Inequities in under-five child malnutrition in South Africa

International Journal for Equity in Health

Diane McIntyre¹  Eyob Zere¹ 

[1] Health Economics Unit, University of Cape Town, Cape Town, South Africa

关键词: South Africa;    concentration index;    socio-economic status;    under-five child malnutrition;    inequity;   

Others  :  1147975
DOI  :  10.1186/1475-9276-2-7

 received in 2003-05-19, accepted in 2003-09-11,  发布年份 2003

【 摘 要 】

Objectives

To assess and quantify the magnitude of inequalities in under-five child malnutrition, particularly those ascribable to socio-economic status and to consider the policy implications of these findings.

Methods

Data on 3765 under-five children were derived from the Living Standards and Development Survey. Household income, proxied by per capita household expenditure, was used as the main indicator of socio-economic status. Socio-economic inequality in malnutrition (stunting, underweight and wasting) was measured using the illness concentration index. The concentration index was calculated for the whole sample, as well as for different population groups, areas of residence (rural, urban and metropolitan) and for each province.

Results

Stunting was found to be the most prevalent form of malnutrition in South Africa. Consistent with expectation, the rate of stunting is observed to be the highest in the Eastern Cape and the Northern Province – provinces with the highest concentration of poverty. There are considerable pro-rich inequalities in the distribution of stunting and underweight. However, wasting does not manifest gradients related to socio-economic position. Among White children, no inequities are observed in all three forms of malnutrition. The highest pro-rich inequalities in stunting and underweight are found among Coloured children and metropolitan areas. There is a tendency for high pro-rich concentration indices in those provinces with relatively lower rates of stunting and underweight (Gauteng and the Western Cape).

Conclusion

There are significant differences in under-five child malnutrition (stunting and underweight) that favour the richest of society. These are unnecessary, avoidable and unjust. It is demonstrated that addressing such socio-economic gradients in ill-health, which perpetuate inequalities in the future adult population requires a sound evidence base. Reliance on global averages alone can be misleading. Thus there is a need for evaluating policies not only in terms of improvements in averages, but also improvements in distribution. Furthermore, addressing problems of stunting and underweight, which are found to be responsive to improvements in household income status, requires initiatives that transcend the medical arena.

【 授权许可】

   
2003 Zere and McIntyre; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 图 表 】

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【 参考文献 】

• [1]Wagstaff A: Socioeconomic inequalities in child mortality: Comparisons across nine developing countries. Bulletin of the World Health Organization 2000, 78(1):19-29.
• [2]Gwatkin DR: Health inequalities and the health of the poor: What do we know? What can we do? Bulletin of the World Health Organization 2000, 78(1):3-18.
• [3]Brockerhoff M, Hewett P: Inequality in child mortality among ethnic groups in sub-Saharan Africa. Bulletin of the World Health Orgaization 2000, 78(1):30-41.
• [4]Gilson L, McIntyre D: South Africa: Addressing the legacy of apartheid. In Challenging inequities in health: From ethics to action. Edited by Evans T, Whitehead M, Diderichsen F, Bhuiya A, Wirth M. New York: Oxford University Press; 2001:190-209.
• [5]Thomas D, Strauss J, Henriques MH: Child survival, height for age and household characteristics in Brazil. Journal of Development Economics 1990, 33:197-234.
• [6]Pelletier DL, Frongillo EA, Schroeder DG, Habicht JP: The effects of malnutrition on child mortality in developing countries. Bulletin of the World Health Organization 1995, 73(4):443-448.
• [7]Svedberg P: Undernutrition in Sub-Saharan Africa: A critical assessment of the evidence. World Institute for Development Economics Research, Working Paper No. 15. Helsinki: UNU/WIDER 1987.
• [8]Nemer L, Gelband H, Jha P: The Evidence Base for Interventions to Reduce Malnutrition in Children Under Five and School-age Children in Low and Middle-income Countries. Commission on Macro-economics and Health, CMH Working Paper Series, Paper No. WG5:11. Geneva: WHO 2001.
• [9]Cravioto J, Arrieta R: Nutrition, mental development and learning. In in Human growth: A comprehensive treatise.. Volume 3. Edited by Falkner F, Tanner J. New York: Plenum Press; 1986::2/e.
• [10]World Health Organization: Physical status: the use and interpretation of anthropometry. Technical Report Series No. 854. Geneva: WHO 1995.
• [11]Braveman P: Monitoring equity in health: A policy-oriented approach in low- and middle-income countries. WHO/CHS/HSS/98.1, Equity Initiative Paper No. 3. Geneva: World Health Organization 1998.
• [12]Makinen M, Waters H, Rauch M, et al.: Inequalities in health care use and expenditures: Empirical data from eight developing countries and countries in transition. Bulletin of the World Health Organization 2000, 78(1):55-65.
• [13]de Onis M: Measuring nutritional status in relation to mortality. Bulletin of the World Health Organization 2000, 78(10):1271-1280.
• [14]WHO Working Group: Use and interpretation of anthropometric indicators on nutritional status. Bulletin of the World Health Organization 1986, 64(6):929-941.
• [15]Skoufias E: Determinants of child health during the economic transition in Romania. World Development 1998, 26(11):2045-2056.
• [16]Alberts JF, Sanderman R, Eimers MJ, van Den Heuvel WJA: Socioeconomic inequity in health care: A study of service utilization in Curaçao. Social Science and Medicine 1997, 45(2):213-220.
• [17]Glewwe P: Investigating the determinants of household welfare in Côte d' Ivoire. Journal of Development Economics 1991, 35:307-337.
• [18]Pal S: An analysis of childhood malnutrition in rural India: Role of gender, income and other household characteristics. World Development 1999, 27(7):1151-1171.
• [19]Wagstaff A, Paci P, van Doorslaer E: On the measurement of inequalities in health. Social Science and Medicine 1991, 33(5):545-557.
• [20]Kakwani N, Wagstaff A, van Doorslaer E: Socioeconomic inequalities in health: Measurement, computation and statistical inference. Journal of Econometrics 1997, 77:87-103.
• [21]World Health Organization: The World Health Report 1999. Geneva: WHO 1999.
• [22]Health Systems Trust: South African Health Review 1998. Durban: Health Systems Trust 1999.
• [23]de Onis M, Frongillo EA, Blossner M: Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980. Bulletin of the World Health Organization 2000, 78(10):1222-1233.
• [24]de Onis M, Monteiro C, Akre J, Clugston G: The worldwide magnitude of protein-energy malnutrition: An overview from WHO global database on child growth. Bulletin of the World Health Organization 1993, 71(6):703-712.
• [25]Sahn DE: The contribution of income to improved nutrition in Côte d'Ivoire. Journal of African Economies 1994, 3(1):29-61.
• [26]World Bank: World Development Report 1981. Washington: World Bank 1981.
• [27]Duflo E: Child health and household resources in South Africa: Evidence from the old age pension programme. The American Economic Review 2000, 90(2):393-398.
• [28]Behrman J, Hoddinott J: An Evaluation of the impact ofPROGRESA on pre-school child height. Washington DC: International Food Policy Research Institute. Mimeo 2000.
• [29]Basta SS: Nutrition and health in low-income urban areas of the third world. Ecology of Food and Nutrition 1977, 6:113-124.
• [30]Bradley D, Stephens C, Harpham T, Cairncross S: A review of environmental health impacts in developing country cities. Washington DC: The World Bank 1992.
• [31]Haddad L, Ruel MT, Garrett JL: Are urban poverty and undernutrition growing? Some newly assembled evidence. World Development 1999, 27(11):1891-1904.
• [32]Menon P, Ruel MT, Morris S: Socioeconomic differentials in child stunting are consistently larger in urban than in rural areas. FCND Discussion Paper No.97. Washington DC: International Food Policy Research Institute 2000.
• [33]Statistics South Africa: The people of South Africa, Population census 1996: Census in brief. Pretoria: Statistics South Africa 1998.
• [34]Reconstruction and Development Programme: Key indicators of poverty in South Africa. Pretoria: RDP 1995.