SOCIO-ECONOMIC STATUS AND HEALTH OUTCOMES AMONG SCHOOL-GOING CHILDREN IN DELHI: A META-ANALYSIS

Background: Extreme socio-economic inequalities exist within the city of Delhi resulting into health inequities across different social strata for school going children. Despite the high proportion (> 35%) of the urban population of India that resides in slums like conditions, there is no systematic synthesis of the evidence regarding its effect on health outcome. Objective: Quantify the association between socio economic status (SES) and health outcomes in school going children (age range: 6–18yrs) of Delhi through a meta-analysis. Methods: A systematic review of all eligible articles retrieved from PubMed, Scopus, Web of Science, Google Scholar, IndMED, IMSEAR, and ProQuest Dissertations databases (through June 2024) was conducted. A random-effects meta-analysis approach was adopted using Review Manager v5.4 software to pool the study results as ORs along with respective CIs and p values. Subgroup analyses were also performed alongside appropriate meta regression techniques to assess source(s) of heterogeneity. Results: Children belonging to the lowest socio-economic status (SES) group had an increased risk of adverse health outcomes [OR = 2.45, 95%CI: 1.89 - 3.18; P <0.001]. Of these nutritional outcomes recorded the highest OR at (OR = 2.89, 95%CI: 2.34 - 3.57), whereas mental health parameters had OR = 2.67 (95%CI: 2.01 – 3.54). This study demonstrated the presence of ‘double burden’ of nutrition problems where both under nutrition (OR=2.89) and overweight /obesity (OR=3.51) existed amongst low and high SES children respectively. Finally, age proved to be significant moderator of effect sizes (P = 0.012). Conclusion: In summary our findings suggest that SES has a considerable impact upon health of school going children in Delhi which includes major problems of under nutrition, mental health issue, and obesity. Therefore, targeted intervention should be designed focusing simultaneously on alleviating problem of undernutrition among lower SES group while targeting prevention of obesity among higher SES. School Health Programme must address socio-economic concerns during designing and implementing.