Trends of wealth-related inequality in stunting and its contributing factors among under-five children in Ethiopia: Decomposing the concentration index using Ethiopian Demographic Health Surveys 2011-2019.

BACKGROUND

Childhood stunting is a critical public health agenda that affects physical and cognitive development, leading to long-term health problems. Understanding its wealth related trends and contributing factors is essential for effective prospective interventions. Therefore, this study is aimed to assess the trends of childhood stunting inequality using Ethiopian Demographic Health Surveys (EDHS).

METHODS

This study employed the three consecutive EDHS datasets collected in 2011, 2016, and 2019. Socioeconomic disparity of stunting among under-five children was estimated through concentration index (CIX). Moreover, Wagstaff approach was used to decompose the relative CIX to assess the contribution of explanatory variables for the overall wealth inequality in childhood stunting.

RESULTS

The overall weighted prevalence of childhood stunting in Ethiopia was 40.76% (95%CI: 40.14%, 41.37%). The trend in the magnitude of childhood stunting decreased from 44.52% in 2011 to 37.08% in 2019. The magnitude of childhood stunting was higher (14.30%) among the poorest households than the richest households (4.70%). Moreover, the CIX of wealth inequality decreased from -0.064 in 2011 to -0.089 in 2019. Wealth index(103.38%), place of residence(34.55%), mother's education(26.73%), place of delivery(12.16%) and utilization of recommended antenatal care(12.02%) were high contributor variables in increasing the inequality, whereas administrative regions (-7.15%) and number of under-five children in the household (-4.63%) were variables contributed in the reduction of wealth inequalities in childhood stunting.

CONCLUSION

This study revealed that children in the poorest households were more likely to experience childhood stunting than the children in the richest households. Factors such as wealth index, mothers education, place of residence, place of delivery, number of under-five children in the household were the contributing variables for the childhood stunting inequality. Therefore, the health decision makers better to improve the access and quality of nutritional services for the children in the poorest households in Ethiopia.