Heterogeneity of child nutritional status between households: A comparison of six sub-Saharan African countries

Using cross-sectional data from Ghana, Malawˆ i, Nigeria, Tanzania, Zambia, and Zimbabwe, a multilevel analysis was performed to determine the extent of correlation of nutritional status between children in the same family and geographical area. Weight-for-age z-scores were used as a measure of nutritional status for children up to three years of age. The percentage of children who were under-weight ranged from 16 in Zimbabwe up to 36 in Nigeria. The effects of socioeconomic factors and individual characteristics on nutritional status between countries varied. However in all six countries, the child's age was the most important factor associated with nutritional status. A clustering effect at the household level was found in all six countries, ranging from 24 per cent in Tanzania and Zimbabwe to 40 per cent in Malawˆ i. There was also a significant, but smaller, clustering effect at community level for Malawˆ i, Nigeria, Tanzania, and Zambia.

[1]  H. Goldstein.  Multilevel Statistical Models , 2006 .

[2]  C. Bellamy.  The State of the World's Children 1998: Focus on Nutrition. , 1998 .

[3]  F. Simondon,et al.  Mothers prolong breastfeeding of undernourished children in rural Senegal. , 1998, International journal of epidemiology.

[4]  K. Tucker,et al.  Food diversity versus breastfeeding choice in determining anthropometric status in rural Kenyan toddlers. , 1998, International journal of epidemiology.

[5]  M. Gupta.  Socio-economic Status and Clustering of Child Deaths in Rural Punjab , 1997 .

[6]  I. Diamond,et al.  CHILD IMMUNISATION IN GHANA: THE EFFECTS OF FAMILY, LOCATION AND SOCIAL DISPARITY , 1997, Journal of Biosocial Science.

[7]  N. Madise,et al.  Child Malnutrition and Feeding Practices in Malawi , 1997 .

[8]  C. Mcmurray.  Cross-sectional anthropometry: what can it tell us about the health of young children? , 1996, Health Transition Review.

[9]  L. Caulfield,et al.  Is prolonged breastfeeding associated with malnutrition? Evidence from nineteen demographic and health surveys. , 1996, International journal of epidemiology.

[10]  F. Steele,et al.  Variations in familial neonatal mortality risks in four countries , 1996, Journal of Biosocial Science.

[11]  Fiona Steele,et al.  Immunization uptake in rural Bangladesh : a multilevel analysis , 1996 .

[12]  K. Mølbak,et al.  Prolonged breast feeding, diarrhoeal disease, and survival of children in Guinea-Bissau , 1994, BMJ.

[13]  E A Frongillo,et al.  Epidemiologic evidence for a potentiating effect of malnutrition on child mortality. , 1993, American journal of public health.

[14]  Nigeria..  Nigeria Demographic and Health Survey 1990 , 1992 .

[15]  J. T. Boerma,et al.  Child anthropometry in cross-sectional surveys in developing countries: an assessment of the survivor bias. , 1992, American journal of epidemiology.

[16]  Chris J. Skinner,et al.  Analysis of complex surveys , 1991 .

[17]  M. Gupta.  Death Clustering, Mothers' Education and the Determinants of Child Mortality in Rural Punjab, India , 1990 .

[18]  B. Melville,et al.  Determinants of Childhood Malnutrition in Jamaica , 1988 .

[19]  B. Büyükgebiz,et al.  Nutrition and Diarrhoeal Diseases , 1988 .

[20]  H. Hoffman,et al.  The tendency to repeat gestational age and birth weight in successive births. , 1979, American journal of obstetrics and gynecology.

[21]  A. Cross,et al.  Zambia Demographic and Health Survey 1992 , 1993 .

[22]  E. Crevatin,et al.  Determinants of child nutrition and mortality in north-west Uganda. , 1992, Bulletin of the World Health Organization.

[23]  R. Martorell,et al.  Characteristics and determinants of child nutritional status in Nepal. , 1984, The American journal of clinical nutrition.