Extent of and trends in inequalities in child stunting in Sierra-Leone from 2005 to 2013: evidence from demographic and health surveys and multiple indicator cluster surveys

Gebretsadik Shibre,Jemal Haidar,Betregiorigis Zegeye

doi:10.1186/s12939-020-01212-5

Gebretsadik Shibre, Jemal Haidar + Show 1 more

Open Access

https://doi.org/10.1186/s12939-020-01212-5

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Abstract

BackgroundComprehensive assessment of stunting disparity in Sierra-Leone has not been done so far. We aimed to document extent and over time dynamics of inequality in stunting in Sierra-Leone using approaches that facilitate implementation of interventions aim to eliminate non-justified stunting disparity in the country.MethodsThe data for the study were derived from two rounds of the Sierra Leone Demographic and Health Survey conducted in 2008 and 2013, and two rounds of the Sierra Leone Multiple Indicator Cluster Survey done in 2005 and 2010. We used the 2019 update WHO Health Equity Assessment Toolkit (HEAT) to do the analysis. The toolkit makes use of data stored in the WHO Health Equity Monitor database. We analyzed stunting inequality using summary measures: Population Attributable Risk, Population Attributable Fraction, Difference and Ratio. The summary measures were computed for five equity stratifers: wealth, education, child’s sex, place of residence and subnational region. We computed 95% Confidence Interval (CI) for each point estimate to show whether or not observed stunting inequalities are statistically significant, and whether or not the disparity changed over time statistically significantly.ResultsThe findings demonstrated stark inequalities in stunting in all the studied dimensions of inequality. While residence and subnational regional related inequalities remain unchanged over time, wealth and educational inequality had seen slight improvement during the same time period. Large sex related stunting inequality remained during the first three surveys time points, but it disappeared in 2013.ConclusionsHuge stunting disparities occurred in Sierra Leone, and the disparity disproportionately affects disadvantaged subpopulations and male children. Nutrition interventions that specifically target the subgroups which suffer more from the burden of stunting are required.

Highlights

Comprehensive assessment of stunting disparity in Sierra-Leone has not been done so far
We presented stunting point estimate in each subgroup along with the corresponding 95% Confidence Interval (CI) to allow comparison between subgroups and over time
While stunting among the poorest subgroup had fallen by about 7 percentage points between 2005 and 2013, the CIs for the richest subgroup had substantial overlap, making it difficult to comment on the rate of reduction of stunting

Summary

Introduction

Comprehensive assessment of stunting disparity in Sierra-Leone has not been done so far. We aimed to document extent and over time dynamics of inequality in stunting in Sierra-Leone using approaches that facilitate implementation of interventions aim to eliminate non-justified stunting disparity in the country. 21.3% of under 5 children suffered from stunting in 2019 [8]. In Africa, two in every five under five children are stunted, with large variations across the five sub-regions; it varied between 2% in Southern Africa to 23.1% in Eastern Africa [8]. Like the situation in SSA, Sierra Leone experiences nutritional problems, and many people suffer from food insufficiency. Chronic malnutrition is a widespread problem in the country, with nearly one in three children suffers from stunting, and Sierra Leone is under the WHO “high” threshold category for stunting burden [9, 10]

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