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

Content Provider	Europe PMC
Author	Alaba, Olufunke A. Hongoro, Charles Thulare, Aquina Lukwa, Akim Tafadzwa
Editor	Tchounwou, Paul B. El-Khatib, Ziad
Copyright Year	2021
Abstract	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".
ISSN	16617827
Journal	International Journal of Environmental Research and Public Health [Int J Environ Res Public Health]
Volume Number	18
DOI	10.3390/ijerph18137114
PubMed Central reference number	PMC8296912
Issue Number	13
PubMed reference number	34281051
e-ISSN	16604601
Language	English
Publisher	Molecular Diversity Preservation International (MDPI)
Publisher Date	2021-07-02
Access Restriction	Open
Subject Keyword	Universal Health Coverage decomposing socioeconomic inequalities food insecurity immunization malnutrition child health under-five
Content Type	Text
Resource Type	Article
Subject	Health, Toxicology and Mutagenesis Pollution Public Health, Environmental and Occupational Health