Extent of and trends in inequalities in child stunting in Sierra-Leone from 2005 to 2013: evidence from demographic and health surveys and multiple indicator cluster surveys

Abstract

Background: Comprehensive assessment of stunting disparity in Sierra-Leone has not been done so far. We aimed to document extent and over time dynamics of inequality in stunting in Sierra-Leone using approaches that facilitate implementation of interventions aim to eliminate non-justified stunting disparity in the country. Methods: The data for the study were derived from two rounds of the Sierra Leone Demographic and Health Survey conducted in 2008 and 2013, and two rounds of the Sierra Leone Multiple Indicator Cluster Survey done in 2005 and 2010. We used the 2019 update WHO Health Equity Assessment Toolkit (HEAT) to do the analysis. The toolkit makes use of data stored in the WHO Health Equity Monitor database. We analyzed stunting inequality using summary measures: Population Attributable Risk, Population Attributable Fraction, Difference and Ratio. The summary measures were computed for five equity stratifers: wealth, education, child's sex, place of residence and subnational region. We computed 95% Confidence Interval (CI) for each point estimate to show whether or not observed stunting inequalities are statistically significant, and whether or not the disparity changed over time statistically significantly. Results: The findings demonstrated stark inequalities in stunting in all the studied dimensions of inequality. While residence and subnational regional related inequalities remain unchanged over time, wealth and educational inequality had seen slight improvement during the same time period. Large sex related stunting inequality remained during the first three surveys time points, but it disappeared in 2013. Conclusions: Huge stunting disparities occurred in Sierra Leone, and the disparity disproportionately affects disadvantaged subpopulations and male children. Nutrition interventions that specifically target the subgroups which suffer more from the burden of stunting are required.

Inequalities in Stunting Prevalence Among Children Under Age 5 in Ghana Between 1998 and 2014

“…Consistent with previous studies conducted in Nepal [23], Nigeria [20], and Sierra Leone [21], our ndings showed that inequalities in childhood stunting were prevalent among children from the poorest wealth categories. The plausible reason could be that people in the poorest wealth quantile may encounter nancial challenges in their attempt to access nutritious foods for their children, and this may increase the likelihood of stunting in their children.…”

“…Finally, our nding showed sex-related stunting inequality favouring female children. This nding is congruent with previous studies conducted in Nigeria [20], Senegal [25], and Sierra Leone [21] that demonstrated that female children have lower odds of experiencing stunting than their male counterparts. The simple measures indicated a signi cant disparity in stunting at the detriment of male children throughout the period studied.…”

“…Maternal educational level emerged as a key variable that contributes to the inequalities in stunting among children under ve years. Our nding that stunting is more common among children of women with no/low educational attainment is in line with previous studies conducted in South Asia [18], some sub-Saharan African countries [19], Nigeria [20], and Sierra Leone [21]. The possible reason for this ndings could be that more educated women are likely to utilize healthcare services which in turn, may affect health-related decisions that improve child nutritional outcomes, such as stunting [22].…”

Rural and Urban Correlates of Stunting Among Under-Five Children in Sierra Leone: A 2019 Nationwide Cross-Sectional Survey

“… 4 Stunting is one of the manifestation of undernutrition and a preferred anthropometric measure for the assessment of chronic nutritional status. 5 , 6 A child is considered stunted when he/she has z -score value for height-for-age below minus 2 standard deviations (−2SD) from the median of the World Health Organization (WHO) standard growth charts. 7 Stunting is considered as “best overall indicator” of children’s well-being and an “accurate reflection” of disparities among populations.…”

“…21 , 22 However, Sierra Leone is far from achieving this having had a meager average annual reduction of only 0.25% between 2005 and 2013. 5 Studies based on national and regional data from the country have shown stark inequalities in stunting prevalence across regions, residence, and socio-economic status. 5 While wealth and educational inequalities have been shown to have slightly improved over time, residence (rural and urban) and subnational regional inequalities have remained unchanged.…”