undernourishment data as “number of the population undernourished in million” and as “prevalence of undernourishment as a percentage of the total population” both as three year-average starting from 2000. During the past two decades, the number of undernourished had declined; so that according to the estimates, in 2000, there were about 9000 million undernourished, and in 2017, it declined to 820.80 million (
1), which shows a very slow improvement in the nutritional status of the world population. Thus, undernourishment still is a major public health challenge worldwide, particularly for South Asia, which, while hosting 25 percent of the world population, is a place of a low standard of living owing to low per capita income (
2).
Undernourishment may cause by malnutrition, which directly affects human productivity and the economy of a nation. People who suffer from malnutrition in childhood generally face poor brain and physical development, which in turn causes poor mental health and cognitive skills, low academic performance during student-hood that is associated with limited job market placements or during their carrier. If occurs in the first years of life, undernourishment may cause long-lasting effect, particularly regarding personal development and economic growth of the country. A study (
3) on South Asia explored the association between per capita income and life expectancy and reported a bidirectional causality. It is worth noting that a healthy population with high life expectancy has a crucial role in economic development. Sometimes undernourishment is used interchangeably with malnutrition, which has far-reaching consequences.
Several factors contribute to undernourishment, including economic, social, behavioral, and disease-related factors. In addition, many diseases such as diarrhea, dysentery, intestinal helminths [like hookworm, roundworm, and schistosomiasis], HIV, malaria, and respiratory infections can cause malnutrition in humans, which jeopardize both mental and physical health. Similarly, some behavioral factors also may cause malnutrition at different stages of life. For instance, child care and feeding practices as well as breastfeeding have a lasting effect on the growth of children’s mental and physical health.
Food habits, complementary feeding practices, and health-seeking behaviors have an important role in determination of health and the life-expectancy of a community. In the current study, a special focus was made on socioeconomic factors, particularly national income [as a proxy for economic context and adult literacy [a proxy for social factor]. In addition, their influence on undernourishment in South Asia was also investigated.
Among all other factors, lack of economic access to necessary food could significantly justify undernourishment at the community level. Also, poor economic access, among other consequences, is the prime cause of malnutrition. Ensured economic access paves the way for economic growth. Generally, the benefits of economic growth should be distributed evenly, especially to the weaker sections of society in developing countries. Therefore, it is postulated that economic growth and improved income distribution are associated with improved nutrition. However, several studies raised concerns about the impacts of economic growth and improved income distribution on the nutritional status of those living in developing countries (
4-
6). Therefore, the current study aimed to investigate the influence of economic growth on undernourishment status in South Asia.
Education directly augments productivity, which in turn results in increased income and better access to foods, which translated into lower rates of undernourishment. There is evidence indicating the significant contribution of education in income level, even after realizing various costs of education. So that those with higher levels of education usually have higher levels of income, even in less-developed countries (
7).
According to the literature, education is a major determinant of malnourishment. For instance, countries with adequate female literacy tend to have a lower prevalence of malnutrition, irrespective of differences in the countries’ wealth or general living standards (
8,
9). Curricula that emphasize basic health and nutritional knowledge not only can gear up the nutritional awareness but also can reduce the undernourishment among populations in South Asia.
There is plenty of literature on nutrition and undernourishment from medical and public health points of view. However, the literature on the impact of socioeconomic factors on undernourishment from the social science point of view is rare. A study (
5) investigated the influence of food prices and several social variables on household health status in Indonesia and found that high commodity prices, health program service levels, and unsafe drinking water sources had a direct impact on the health status of family members. Another study (
6) examined whether the rise in income led to increased nutrient intakes through analyses of subsample data from the “International Crops Research Institute for the Semi-Arid Tropics Village Level studies” panel data set for rural south India and reported that the real nutrient elasticities to income might be close to zero. The mechanism of the association between mother’s education and child wellbeing has been investigated by a study conducted in Morocco and reported that mother’s health knowledge is an important child-nurturing skill, which they gained outside school, but through knowledge and numeracy skills such knowledge can be achieved through classroom learnings (
9). Hence, the study suggested that teaching health-related topics at schools could significantly uphold child health and nutritional status in Morocco. Several studies highlighted the role of education in raising income and argued that the potential gain was much higher than the costs of education (both direct and indirect), particularly in less-developed countries (
7,
10).
Babar et al. (
11) investigated the influence of socioeconomic factors on the nutritional status of children in the primary school of Pakistan using the data of a cross-sectional survey and mentioned poverty, lack of education, family size, food safety, and insecurity as important underlying factors responsible for poor health status. Kanjilal et al. (
12) attempted to specify the extent of socioeconomic disparity in chronic childhood malnutrition across Indian states and identified the role of household socioeconomic status on the nutritional status of children. Wu et al. (
13) investigated the association between socioeconomic progress and malnutrition among children younger than 5 years in China from 1990 to 2010 and reported a negative association between per capita income, size of family, and prevalence of malnutrition.
Khattak et al. (
14) explored the association between parental education and malnutrition based on a primary survey of 400 mothers commuting to primary health care centers in Pakistan. They reported that higher paternal and maternal educational status were significantly correlated with normal child nutritional status. It appeared that higher literacy among parents was associated with lower rates of malnutrition; hence, they argued that illiteracy is a main cause of undernourishment. Galgamuwa et al. (
15) investigated the socioeconomic determinants of nutritional status among playschool and school-going kids in rural communities of Sri Lanka. They found that maternal employment, more siblings, high orders of birth, and female children were significantly connected with undernutrition among playschool children; while maternal employment, dwelling in tiny houses, larger family size, and little monthly income were significantly related to undernutrition among school-going children. Ravaoarisoa et al. (
16) identified the socioeconomic determinants of maternal malnutrition in Madagascar following a cross-sectional design and found that larger family sizes and use of unsafe water were significantly associated with malnutrition.
Islam (
3) examined the association between per capita income, adult literacy rate, and life expectancy at birth in several countries of South Asia. The study reported a bidirectional causality between life expectancy and per capita income; adult literacy and per capita income; and adult literacy and life expectancy. Islam (
2), using time series annual data for the 1998 - 2017 period, has investigated the effects of education and health on food security in Bangladesh and documented a positive association between education expenditure and healthy community and food security in the country. Most of the above-cited studies examined the determinants of undernourishment and malnutrition based on cross-section data, and this study does the same based on macrolevel annual panel data.