Socioeconomic inequalities trends in child health comparing within and between group inequalities: Food insecurity and malnutrition in Zimbabwe

Abstract Background Food insecurity and malnutrition in children are pervasive public health concerns in Zimbabwe. Several studies previously done, only identified determinants of food insecurity and malnutrition with very little efforts have been done in assessing related inequalities and decomposing the inequalities across household characteristics in Zimbabwe. This study explored socioeconomic inequalities trends in child health using the 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 children was determined based on the WHO dietary diversity score. Minimum dietary diversity was defined by a cut- off point of >4 therefore, in this study children with less than 3 of the 13 food groups were defined as food insecure. Malnutrition was assessed using weight for age Z-score, with children whose weight-for-age Z-score below minus two standard deviations (-2 SD) from the median considered malnourished. Concentration 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 (geographical clusters and socioeconomic status). Results Over the study period, malnutrition prevalence increased by 1.03 percentage points (p.p), while food insecurity prevalence decreased by 4.35p.p. Prevalence of malnutrition and food insecurity increased among poor rural children. Theil indices for nutrition status show socioeconomic inequality gaps to have widened, while food security status socioeconomic inequality gaps contracted for the period under review. Conclusion: Within-group inequalities are driving most of the socioeconomic inequalities in nutritional status and food security status among children in Zimbabwe. To address the socioeconomic inequalities, there is need to tackle the four pillars (availability, accessibility, utilization and stability of food supply) of food and nutrition security.