Anteneh Rahel Mulatie, Moges Natnael, Gebeyehu Asaye Alamneh, Anley Denekew Tenaw, Chanie Ermias Sisay, Tsega Sintayehu Simie, Alemayehu Ermiyas, Belete Melaku Ashagrie, Kebede Natnael, Asmare Zufan Alamrie, Adugna Matyas, Gashu Zekaryas Ewnetu, Dessie Anteneh Mengist, Zemene Melkamu Aderajew
Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
Sci Rep. 2025 May 30;15(1):19010. doi: 10.1038/s41598-025-01842-1.
Undernutrition among under five children is a significant public health concern and a key factor in child mortality in developing nations. Addressing early childhood health disparities requires increased focus, as these issues are likely to persist into adulthood. This study examined wealth based inequalities in under-five undernutrition across 35 sub-Saharan African countries. This study utilized a total of 202,290 weighted samples from Demographic and Health Survey datasets across 35 sub-Saharan African countries. Data cleaning was performed using MS Excel, followed by extraction and analysis with STATA V.17 software. To assess wealth-related inequalities in undernutrition, the concentration index and curve, along with Wagstaff decomposition analysis, were employed. A p value of less than 0.05 was considered statistically significant. The overall pooled prevalence of undernutrition among children under five in sub-Saharan Africa was found to be 35.5% (95% CI 32.08, 38.88%), with a high heterogeneity (I = 99.9%). Prevalence rates varied significantly, ranging from 17.25% in Gabon to 58.57% in Burundi. The concentration index for wealth-related inequality in undernutrition indicated a pro-poor distribution, with a value of CI - 0.1719 (95% CI - 0.179, - 0.165) and a standard error of 0.0037 (p value < 0.0001). The decomposition analysis revealed that factors such as media exposure, access to improved water sources, improved toilet facilities, and maternal education were inversely associated with undernutrition. In contrast, living in rural areas and maternal occupation showed a positive association with undernutrition. Wealth related disparities to undernutrition showed a trend that favored poorer populations. Individuals from lower socioeconomic backgrounds were more likely to experience undernutrition compared to those from higher socioeconomic groups. Key factors contributing to wealth-related inequalities in child undernutrition included media exposure, place of residence, and access to sanitation facilities. The persistence of these inequalities highlights a significant social injustice. To effectively reduce these disparities, it is essential to implement integrated interventions during early life that address the multiple challenges faced by disadvantaged children. Therefore, policies should take into account the distribution of childhood undernutrition across all socioeconomic groups.
五岁以下儿童营养不良是一个重大的公共卫生问题，也是发展中国家儿童死亡率的一个关键因素。解决幼儿健康差距问题需要更多关注，因为这些问题可能会持续到成年。本研究调查了撒哈拉以南非洲35个国家五岁以下儿童营养不良方面基于财富的不平等情况。本研究使用了来自撒哈拉以南非洲35个国家人口与健康调查数据集的总共202,290个加权样本。数据清理使用MS Excel进行，随后使用STATA V.17软件进行提取和分析。为了评估营养不良方面与财富相关的不平等情况，采用了集中指数和曲线以及瓦格斯塔夫分解分析。p值小于0.05被认为具有统计学意义。撒哈拉以南非洲五岁以下儿童营养不良的总体合并患病率为35.5%（95%置信区间32.08, 38.88%），异质性较高（I = 99.9%）。患病率差异显著，从加蓬的17.25%到布隆迪的58.57%不等。营养不良方面与财富相关不平等的集中指数表明是有利于穷人的分布，值为CI -0.1719（95%置信区间 -0.179, -0.165），标准误差为0.0037（p值<0.0001）。分解分析表明，媒体接触、获得改善的水源、改善的卫生设施和母亲教育等因素与营养不良呈负相关。相比之下，生活在农村地区和母亲职业与营养不良呈正相关。与财富相关的营养不良差距呈现出有利于较贫困人群的趋势。社会经济背景较低的个体比社会经济群体较高的个体更有可能经历营养不良。导致儿童营养不良方面与财富相关不平等的关键因素包括媒体接触、居住地点和获得卫生设施的情况。这些不平等的持续存在凸显了严重的社会不公。为了有效减少这些差距，在儿童早期实施综合干预措施以应对弱势儿童面临的多重挑战至关重要。因此，政策应考虑到所有社会经济群体中儿童营养不良的分布情况。
