Shewarega Ever Siyoum, Tebeje Tsion Mulat, Alem Makida Berhan, Assres Mulugeta Lulie, Fentie Elsa Awoke
Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia.
School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia.
BMC Public Health. 2025 Apr 25;25(1):1549. doi: 10.1186/s12889-025-22807-z.
Adolescent undernutrition is a key factor influencing health outcomes. An undernourished adolescent girl who begins pregnancy with inadequate nutrient reserves often delivers low birth weight or growth-restricted infants, who is more prone to metabolic disorders in adulthood and faces higher risks of infant mortality and lower chances of survival. There is limited information on socioeconomic inequality in undernutrition among late female adolescent girls in sub-Saharan Africa. Therefore, this study aimed to assess the presence of socioeconomic inequality in undernutrition and its contributors in sub-Saharan African countries.
This study was based on recent Demographic and Health Survey of 30 Sub-Saharan African countries from 2010 to 2020. A total weighted sample of 45,598 late female adolescents was included. The Erreygers normalized concentration index and its concentration curve were applied to assess socioeconomic-related inequality in undernutrition. Decomposition analysis was conducted to identify factors contributing to socioeconomic related inequality.
The weighted Erreygers normalized concentration index for undernutrition was - 0.070 with Standard error = 0.0053 (P value < 0.0001); this revealed that undernutrition was disproportionately concentrated among the poor (pro-poor). The weighted ECI values for each country ranged from - 0.0356 in Liberia to -0.1981 in Burkina Faso, with Kenya (-0.1343), Namibia (-0.1207), and Nigeria (-0.1161) exhibiting the highest levels of inequality after Burkina Faso. The decomposition analysis revealed that wealth index (62.79%), educational level (55.84%), media exposure (40.53%) and place of residence (17.00%) were the major contributors for the pro-poor socioeconomic inequalities in undernutrition.
This study revealed a small but statistically significant pro-poor inequality in undernutrition among late female adolescents. Therefore, interventions should be prioritized in countries with high pro-poor inequality in undernutrition, such as Burkina Faso, Kenya, Nigeria, Namibia, and Burundi. Targeting disadvantaged late female adolescents in these countries through measures like women's economic empowerment and mass media awareness campaigns can help reduce these inequalities and contribute to achieving universal health coverage.
青少年营养不良是影响健康结果的关键因素。营养储备不足的青春期少女怀孕后，往往会产下低体重或生长受限的婴儿，这些婴儿成年后更容易患代谢紊乱疾病，面临更高的婴儿死亡率和更低的生存几率。关于撒哈拉以南非洲地区大龄少女营养不良方面的社会经济不平等信息有限。因此，本研究旨在评估撒哈拉以南非洲国家营养不良方面社会经济不平等的存在情况及其影响因素。
本研究基于2010年至2020年对30个撒哈拉以南非洲国家最近的人口与健康调查。共纳入45598名大龄少女的加权样本。应用埃雷格斯标准化浓度指数及其浓度曲线来评估营养不良方面与社会经济相关的不平等。进行分解分析以确定导致与社会经济相关不平等的因素。
营养不良的加权埃雷格斯标准化浓度指数为-0.070，标准误差=0.0053（P值<0.0001）；这表明营养不良在贫困人口中分布不均（有利于穷人）。每个国家的加权ECI值范围从利比里亚的-0.0356到布基纳法索的-0.1981，布基纳法索之后，肯尼亚（-0.1343）、纳米比亚（-0.1207）和尼日利亚（-0.1161）的不平等程度最高。分解分析表明，财富指数（62.79%）、教育水平（55.84%）、媒体接触（40.53%）和居住地点（17.00%）是营养不良方面有利于穷人的社会经济不平等的主要影响因素。
本研究揭示了大龄少女营养不良方面存在虽小但在统计学上有显著意义的有利于穷人的不平等。因此，对于营养不良方面有利于穷人的不平等程度较高的国家，如布基纳法索、肯尼亚、尼日利亚、纳米比亚和布隆迪，应优先开展干预措施。通过妇女经济赋权和大众媒体宣传活动等措施，针对这些国家处于不利地位的大龄少女，可以帮助减少这些不平等现象，并有助于实现全民健康覆盖。
