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

Abstract

BackgroundOver the years, Ghana has made significant improvements in the nutritional status of children, particularly concerning stunting. Though these improvements are commendable, there are concerns of inequalities in the prevalence of stunting among children under five. To this end, we examined the trends and inequalities in the determinants of stunting prevalence in children under five in Ghana, throughout 1998-2014.MethodsUsing the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, we analysed data from the 1998-2014 Ghana Demographic and Health Surveys (GDHS). We approached the inequality analysis in two steps. First, we disaggregated stunting prevalence among children < 5 years by five equity stratifiers: wealth index, education, sex, residence, and region. Second, we measured the inequality through summary measures, namely Difference, Population Attributable Risk, Ratio, and Population Attributable Fraction. A 95% confidence interval was constructed for point estimates to measure statistical significance.ResultsConcerning economic status, only the simple summary measures (Difference [D], Ratio [R]) showed significant inequality in stunting. For instance, both D (23.40; 17.55-29.25) and R (2.43; 1.78-3.09) revealed substantial economic variation in stunting in 1998 and the same trend was noted across all the survey years. The complex summary measures, however, showed a significant but negative association. Both D (16.36; 12.13-20.60) and R (1.90; 1.51-2.28) revealed a positive significant disparity in favour of urban residents in 1998. The simple measures further indicated a significant disparity in stunting at the detriment of male children throughout the period studied. Finally, a significant disparity at the expense of children in the Northern Region was evident in 1998 (D=31.00; R=3.22), 2003 (D=37.21; R=3.17) and 2014 (D=22.73; R=3.19).ConclusionInequalities in stunting prevalence in Ghana is to the disadvantaged children of poorest wealth quintile, mothers with no formal education, male children, rural residents and the Northern Region of Ghana. We recommend the introduction and strengthening of equitable interventions focusing on nutrition on sub-populations in the country who suffer from a higher burden of stunting.