Socioeconomic inequalities in early childhood malnutrition and morbidity: modification of the household-level effects by the community SES
Section snippets
Background
Malnutrition and infectious diseases among preschoolers feature prominently among the major public health concerns in developing countries (UNICEF, 1998; WHO, 1999; Kuate-Defo, 2001). Childhood malnutrition is widespread and is associated with increased susceptibility to disease and risk of mortality, and with poor mental development and learning ability. There is also a growing evidence of reduced work efficiency and poor reproductive outcomes among individuals who experienced persistent
Conceptual framework
Along the lines of Mosley and Chen (1984) and UNICEF (1990) frameworks, we postulate that socioeconomic factors at different levels (community, family) operate through more proximate determinants to influence child's nutritional and morbid statuses, as depicted in Fig. 1. These factors include: (i) household size and composition that may be measured by both the total number of its members and especially those under 5 years of age as well as the gender composition of the household; (ii) access
Data
To achieve the objectives of this study, we use data from the Demographic and Health Surveys (DHS) of five African countries which have carried out more than one DHS in the 90s: Burkina Faso (1992/93, 1998/99); Cameroon (1991, 1998); Egypt (1992, 2000); Kenya (1993, 1998) and Zimbabwe (1994, 1999). The selected countries exhibit quite different socioeconomic and demographic profiles, with Burkina Faso being one of the least developed country and Egypt by contrast, one of the most affluent.
Results
For descriptive analyses, Fig. 2, Fig. 3, Fig. 4 display the association between SES and childhood malnutrition and diarrhea morbidity in the DHS-1; Fig. 5 shows the prevalence of the three outcomes, and Fig. 6, Fig. 8 illustrate the socioeconomic inequalities in child health. Results of multivariate analyses are in Table 1 (stunting), Table 2 (underweight), Table 3 (diarrhea), Table 4 (stunting diarrhea) and Table 5 (underweight diarrhea), whilst conditional effects are in Table 6 (household
Summary and discussion
This paper has examined the clustering of, and socioeconomic inequalities in, childhood malnutrition and morbidity among communities and families in Africa. Its novelty is to define and use more standardized measures of the SES within a multilevel framework; to model the co-occurrence of malnutrition and morbidity; and to demonstrate the ways in which interaction between family and community characteristics on child health can be comprehensively considered in the case of continuous measures. In
Acknowledgements
This study was supported by a doctoral fellowship in the social science awarded to Jean-Christophe Fotso by the Population Council. Its topic emerged during a seminar at the Population Reference Bureau (PRB) in July 2003. We thank the reviewers for their comments.
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