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International Journal for Equity in Health

, 2:7

First Online: 11 September 2003Received: 19 May 2003Accepted: 11 September 2003DOI: 10.1186-1475-9276-2-7

Cite this article as: Zere, E. & McIntyre, D. Int J Equity Health 2003 2: 7. doi:10.1186-1475-9276-2-7


ObjectivesTo assess and quantify the magnitude of inequalities in under-five child malnutrition, particularly those ascribable to socio-economic status and to consider the policy implications of these findings.

MethodsData on 3765 under-five children were derived from the Living Standards and Development Survey. Household income, proxied by per capita household expenditure, was used as the main indicator of socio-economic status. Socio-economic inequality in malnutrition stunting, underweight and wasting was measured using the illness concentration index. The concentration index was calculated for the whole sample, as well as for different population groups, areas of residence rural, urban and metropolitan and for each province.

ResultsStunting was found to be the most prevalent form of malnutrition in South Africa. Consistent with expectation, the rate of stunting is observed to be the highest in the Eastern Cape and the Northern Province – provinces with the highest concentration of poverty. There are considerable pro-rich inequalities in the distribution of stunting and underweight. However, wasting does not manifest gradients related to socio-economic position. Among White children, no inequities are observed in all three forms of malnutrition. The highest pro-rich inequalities in stunting and underweight are found among Coloured children and metropolitan areas. There is a tendency for high pro-rich concentration indices in those provinces with relatively lower rates of stunting and underweight Gauteng and the Western Cape.

ConclusionThere are significant differences in under-five child malnutrition stunting and underweight that favour the richest of society. These are unnecessary, avoidable and unjust. It is demonstrated that addressing such socio-economic gradients in ill-health, which perpetuate inequalities in the future adult population requires a sound evidence base. Reliance on global averages alone can be misleading. Thus there is a need for evaluating policies not only in terms of improvements in averages, but also improvements in distribution. Furthermore, addressing problems of stunting and underweight, which are found to be responsive to improvements in household income status, requires initiatives that transcend the medical arena.

Keywordsinequity under-five child malnutrition socio-economic status concentration index South Africa Electronic supplementary materialThe online version of this article doi:10.1186-1475-9276-2-7 contains supplementary material, which is available to authorized users.

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Autor: Eyob Zere - Diane McIntyre


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