Peer-reviewed article
Water, sanitation, and hygiene and nutritional status of children under-5 years born to young mothers in Ghana: a spatial inequality analysis
Deda Ogum, Yula Salifu, Abdul Razak Abubakari, Gilbert Abotisem Abiiro, Torjim Salifu et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This study looked at data from 620 mother-child pairs in Ghana, where mothers were aged 15 to 24, to understand how water, sanitation and hygiene relate to child malnutrition. It used the 2022 Ghana Demographic and Health Survey and mapped where stunting, wasting and underweight were most common. The Volta region had the highest rates of all three problems, though this was based on a small number of cases. Poorer and less educated households carried a larger share of malnutrition, but once other factors were accounted for, WASH conditions themselves were not clearly linked to nutrition outcomes.
Key points
- Stunting prevalence was 18.8%, wasting 8.7%, and underweight 15.6% among children of young mothers.
- Volta Region had the highest observed rates for all three outcomes, but this was based on only 20 unweighted cases.
- No statistically significant overall spatial clustering was found for any outcome (all p ≥ 0.296), though Oti was a possible hotspot for underweight and Central/Bono were cold spots for stunting and wasting.
- Concentration indices were negative for all outcomes, showing malnutrition was concentrated among poorer, less-educated households, significant for underweight.
- In fully adjusted models, WASH covariates were not significantly associated with stunting, wasting, or underweight.
Limitations
The cross-sectional design cannot show cause and effect, and some regional estimates (like Volta) are based on very small sample sizes, making them unreliable.
Abstract
Background Malnutrition among children under five remains a major public health challenge in sub-Saharan Africa, with those born to young mothers being particularly vulnerable. Evidence on the role of water, sanitation, and hygiene (WASH) in this subgroup is limited in Ghana. We estimated the association between WASH and childhood malnutrition, and characterized its spatial and socioeconomic distribution, in young mother–child pairs in Ghana. Methods We analyzed 620 child–mother pairs (mothers aged 15–24 years) from the 2022 Ghana Demographic and Health Survey. Outcomes were stunting, wasting, and underweight, defined using WHO growth standards (< −2 SD). Survey-weighted multilevel logistic regression examined WASH–nutrition associations. Spatial patterns were assessed using Global Moran’s I, and LISA and Getis-Ord G*. Socioeconomic inequality was measured via concentration indices, the Theil T index, Lorenz curves, and difference/relative indices. Population attributable fractions (PAF) and risks (PAR) were estimated for binary WASH exposures. Results Stunting prevalence was 18.8% (95% CI 15.5–22.6), wasting 8.7% (6.2–11.9), and underweight 15.6% (12.4–19.4). Volta Region recorded the highest observed weighted prevalence for all three outcomes (stunting 32.0%, wasting 16.8%, underweight 39.4%), but these estimates were based on a small subsample (unweighted n = 20). Global spatial autocorrelation was not statistically significant for any outcome (all p ≥ 0.296). LISA identified Oti as a possible hotspot for underweight ( p = 0.039), and Central and Bono as cold spots for stunting ( p = 0.047) and wasting ( p = 0.018). Improved water access showed the largest protective population-level association (PAF: stunting −36 to −41%; underweight −37%), interpreted as a population-level attributable-burden estimate under a cross-sectional design. Concentration indices were negative for all outcomes, indicating disproportionate burden among poorer and less-educated households, reaching statistical significance for underweight. WASH covariates were not significantly associated with any outcome in fully adjusted models. Multilevel models showed high apparent discrimination (AUC 0.859–0.868). Conclusion Malnutrition among children of young mothers in Ghana is unevenly distributed and concentrated among socioeconomically disadvantaged populations. Equitable WASH services, alongside targeted nutrition programming, may help reduce nutritional inequalities in support of SDG 2 and SDG 6.