Temporal socio-economic inequalities in the double burden of malnutrition (DBM) among under-five Children: An analysis of within- and between-group disparities in 20 sub-Saharan African countries (2004–2024)

Akim Tafadzwa Lukwa; Denis Okova; Paidamoyo Bodzo; Sikelela Charles Maseko; Melisa Bhebe; Folahanmi Tomiwa Akinsolu; Abodunrin Olunike; Emmanuella Nzeribe; Aggrey Siya; Admire Nyabunze; Charles Hongoro; Plaxcedes Chiwire

doi:10.1016/j.glt.2025.04.008

Global Transitions (Jan 2025)

Temporal socio-economic inequalities in the double burden of malnutrition (DBM) among under-five Children: An analysis of within- and between-group disparities in 20 sub-Saharan African countries (2004–2024)

Akim Tafadzwa Lukwa,
Denis Okova,
Paidamoyo Bodzo,
Sikelela Charles Maseko,
Melisa Bhebe,
Folahanmi Tomiwa Akinsolu,
Abodunrin Olunike,
Emmanuella Nzeribe,
Aggrey Siya,
Admire Nyabunze,
Charles Hongoro,
Plaxcedes Chiwire

Affiliations

Akim Tafadzwa Lukwa: Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Family Medicine, Family, Community and Emergency Care (FaCE), Faculty of Health Sciences, University of Cape Town, South Africa; Corresponding author. Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town. South Africa.
Denis Okova: Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Corresponding author.
Paidamoyo Bodzo: Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
Sikelela Charles Maseko: Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
Melisa Bhebe: Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
Folahanmi Tomiwa Akinsolu: Center for Reproduction and Population Health Studies (CeRPHS), Nigerian Institute of Medical Research, Lagos, Nigeria; Department of Public Health, Faculty of Basic Medical and Health Sciences, Lead City University, Ibadan, Oyo State, Nigeria
Abodunrin Olunike: Center for Reproduction and Population Health Studies (CeRPHS), Nigerian Institute of Medical Research, Lagos, Nigeria; Department of Biostatistics and Epidemiology, Nanjing Medical University, Jiangning District, Nanjing, Jiangsu 211166, PR China
Emmanuella Nzeribe: Sydani Institute for research and Innovation, Sydani Group, Plot 1422 Independence Avenue, Central Business District, Abuja, Nigeria
Aggrey Siya: Uganda Wildlife Research and Training Institute, P.O. Box 173, Kasese, Uganda; Makerere University School of Public Health, P.O. Box 7062, Kampala Uganda
Admire Nyabunze: Zimbabwe National Statistics Agency, Statistician (Macroeconomics Division), Kaguvi Building, Cnr Central Avenue/Fourth Street, Causeway, P.O. Box CY 342, Harare, Zimbabwe
Charles Hongoro: Developmental, Capable and Ethical State, Human Sciences Research Council, Pretoria, 0001, Gauteng Province, South Africa; School of Health Systems and Public Health (SHSPH), Faculty of Health Sciences, University of Pretoria, Pretoria, 0028, Gauteng Province, South Africa
Plaxcedes Chiwire: Western Cape Department: Health, Western Cape Province, P.O. Box 2060, Cape Town, 8000, South Africa; Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD, Maastricht, the Netherlands

DOI: https://doi.org/10.1016/j.glt.2025.04.008
Journal volume & issue: Vol. 7
pp. 262 – 275

Abstract

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Background: The double burden of malnutrition (DBM) in sub-Saharan Africa is a pressing public health issue, particularly among children under five years old. DBM encompasses both undernutrition (stunting) and overnutrition (overweight) within the same population, often shaped by socio-economic disparities. Addressing DBM in early childhood is vital, as malnutrition can lead to long-term health, cognitive, and developmental challenges. Methods: Using nationally representative data from the Demographic and Health Surveys (DHS) across 20 sub-Saharan African countries, this study examines temporal socio-economic inequalities in DBM. Countries include Zimbabwe, Kenya, Nigeria, and Mozambique, among others. DBM was defined using anthropometric measures, while socio-economic status (SES) was categorized as poor, middle, or rich. Temporal trends were analyzed, and inequalities were quantified using Erreygers Normalized Concentration Indices (ENCI) and Theil indices to explore within- and between-group disparities by SES and urban/rural residence. Results: DBM prevalence across countries ranged from 0.2 % to 4.6 %. Declines were noted in Zimbabwe and Kenya. Socio-economic inequalities were significant, with overnutrition increasingly concentrated in wealthier households, while undernutrition remained prevalent among poorer populations. Theil index analyses revealed within-group disparities as the primary drivers of overall inequality, particularly in urban wealthier populations, though rural and low-SES groups also contributed significantly in countries like Senegal and Mali. Conclusion: DBM is still present in sub-Saharan Africa and is driven by socio-economic inequalities. Targeted interventions focusing on improving access to nutritious food, healthcare, and education for vulnerable populations, particularly in rural and low-SES groups, are essential to reduce malnutrition disparities.

Published in Global Transitions

ISSN: 2589-7918 (Online)
Publisher: KeAi Communications Co., Ltd.
Country of publisher: China
LCC subjects: Technology; Medicine
Website: https://www.keaipublishing.com/en/journals/global-transitions/

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