Inequalities in childhood stunting: evidence from Sudan multiple indicator cluster surveys (2010–2014)

Abstract

Background Leaving no one behind has been an important marker of the Sustainable Development Goals. Closing the gap in malnutrition between children of different backgrounds aligns well with the tenet of this international agenda. To this end, high-quality evidence of the magnitude and trends of socioeconomic and geographic related existing inequalities in the childhood stunting among Sudanese children emanate from this study help for policy maker and planners to design and implement effective interventions to narrow down inequality. Methods We used the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) for our analysis of stunting inequality. Following standard equity analysis methods recommended by the WHO, we performed the disaggregated analysis of stunting across five equity stratifiers: Wealth, education, residence, sex, and sub-national regions. Then, we summarized stunting inequality through four measures of inequality: Difference, Ratio, Slope Index of Inequality (SII), and Relative Index of Inequality (RII). The point estimates of stunting were accompanied by 95% confidence intervals to measure the statistical significance of the findings. Results In this study, the national average childhood stunting prevalence was increased by 4% from 2010 to 2014. The findings revealed stark inequalities in stunting in all the studied dimensions of inequality. Huge inequality has existed along the wealth quintiles. Simple difference measure for education was increased by four points and simple relative measure decreased by one point for economic status. Conclusions Sex, residence and, geographically related inequalities remain unchanged over time, while economic status and educational inequality had seen a change by some inequality measures over the same time period.

Factors associated with stunting in children under-5 in Sudan A secondary analysis of the second Sudan Household Health Survey, 2010

“…Our study found that the odds of children living in poorer households being stunted were signi cantly higher than those from richer households, a nding supporting that found in the literature [3,9,12,[37][38][39][40][41]. Evidence shows inter-country differences in levels of stunting along socioeconomic lines, with obvious disadvantages for children in lower wealth quintiles [9,12,41]. Gender differences and the effect of maternal education are also more visible in poorer households and provinces [3,12,39].…”

“…Poverty leads to diminished access to health care, exposure to contaminated environments from poor sanitation and hygiene leading to recurrent illnesses, poor child care practices and food insecurity, as well as being associated with inadequate nutrition and poor maternal education [1,[34][35][36]. Our study found that the odds of children living in poorer households being stunted were signi cantly higher than those from richer households, a nding supporting that found in the literature [3,9,12,[37][38][39][40][41]. Evidence shows inter-country differences in levels of stunting along socioeconomic lines, with obvious disadvantages for children in lower wealth quintiles [9,12,41].…”

“…While around 16% and 45% of all children live in low-income and lower-middle income countries, respectively, the former is home to 25% of stunted children and the latter has 59% of all children affected by stunting [6]. Even within countries, stunting follows socioeconomic lines in distribution, with poorer populations faring worse than richer populations, and studies show that countries implementing redistributive policies addressing elimination of hunger and poverty have reduced their stunting prevalence and narrowed this gap [7][8][9].…”

“…Existing literature on stunting in Sudan examines the issue mainly within the context of undernutrition in general, its prevalence in speci c areas in the country, nutritional factors associated with stunting and those associated with reversal of stunting, and the economic impact of undernutrition as a whole [9,21,[24][25][26][27][28][29][30]. This study aimed to examine factors associated with stunting in children under the age of ve in Sudan with a focus on socioeconomic factors utilizing the UNICEF framework for childhood undernutrition.…”

Mapping of national population-based surveys for better reporting of health-related indicators in the Eastern Mediterranean Region

“…One of the popular surveys in the regional countries is DHS/MICS [ 29 , 30 ]. Since there are many overlaps between HES and DHS/MICS, conducting both of these surveys in a country is not ideal.…”