Prevalence and Socioeconomic inequalities trends in child health comparing within and between group inequalities: Food insecurity and malnutrition in Zimbabwe

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Abstract BackgroundInequalities in child health remain a threat to this global efforts to achieve universal health coverage. We assessed socioeconomic inequalities in child health focusing on malnutrition and food insecurity in Zimbabwe.MethodsWe used Demographic Health Survey (DHS) data sets of 2010\11 and 2015. Food insecurity in children was determined based on the WHO dietary diversity score. Minimum dietary diversity was defined by a cut- off point of >4 therefore, in this study children with less than 3 of the 13 food groups were defined as food insecure. Malnutrition was assessed using weight for age Z-score, with children whose weight-for-age Z-score below minus two standard deviations (-2 SD) from the median considered malnourished. Concentration indices were computed to understand if malnutrition was dominant among the poor or rich. The study used the Theil index and decomposed the index by population subgroups (geographical clusters and socioeconomic status).ResultsOver the study period, malnutrition prevalence increased by 1.03 percentage points (p.p) [2010/11(3.73%); 2015(4.76%)], while food insecurity prevalence decreased by 4.35p.p [2010/11(78.29%);2015(73.94)]. Prevalence of malnutrition and food insecurity increased by; 9.6p.p and 2p.p among poor children & 10.23p.p and 0.5p.p among rural children. Children from wealthy households were more likely to be food secure and children from poor households were more likely to be nutritious. For nutrition status, socioeconomic inequality gaps appeared to be widening as the concentration indices between the two time periods increased, while for food security status socioeconomic inequality gaps appeared to be contracting as the concentration indices between the two time periods reduced. Food security status showed contracting socioeconomic inequality gaps in both geographical clusters (urban & rural), while for nutrition status there were widening socioeconomic inequality gaps among urban children and contracting socioeconomic inequality gaps among rural children.ConclusionWithin-group inequalities are driving most of the socioeconomic inequalities in nutritional status and food security status among children in Zimbabwe. There is need for policies that focus on addressing within-group inequalities and direct food security interventions for food insecure children through availing food aid parcels especially for children from poor households irrespective of where they reside.

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