Assessing socioeconomic inequalities in the reduction of child stunting in sub-Saharan Africa

  • Derek AsumanEmail author
  • Charles Godfred Ackah
  • Ama P. Fenny
  • Frank Agyire-Tettey
Original Article



Health and nutrition in early childhood are essential for survival, growth and adult life outcomes. As such, a number of global and national interventions have been pursued to improve early childhood health and nutrition. However, child malnutrition is pervasive and endemic across the sub Saharan Africa. This paper therefore assesses the nature and trends of socioeconomic inequalities in child stunting. The paper proceeds to decompose the causes of such socioeconomic-related inequalities over the period covered.

Subjects and methods

We used data from Demographic and Health Surveys (DHSs) for ten sub-Saharan African countries conducted between 2000 and 2016. The study employs an extension to the concentration index for binary health outcomes to measure socioeconomic inequalities in stunting and decompose the causes of inequalities in stunting using a generalized decomposition technique based on recentered influence function regressions.


The results show substantial pro-rich inequalities in child stunting across sub-Saharan Africa. The incidence of stunting are concentrated among children living in households with low socioeconomic status. In spite of persistent declines in the prevalence of stunting among children under 5 years across the study countries since 2000, trends in socioeconomic inequalities in stunting are mixed. We find significant contributions of child, maternal, and household characteristics to inequalities in child stunting.


The results suggest that there is the need to design and target nutrition-based interventions at children in low socioeconomic households. In addition, promoting female education and improving access to health and nutrition information will be key to improving child nutrition across the region.


Malnutrition Stunting Inequalities Decomposition Africa 



We are grateful to the editor and the anonymous referees of the journal for their constructive comments which helped improve the quality of our manuscript. We are grateful to the Demographic and Health Survey forum for ease of access to the data. This organization bears no responsibility for the analysis or interpretations that are presented in this paper.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical treatment of experimental subjects (animal and human)

This article does not contain any studies with human or animal subjects performed by the authors.

Informed consent

The study used data sets that are available online in the public domain; hence, there was no need to seek ethical consent to publish this study.

Data sharing statement

The authors confirm that all data underlying the findings are fully available without restriction. Data are publicly available from the Demographic and Health Survey website:

Supplementary material

10389_2019_1068_MOESM1_ESM.docx (23 kb)
ESM 1 (DOCX 22 kb)
10389_2019_1068_MOESM2_ESM.docx (33 kb)
ESM 2 (DOCX 32 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Statistical, Social and Economic ResearchUniversity of GhanaLegonGhana
  2. 2.Centre for Social Policy StudiesUniversity of GhanaLegonGhana
  3. 3.Department of EconomicsUniversity of GhanaLegonGhana

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