Socioeconomic inequalities in food insecurity and malnutrition among under-five children: within and between-group inequalities in Zimbabwe.
BACKGROUND
Food insecurity and malnutrition in children are pervasive public health concerns in Zimbabwe. Previous studies only identified determinants of food insecurity and malnutrition with very little efforts done in assessing related inequalities and decomposing the inequalities across household characteristics in Zimbabwe. This study explored socioeconomic inequalities trend in child health using regression decomposition approach to compare within and between group inequalities.


METHODS
The study used Demographic Health Survey (DHS) data sets of 2010\11 and 2015. Food insecurity in under-five children was determined based on the WHO dietary diversity score. Minimum dietary diversity was defined by a cut- off point of > 4 therefore, children with at least 3 of the 13 food groups were defined as food insecure. Malnutrition was assessed using weight for age (both acute and chronic under-nutrition) Z-scores. Children whose weight-for-age Z-score below minus two standard deviations (- 2 SD) from the median were considered malnourished. Concentration curves and 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 (place of residence and socioeconomic status).


RESULTS
Over the study period, malnutrition prevalence increased by 1.03 percentage points, while food insecurity prevalence decreased by 4.35 percentage points. Prevalence of malnutrition and food insecurity increased among poor rural children. Theil indices for nutrition status showed socioeconomic inequality gaps to have widened, while food security status socioeconomic inequality gaps contracted for the period under review.


CONCLUSION
The study concluded that unequal distribution of household wealth and residence status play critical roles in driving socioeconomic inequalities in child food insecurity and malnutrition. Therefore, child food insecurity and malnutrition are greatly influenced by where a child lives (rural/urban) and parental wealth.
['Lukwa|Akim Tafadzwa|AT|http://orcid.org/0000-0003-2534-3731', 'Siya|Aggrey|A|', 'Zablon|Karen Nelwin|KN|', 'Azam|James Mba|JM|', 'Alaba|Olufunke A|OA|']
D000293:Adolescent D001837:Body Weights and Measures D002648:Child D015362:Child Nutrition Disorders D002675:Child, Preschool D004032:Diet D005260:Female D054624:Health Status Disparities D006306:Health Surveys D006801:Humans D008297:Male D044342:Malnutrition D009752:Nutritional Status D015995:Prevalence D012424:Rural Population D012923:Social Class D015030:Zimbabwe
Malnutrition in children Decomposing the Theil index Food insecurity in children Socioeconomic inequalities in children Under-five child health