Osborne Augustus, Bangura Camilla, Sesay Umaru, Ahinkorah Bright Opoku
Department of Biological Sciences, School of Basic Sciences, Njala University, PMB, Freetown, Sierra Leone.
Sierra Leone Field Epidemiology Training Program, National Public Health Agency, Freetown, Sierra Leone.
Int J Equity Health. 2025 Jun 10;24(1):168. doi: 10.1186/s12939-025-02519-x.
Stunting and underweight remain significant public health issues in many low- and middle-income countries, including Ghana. This study examined the trends and inequalities in stunting and underweight among children aged 0–59 months in Ghana between 1993 and 2022.
We utilised data from the Ghana Demographic Health Survey rounds conducted between 1993 and 2022, among mothers of children aged 0–59 months. The World Health Organisation Health Equity Assessment Toolkit software was used to calculate various inequality measures, including Difference (D), Ratio (R), Population Attributable Risk (PAR), and Population Attributable Fraction (PAR). An inequality assessment was conducted for six stratifiers: child’s age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national region.
Stunting and underweight prevalence among children aged 0–59 months in Ghana both declined between 1993 and 2022, with stunting decreasing from 32.7 to 17.3% and underweight decreasing from 24.5 to 11.9%. Regarding children’s age, between 1998 and 2022, the difference in stunting prevalence between older children and younger children decreased from -29.5 to -0.9 percentage points, and underweight rates from -10.0 to -2.6 percentage points, indicating reduction in inequality. Economically, the disparity in stunting between children of the richest and poorest mothers declined from 27.2 to 15.3 percentage points, and underweight from 19.6 to 8.3 percentage points by 2022, highlighting reduction in inequality. With educational level, the stunting gap between children of mothers with high and low education reduced from 24.7 in 1993 to 10.5 percentage points in 2022, while underweight decreased from 23.3 to 5.6 percentage points between the same period, suggesting a reduction of inequality in stunting and underweight between of higher educated mothers and those of mothers with no formal education. Regarding place of residence, the difference between children from urban areas and those from rural areas decreased from 15.3 percentage points in 1993 to 4.5 percentage points for stunting in 2022, and from 11.8 percentage points in 1993 to 2.2 percentage points for underweight in 2022, indicating reduction in inequality. Finally, the subnational region difference was 19.1 percentage points for stunting in 2022, and 12.0 percentage points for underweight in 2022, revealing reduced regional disparities in both stunting and underweight rates among regions.
Our findings on stunting and underweight prevalence among children aged 0–59 months in Ghana from 1993 to 2022 underscore notable progress and persistent inequalities. The inequalities observed across dimensions such as economic status, maternal education, and geographic region indicate the multifaceted nature of stunting and underweight. This situation calls for a continued concerted effort by Government and partner organisations in Ghana to address the underlying socioeconomic determinants of stunting and underweight, aligning with global commitments such as the Sustainable Development Goals.
发育迟缓与体重不足在包括加纳在内的许多低收入和中等收入国家仍是重大的公共卫生问题。本研究调查了1993年至2022年间加纳0至59个月儿童发育迟缓和体重不足的趋势及不平等情况。
我们利用了1993年至2022年间对0至59个月儿童的母亲进行的加纳人口与健康调查轮次的数据。使用世界卫生组织健康公平评估工具包软件来计算各种不平等指标，包括差异（D）、比率（R）、人群归因风险（PAR）和人群归因分数（PAR）。对六个分层因素进行了不平等评估：儿童年龄、母亲经济状况、母亲教育水平、居住地点、儿童性别和国家以下区域。
1993年至2022年间，加纳0至59个月儿童的发育迟缓和体重不足患病率均有所下降，发育迟缓率从32.7%降至17.3%，体重不足率从24.5%降至11.9%。关于儿童年龄，1998年至2022年间，大龄儿童与小龄儿童发育迟缓患病率的差异从-29.5个百分点降至-0.9个百分点，体重不足率从-10.0个百分点降至-2.6个百分点，表明不平等程度降低。在经济方面，到2022年，最富有母亲的孩子与最贫穷母亲的孩子之间发育迟缓的差距从27.2个百分点降至15.3个百分点，体重不足的差距从19.6个百分点降至8.3个百分点，突出了不平等程度的降低。就教育水平而言，母亲受高等教育的孩子与母亲未接受正规教育的孩子之间发育迟缓的差距从1993年的24.7个百分点降至2022年的10.5个百分点，而体重不足在同一时期从23.3个百分点降至5.6个百分点，表明受过高等教育的母亲与未接受正规教育的母亲的孩子在发育迟缓和体重不足方面的不平等有所减少。关于居住地点，城市地区儿童与农村地区儿童之间的差异，发育迟缓从1993年的15.3个百分点降至2022年的4.5个百分点，体重不足从1993年的11.8个百分点降至2022年的2.2个百分点，表明不平等程度降低。最后，2022年国家以下区域发育迟缓的差异为19.1个百分点，体重不足的差异为12.0个百分点，显示出各区域在发育迟缓和体重不足率方面的区域差距有所缩小。
我们关于1993年至2022年间加纳0至59个月儿童发育迟缓和体重不足患病率的研究结果强调了显著进展和持续存在的不平等。在经济状况、母亲教育程度和地理区域等多个方面观察到的不平等表明了发育迟缓和体重不足的多面性。这种情况要求加纳政府和伙伴组织继续共同努力，解决发育迟缓和体重不足的潜在社会经济决定因素，与可持续发展目标等全球承诺保持一致。
