Malnutrition and the disproportional burden on the poor: the case of Ghana

Abstract

Background: Malnutrition is a major public health and development concern in the developing world and in poor communities within these regions. Understanding the nature and determinants of socioeconomic inequality in malnutrition is essential in contemplating the health of populations in developing countries and in targeting resources appropriately to raise the health of the poor and most vulnerable groups.

Methods: This paper uses a concentration index to summarize inequality in children's height-for-age z-scores in Ghana across the entire socioeconomic distribution and decomposes this inequality into different contributing factors. Data is used from the Ghana 2003 Demographic and Health Survey.

Results: The results show that malnutrition is related to poverty, maternal education, health care and family planning and regional characteristics. Socioeconomic inequality in malnutrition is mainly associated with poverty, health care use and regional disparities. Although average malnutrition is higher using the new growth standards recently released by the World Health Organization, socioeconomic inequality and the associated factors are robust to the change of reference population.

Conclusion: Child malnutrition in Ghana is a multisectoral problem. The factors associated with average malnutrition rates are not necessarily the same as those associated with socioeconomic inequality in malnutrition.

Figure 1

Distribution of stunting across wealth quintiles.

Figure 2

Average stunting versus socioeconomic inequality in stunting in under-five children in Sub-Saharan Africa. Data from recent Demographic Health surveys. Stunting is measured using the WHO child growth standards. Concentration index as suggested by [40] is used since it is invariant to the mean of the binary variable.

Figure 3

Inequality in stunting by regions (A) and grouped regions (B) (as in [55]).