Abstract
The study investigates sex differences in the prevalence of undernutrition in sub-Saharan Africa. Undernutrition was defined by Z-scores using the CDC-2000 growth charts. Some 128 Demographic and Health Surveys (DHS) were analysed, totalling 700,114 children under-five. The results revealed a higher susceptibility of boys to undernutrition. Male-to-female ratios of prevalence averaged 1.18 for stunting (height-for-age Z-score <-2.0); 1.01 for wasting (weight-for-height Z-score <-2.0); 1.05 for underweight (weight-for-age Z-score <-2.0); and 1.29 for concurrent wasting and stunting (weight-for-height and height-for-age Z-scores <-2.0). Sex ratios of prevalence varied with age for stunting and concurrent wasting and stunting, with higher values for children age 0-23 months and lower values for children age 24-59 months. Sex ratios of prevalence tended to increase with declining level of mortality for stunting, underweight and concurrent wasting and stunting, but remained stable for wasting. Comparisons were made with other anthropometric reference sets (NCHS-1977 and WHO-), and the results were found to differ somewhat from those obtained with CDC-2000. Possible rationales for these patterns are discussed.
Highlights
Sex differences in health status are complex and evolve with the health transition, i.e.with declining mortality
Sex differences in mortality differ by age and by causes of death, and these differences evolve with the health transition [Stolnitz 1956; Preston 1976]
These observations apply to morbidity and mortality of children under-five: sex differences in mortality vary with age, with level of mortality in the population, and with pathology or causes of death [Preston 1976; Garenne 2003; Garenne & Lafon 1998]
Summary
Sex differences in health status are complex and evolve with the health transition, i.e.with declining mortality. Sex-ratios of prevalence tended to increase with declining level of mortality for stunting, under-weight and concurrent wasting and stunting, but remained stable for wasting. In published data from African DHS surveys, the prevalence of undernutrition was almost always higher for boys than for girls: 134/137 surveys for stunting, 115/136 surveys for wasting, and 119/136 surveys for underweight
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