Wealth-related inequalities in undernutrition among under-five children in sub-Saharan Africa

Abstract 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...

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Main Authors: Rahel Mulatie Anteneh, Natnael Moges, Asaye Alamneh Gebeyehu, Denekew Tenaw Anley, Ermias Sisay Chanie, Sintayehu Simie Tsega, Ermiyas Alemayehu, Melaku Ashagrie Belete, Natnael Kebede, Zufan Alamrie Asmare, Matyas Adugna, Zekaryas Ewnetu Gashu, Anteneh Mengist Dessie, Melkamu Aderajew Zemene
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Language:English
Published: Nature Portfolio 2025-05-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-01842-1
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author Rahel Mulatie Anteneh
Natnael Moges
Asaye Alamneh Gebeyehu
Denekew Tenaw Anley
Ermias Sisay Chanie
Sintayehu Simie Tsega
Ermiyas Alemayehu
Melaku Ashagrie Belete
Natnael Kebede
Zufan Alamrie Asmare
Matyas Adugna
Zekaryas Ewnetu Gashu
Anteneh Mengist Dessie
Melkamu Aderajew Zemene
author_facet Rahel Mulatie Anteneh
Natnael Moges
Asaye Alamneh Gebeyehu
Denekew Tenaw Anley
Ermias Sisay Chanie
Sintayehu Simie Tsega
Ermiyas Alemayehu
Melaku Ashagrie Belete
Natnael Kebede
Zufan Alamrie Asmare
Matyas Adugna
Zekaryas Ewnetu Gashu
Anteneh Mengist Dessie
Melkamu Aderajew Zemene
author_sort Rahel Mulatie Anteneh
collection DOAJ
description Abstract 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 (I2 = 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.
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spelling doaj-art-4d8d303a60b345fa8b0ac921370e52ca2025-08-20T02:00:12ZengNature PortfolioScientific Reports2045-23222025-05-0115111410.1038/s41598-025-01842-1Wealth-related inequalities in undernutrition among under-five children in sub-Saharan AfricaRahel Mulatie Anteneh0Natnael Moges1Asaye Alamneh Gebeyehu2Denekew Tenaw Anley3Ermias Sisay Chanie4Sintayehu Simie Tsega5Ermiyas Alemayehu6Melaku Ashagrie Belete7Natnael Kebede8Zufan Alamrie Asmare9Matyas Adugna10Zekaryas Ewnetu Gashu11Anteneh Mengist Dessie12Melkamu Aderajew Zemene13Department of Public Health, College of Health Sciences, Debre Tabor UniversityDepartment of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor UniversityDepartment of Public Health, College of Health Sciences, Debre Tabor UniversityDepartment of Public Health, College of Health Sciences, Debre Tabor UniversityDepartment of Pediatric and Child Health, Debre Tabor UniversityDepartment of Medical Nursing, School of Nursing, College of Medicine and Health Science, University of GondarDepartment of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo UniversityDepartment of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo UniversityDepartment of Health Promotion, School of Public Health, College of Medicine Health Sciences, Wollo UniversityDepartment of Ophthalmology, School of Medicine and Health Science, Debre Tabor UniversityDepartment of Neurology, College of Medicine and Health Science, Bahir Dar UniversityDepartment of pediatrics and child health, School of medicine, College of Medicine and Health Science, University of GondarDepartment of Public Health, College of Health Sciences, Debre Tabor UniversityDepartment of Public Health, College of Health Sciences, Debre Tabor UniversityAbstract 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 (I2 = 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.https://doi.org/10.1038/s41598-025-01842-1UndernutritionWealth inequalityUnder-five childrenSSA
spellingShingle Rahel Mulatie Anteneh
Natnael Moges
Asaye Alamneh Gebeyehu
Denekew Tenaw Anley
Ermias Sisay Chanie
Sintayehu Simie Tsega
Ermiyas Alemayehu
Melaku Ashagrie Belete
Natnael Kebede
Zufan Alamrie Asmare
Matyas Adugna
Zekaryas Ewnetu Gashu
Anteneh Mengist Dessie
Melkamu Aderajew Zemene
Wealth-related inequalities in undernutrition among under-five children in sub-Saharan Africa
Scientific Reports
Undernutrition
Wealth inequality
Under-five children
SSA
title Wealth-related inequalities in undernutrition among under-five children in sub-Saharan Africa
title_full Wealth-related inequalities in undernutrition among under-five children in sub-Saharan Africa
title_fullStr Wealth-related inequalities in undernutrition among under-five children in sub-Saharan Africa
title_full_unstemmed Wealth-related inequalities in undernutrition among under-five children in sub-Saharan Africa
title_short Wealth-related inequalities in undernutrition among under-five children in sub-Saharan Africa
title_sort wealth related inequalities in undernutrition among under five children in sub saharan africa
topic Undernutrition
Wealth inequality
Under-five children
SSA
url https://doi.org/10.1038/s41598-025-01842-1
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