Prevalence and Socioeconomic inequalities trends in child health comparing within and between group inequalities: Food insecurity and malnutrition in Zimbabwe

Abstract

BackgroundInequalities in child health remain a threat to this global efforts to achieve universal health coverage. We assessed socioeconomic inequalities in child health focusing on malnutrition and food insecurity in Zimbabwe.MethodsWe used Demographic Health Survey (DHS) data sets of 2010\11 and 2015. Food insecurity in children was determined based on the WHO dietary diversity score. Minimum dietary diversity was defined by a cut- off point of >4 therefore, in this study children with less than 3 of the 13 food groups were defined as food insecure. Malnutrition was assessed using weight for age Z-score, with children whose weight-for-age Z-score below minus two standard deviations (-2 SD) from the median considered malnourished. Concentration indices were computed to understand if malnutrition was dominant among the poor or rich. The study used the Theil index and decomposed the index by population subgroups (geographical clusters and socioeconomic status).ResultsOver the study period, malnutrition prevalence increased by 1.03 percentage points (p.p) [2010/11(3.73%); 2015(4.76%)], while food insecurity prevalence decreased by 4.35p.p [2010/11(78.29%);2015(73.94)]. Prevalence of malnutrition and food insecurity increased by; 9.6p.p and 2p.p among poor children & 10.23p.p and 0.5p.p among rural children. Children from wealthy households were more likely to be food secure and children from poor households were more likely to be nutritious. For nutrition status, socioeconomic inequality gaps appeared to be widening as the concentration indices between the two time periods increased, while for food security status socioeconomic inequality gaps appeared to be contracting as the concentration indices between the two time periods reduced. Food security status showed contracting socioeconomic inequality gaps in both geographical clusters (urban & rural), while for nutrition status there were widening socioeconomic inequality gaps among urban children and contracting socioeconomic inequality gaps among rural children.ConclusionWithin-group inequalities are driving most of the socioeconomic inequalities in nutritional status and food security status among children in Zimbabwe. There is need for policies that focus on addressing within-group inequalities and direct food security interventions for food insecure children through availing food aid parcels especially for children from poor households irrespective of where they reside.

Leaving No Child Behind: Decomposing Socioeconomic Inequalities in Child Health for India and South Africa

“…Our study also reported high food insecurity prevalence among poor rural nourished children whose mothers had attained at least secondary education for both countries. The observed disproportionate health inequalities reported in India and argue that, even though children were receiving nutritious food, challenges in food access were being experienced; this was also observed in other studies [35,58,62,63]. Computed concentration curves for food security status in India and South Africa were all negative, indicating that children from wealthy households were food secure, concurring with findings in the literature [7,22,29,32,37,58,[62][63][64][65][66].…”

“…The observed disproportionate health inequalities reported in India and argue that, even though children were receiving nutritious food, challenges in food access were being experienced; this was also observed in other studies [35,58,62,63]. Computed concentration curves for food security status in India and South Africa were all negative, indicating that children from wealthy households were food secure, concurring with findings in the literature [7,22,29,32,37,58,[62][63][64][65][66]. The differences between quantity and quality dietary intake among children have been widely documented in literature [7,[64][65][66][67].…”

“…Our study observed similar findings in both countries as food-insecure children accounted for the biggest proportions of malnourished children. However, it was only India's results on food insecurity and malnutrition that confirmed the generalized hypothesized argument in literature, that food insecurity and malnutrition are more dominant in the peri-urban and rural locations [7,[15][16][17][22][23][24]29,32,34,35,37,58,62,63,[65][66][67][68][69].…”

“…If perfect health equality exists, the concentration curve will be a 45-degree d line (line of equality); thus, the share of immunization coverage, food insecurity a nutrition will exactly match the share of children belonging to each wealth rank the health inequalities are dominant among the poor, the concentration curve wi low the line of equality, and if dominant among the rich, the curve will lie above of equality. The further the concentration curve lies from the equality line, the gre health inequality [58].…”

“…When the health inequalities are dominant among the poor, the concentration curve will lie below the line of equality, and if dominant among the rich, the curve will lie above the line of equality. The further the concentration curve lies from the equality line, the greater the health inequality [58].…”