Socioeconomic, sex and area related inequalities in childhood stunting in Mauritania: Evidence from the Mauritania Multiple Indicator Cluster Surveys (2007–2015)

Abstract

INTRODUCTION: The prevalence of stunting in under five children is high in Mauritania. However, there is a paucity of evidence on the extent and the overtime alteration of inequality in stunting. To this end, we did this study to investigate stunting inequality and the change with time using three rounds of Mauritania Multiple Indicator Cluster Surveys. The evidence is important to inform implementation of equitable nutrition interventions to help narrow inequality in stunting between population groups. METHODS: World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) was used in the analysis of stunting inequality. Following standard equity analysis methods recommended by the WHO, we performed disaggregated analysis of stunting across five equity stratfiers: Wealth, education, residence, sex and sub-national regions. Then, we summarized stunting inequality through four measures of inequality: Difference, Ratio, Population Attributable Fraction and Population Attributable Risk. The point estimates of stunting were accompanied by 95% confidence intervals to measure the statistical significance of the findings. RESULTS: The national average of childhood stunting in 2007, 2011 and 2015 was 31.3%, 29.7% and 28.2%, respectively. Glaring inequalities in stunting around the five equity stratifiers were observed in all the studied periods. In the most recent survey included in our study (2015), for instance, we recorded substantial wealth (PAF = -33.60; 95% CI: -39.79, -27.42) and education (PAF = -5.60; 95% CI: -9.68, -1.52) related stunting inequalities. Overall, no substantial improvement was documented in wealth and sex related inequality in stunting between 2007 and 2011 while region-based inequality worsened during the same time periods. CONCLUSIONS: The burden of stunting appeared to be heavily concentrated among children born to socioeconomically worse-off women, women who live in rural settings and certain subnational regions. Targeted nutrition interventions are required to address drivers of stunting embedded within geographic and socioeconomic contexts.