Peer-reviewed article
Socioeconomic inequality in the co-occurrence of anemia and stunting among adolescent girls aged 15-19 years in Sub-Saharan African countries: a decomposition analysis.
Tewodros Getaneh Alemu, Elsa Awoke Fentie, Daniel Gashaneh Belay, Desale Bihonegn Asmamaw, Ever Siyoum Shewarega et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed data from nearly 40,000 adolescent girls across Sub-Saharan African countries to examine socioeconomic inequality in the combined occurrence of anemia and stunting. The research found that both conditions together disproportionately affect girls from poorer households. Wealth, rural location, lower education, and lack of safe water were identified as the main factors driving these inequalities. The findings highlight that reducing these inequalities requires improvements in girls' education, water access, and overall economic development.
Key points
- Co-occurrence of anemia and stunting is concentrated among the poorest adolescent girls (Erreygers normalized concentration index = -0.046, P < 0.0001)
- Wealth index was identified as a major contributor to socioeconomic inequality in the co-occurrence of both conditions
- Place of residence (rural vs urban) significantly contributes to the inequality
- Adolescent girls' educational level and access to improved water sources are key factors affecting the concentration of both conditions among the poor
- The study used Demographic and Health Survey (DHS) data covering multiple Sub-Saharan African countries
Limitations
The study describes patterns of inequality but does not establish causation or test interventions. The analysis is cross-sectional and cannot determine whether poverty causes malnutrition or whether other unmeasured factors explain the observed associations.
Abstract
INTRODUCTION: Undernutrition, particularly stunting, and deficiency of micronutrients are prevalent nutrition-related problems in adolescent girls residing in low- and middle-income countries. The coexistence of both kinds of malnutrition typically impacts the most vulnerable people, such as women of reproductive age, and it has a detrimental impact on maternal and child health. Besides, malnutrition and inequality form a vicious cycle that is hard to break without all-encompassing solutions that address every stage of the life cycle. Therefore, this study aimed to assess the presence of socioeconomic inequality in the co-occurrence of anemia and stunting and its contributors in sub-Saharan African countries. METHODS: A total of 39,712 weighted adolescent girl samples from DHS data SSA countries were included in the study. Erreygers normalized concentration index and its concentration curve were used to assess socioeconomic-related inequality in the co-occurrence of anemia and stunting. Decomposition analysis was performed to identify factors contributing to socioeconomic-related inequality. RESULTS: The weighted Erreygers normalized concentration index for co-occurrence of anemia and stunting was - 0.046 with Standard error = 0.0043 (P value < 0.0001); indicating that co-occurrence of anemia and stunting was disproportionately concentrated among the poor. The decomposition analysis revealed that wealth index, place of residency, adolescent educational level, and unimproved source of water were the major contributors to the pro-poor socioeconomic inequalities in the co-occurrence of anemia and stunting. CONCLUSION AND RECOMMENDATION: In this study, there is a pro-poor inequality in the co-occurrence of anemia and stunting. Therefore, it's vital to step up initiatives that improve access to education for adolescent girls, supply of safe water, and boost the economic standing of their country to enhance the level of living status of the population.