Socioeconomic inequalities in skilled birth attendance in Zimbabwe: a comparative analysis

This dissertation assessed socioeconomic inequalities in skilled birth attendance in Zimbabwe. High maternal mortality in low-income countries is a cause of concern globally. Skilled birth attendance prevents a substantial number of maternal deaths and it is critical for ensuring overall maternal health. However, sub-Saharan Africa is characterized by challenges in accessing skilled birth attendance. The existence of health inequalities has been demonstrated when simple comparisons are made by residence (rural-urban), education and wealth (poorrich) in developing nations. The study used data from the Zimbabwe Demographic and Health Surveys (ZDHS) of 2010/11 and 2015. The analysis focused on women of child-bearing age (15-49 years). Skilled birth attendance was determined by women assisted by health personnel with midwife training. Health personnel was defined as a nurse, midwife or doctor. A binary logistic regression model was computed to understand the relationship between skilled birth attendance, demographic attributes and some explanatory variables. Standard concentration curves and Wagstaff normalized concentration indices were used to assess whether skilled birth attendance was dominant among the poor or rich in Zimbabwe. Overall skilled birth attendance prevalence increased for the periods under review. Regression results showed that antenatal care visits, residence status, place of delivery, women level of education, employment status and marital status are statistically significant predictors of skilled birth attendance. Wagstaff normalized concentration indices of aggregated use of skilled birth personnel reflected that wealthy women were more likely to receive skilled birth attendance. The concentration curves for aggregated skilled birth attendance showed minimal existence of health inequalities, as the concentration curves almost coincided with the line of equality. However, a disaggregated analysis by health personnel revealed the existence of health inequalities. In summary, minimal socioeconomic inequalities exist if skilled birth attendance aggregated, but when assessed by different health personnel categories, widening socioeconomic inequalities are observed

Can Informal Savings Groups Promote Food Security and Social, Economic and Health Transformations, Especially among Women in Urban Sub-Saharan Africa: A Narrative Systematic Review

This narrative review aimed to identify if roles of common informal savings groups known as Accumulating Savings and Credit Associations (ASCAs) or Rotating Savings and Credit Associations (ROSCAs) can play a significant role in mitigating food insecurity, socioeconomic inequality, promoting health, and/or increasing agency in women in urban sub-Saharan Africa (SSA). These organizations exist in most low- and middle-income countries (LMICs) worldwide under various names. A comprehensive search of scholarly outputs across six electronic databases (Pub-Med, Google Scholar, EBSCOhost, Scopus, Sabinet, and Cochrane) from 2000 to 2021 was completed. Twenty-eight (28) records met our inclusion criteria, and their quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative checklist. We identified through thematic analysis that ROSCAs/ASCAs play a crucial role in advancing social, economic, and health transformations, especially among women in urban SSA. However, while ROSCAs/ACSAs played important roles in food security, it was often not the primary motivation for participation. None of the selected studies identified the importance of dietary quality or access to healthy food in relation to food security. This review suggests a window of opportunity to promote partnerships and collaborations of ROSCAs/ASCAs with relevant stakeholders to leverage the functionalities of ROSCAs/ASCAs as vehicles for re-alignment of priorities, increased knowledge, and opportunities to encourage affordable healthy diets in urban SSA

Stakeholder mapping to explore social and economic capital of Rotating Savings and Credit Associations (ROSCAs) to increase demand for and access to healthy food

IntroductionSouth Africa, grappling with the complexities of malnutrition, faces a dual challenge of undernutrition in children and overnutrition in adults, particularly among women. This situation is exacerbated by high rates of food insecurity, affecting nearly one-fourth of households. In this context, the role of Rotating Savings and Credit Associations (ROSCAs), locally known as stokvels, becomes increasingly significant. These informal, often women-led, savings and borrowing groups present a unique opportunity to address dietary challenges and promote healthier eating practices in urban, low-income settings. This study explores the potential of stokvels in mitigating the dual burden of malnutrition by facilitating access to healthy, affordable foods.MethodsWe conducted stakeholder mapping to understand the roles and influences of various actors within South Africa's food system, particularly their interactions with stokvels. Our research focuses on how these groups, deeply embedded in the community fabric, can leverage their collective power to negotiate better access to nutritious food and influence healthier dietary choices. Stakeholders identified in the study span diverse sectors, including retail, agriculture, finance, and community organizations.ResultsThe research reveals that stokvels are perceived as vital social and economic entities capable of maximizing value through partnerships and networks. However, challenges such as the informal nature of stokvels and the lack of formal legal agreements often hinder their ability to form partnerships with formal institutions. The findings emphasize the importance of understanding and leveraging the social dynamics within stokvels, recognizing their role in enhancing food security and contributing to economic empowerment, especially for women. The study also identifies the need for formalizing stokvel structures to enhance their operational efficiency and increase their impact on food systems.DiscussionIn conclusion, this research highlights the untapped potential of stokvels in addressing South Africa's nutritional challenges. By fostering stronger connections between stokvels and various food system actors, there is a significant opportunity to improve food security and promote healthier eating habits in low-income communities. Future research should aim to include unrepresented stakeholders and explore strategies to enhance the role of ROSCAs in promoting healthier food choices and addressing affordability and accessibility barriers

Can Informal Savings Groups Promote Food Security and Social, Economic and Health Transformations, Especially among Women in Urban Sub-Saharan Africa: A Narrative Systematic Review

This narrative review aimed to identify if roles of common informal savings groups known as Accumulating Savings and Credit Associations (ASCAs) or Rotating Savings and Credit Associations (ROSCAs) can play a significant role in mitigating food insecurity, socioeconomic inequality, promoting health, and/or increasing agency in women in urban sub-Saharan Africa (SSA). These organizations exist in most low- and middle-income countries (LMICs) worldwide under various names. A comprehensive search of scholarly outputs across six electronic databases (Pub-Med, Google Scholar, EBSCOhost, Scopus, Sabinet, and Cochrane) from 2000 to 2021 was completed. Twenty-eight (28) records met our inclusion criteria, and their quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative checklist. We identified through thematic analysis that ROSCAs/ASCAs play a crucial role in advancing social, economic, and health transformations, especially among women in urban SSA. However, while ROSCAs/ACSAs played important roles in food security, it was often not the primary motivation for participation. None of the selected studies identified the importance of dietary quality or access to healthy food in relation to food security. This review suggests a window of opportunity to promote partnerships and collaborations of ROSCAs/ASCAs with relevant stakeholders to leverage the functionalities of ROSCAs/ASCAs as vehicles for re-alignment of priorities, increased knowledge, and opportunities to encourage affordable healthy diets in urban SSA

Leaving No Child Behind: Decomposing Socioeconomic Inequalities in Child Health for India and South Africa

Background: The United Nations’ 2030 Agenda for Sustainable Development argues for the combating of health inequalities within and among countries, advocating for “leaving no one behind”. However, child mortality in developing countries is still high and mainly driven by lack of immunization, food insecurity and nutritional deficiency. The confounding problem is the existence of socioeconomic inequalities among the richest and poorest. Thus, comparing South Africa’s and India’s Demographic and Health Surveys (DHS) of 2015/16, this study examines socioeconomic inequalities in under-five children’s health and its associated factors using three child health indications: full immunization coverage, food insecurity and malnutrition. Methods: Erreygers Normalized concentration indices were computed to show how immunization coverage, food insecurity and malnutrition in children varied across socioeconomic groups (household wealth). Concentration curves were plotted to show the cumulative share of immunization coverage, food insecurity and malnutrition against the cumulative share of children ranked from poorest to richest. Subsequent decomposition analysis identified vital factors underpinning the observed socioeconomic inequalities. Results: The results confirm a strong socioeconomic gradient in food security and malnutrition in India and South Africa. However, while full childhood immunization in South Africa was pro-poor (−0.0236), in India, it was pro-rich (0.1640). Decomposed results reported socioeconomic status, residence, mother’s education, and mother’s age as primary drivers of health inequalities in full immunization, food security and nutrition among children in both countries. Conclusions: The main drivers of the socioeconomic inequalities in both countries across the child health outcomes (full immunization, food insecurity and malnutrition) are socioeconomic status, residence, mother’s education, and mother’s age. In conclusion, if socioeconomic inequalities in children’s health especially food insecurity and malnutrition in South Africa; food insecurity, malnutrition and immunization in India are not addressed then definitely “some under-five children will be left behind”

Socioeconomic inequalities in food insecurity and malnutrition among underfive children : within and between-group inequalities in Zimbabwe

CITATION: Lukwa, A. T., et al. 2020. Socioeconomic inequalities in food insecurity and malnutrition among under-five children : within and between-group inequalities in Zimbabwe. BMC Public Health, 20:1199, doi:10.1186/s12889-020-09295-z.The original publication is available at http://bmcpublichealth.biomedcentral.comBackground: Food insecurity and malnutrition in children are pervasive public health concerns in Zimbabwe. Previous studies only identified determinants of food insecurity and malnutrition with very little efforts done in assessing related inequalities and decomposing the inequalities across household characteristics in Zimbabwe. This study explored socioeconomic inequalities trend in child health using regression 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 under-five children was determined based on the WHO dietary diversity score. Minimum dietary diversity was defined by a cut- off point of > 4 therefore, children with at least 3 of the 13 food groups were defined as food insecure. Malnutrition was assessed using weight for age (both acute and chronic under-nutrition) Z-scores. Children whose weight-for-age Z-score below minus two standard deviations (− 2 SD) from the median were considered malnourished. Concentration curves and 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 (place of residence and socioeconomic status). Results: Over the study period, malnutrition prevalence increased by 1.03 percentage points, while food insecurity prevalence decreased by 4.35 percentage points. Prevalence of malnutrition and food insecurity increased among poor rural children. Theil indices for nutrition status showed socioeconomic inequality gaps to have widened, while food security status socioeconomic inequality gaps contracted for the period under review. Conclusion: The study concluded that unequal distribution of household wealth and residence status play critical roles in driving socioeconomic inequalities in child food insecurity and malnutrition. Therefore, child food insecurity and malnutrition are greatly influenced by where a child lives (rural/urban) and parental wealth.Publisher's versio

Socio-Economic Inequalities in the Double Burden of Malnutrition among under-Five Children: Evidence from 10 Selected Sub-Saharan African Countries

Background: Africa is unlikely to end hunger and all forms of malnutrition by 2030 due to public health problems such as the double burden of malnutrition (DBM). Thus, the aim of this study is to determine the prevalence of DBM and degree of socio-economic inequality in double burden of malnutrition among children under 5 years in sub-Saharan Africa. Methods: This study used multi-country data collected by the Demographic and Health Surveys (DHS) Program. Data for this analysis were drawn from the DHS women’s questionnaire focusing on children under 5 years. The outcome variable for this study was the double burden of malnutrition (DBM). This variable was computed from four indicators: stunting, wasting, underweight and overweight. Inequalities in DBM among children under 5 years were measured using concentration indices (CI). Results: The total number of children included in this analysis was 55,285. DBM was highest in Burundi (26.74%) and lowest in Senegal (8.80%). The computed adjusted Erreygers Concentration Indices showed pro-poor socio-economic child health inequalities relative to the double burden of malnutrition. The DBM pro-poor inequalities were most intense in Zimbabwe (−0.0294) and least intense in Burundi (−0.2206). Conclusions: This study has shown that across SSA, among under-five children, the poor suffer more from the DBM relative to the wealthy. If we are not to leave any child behind, we must address these socio-economic inequalities in sub-Saharan Africa