Is malnutrition among children high or low in Ghana?

Children suffering under-nutrition remain a major public health problem confronting many low and middle-income countries. Ghana happens to be one of the countries with high proportion of children less than five years being under-nourished. Over the years, the government of Ghana, in collaboration with her local and international partners has put in place deliberate programs to help curb the menace of under-nutrition among infants and young children in the country.

It is important to find out if these programs have had an impact on child under-nutrition in the country. This is particularly vital because in Ghana, most of the analyses in this area focus on the national level trends. This may mask important departures in the various segments of the country. This article intends to look at the achievements Ghana has made in the last two decades, by presenting national as well as disaggregated analysis of Ghana Demographic and Health Surveys (GDHS), collected between 1993 and 2008.

The article focuses on all the three main indicators of under-nutrition, namely, stunting (too short for age), wasting (too thin for height) and underweight (too light for age). The factors responsible for under-nutrition are many and varied. For example, stunting is mostly due to prolong deprivation of nutritious food, while wasting and underweight are respectively as a result of acute significant food shortage and /or disease and indication of extreme hunger.

My analyses show that overall; Ghana has made some gains in the reduction of under-nutrition among children under-five years old. Stunting for instance has decreased among Ghanaian children from 34% in 1993 to 26% (a 23% reduction) by 2008. Although, the decrease is a positive development, the 23% reduction over 15 years is not good enough for Ghana to be able to meet the target set by the World Health Organization (WHO) that every country should endeavor to reduce childhood stunting by 40% by 2025. Notwithstanding, if this progress continues, Ghana may be able to reduce child under-nutrition to an appreciable level in the near future.

Turning to childhood wasting, this indicator has achieved the modest reduction over the period, decreasing from 15% in 1993 to 13% by 2008 (still high by the WHO standard). This is worrying, especially for the fact that children who are wasted are at higher risk of dying. Therefore, Ghana needs to redouble her effort at tackling childhood wasting in the country. As the problem of child mortality in the country may not be solved if childhood wasting is not addressed head-on.

Although, the picture with regards to stunting and wasting is not as bright as expected, underweight appears to paint a good picture of the country’s effort at reducing under-nutrition. During 1993 to 2008, underweight among Ghanaian children has significantly decreased, from 25% to 15% (a 60% reduction). This means that in 2008, Ghana has achieved the United Nations Millennium Development Goals (MDGs) target set for all developing countries to reduce underweight by halve by 2015. This is absolutely a positive development for Ghana, however, more efforts are still needed to maintain this achievement or further improve on it.

The picture presented above mask important departures in the various segments of the economy. For example, in the rural areas, stunting is significantly decreasing, while increasing among urban children, albeit marginally. In 1993, stunting prevalence was 38% among rural children, this reduced to 28% in 2008, while the prevalence increased in the urban areas, from 21% to 22%. The implication of this is that the difference in stunting prevalence between rural and urban in 1993 was 17 percentage points (38%-21%). This difference narrowed down to 6 percent as pointed out in 2008. This may suggest that the inequalities between rural and urban settings are narrowing. Nevertheless, one cannot lose sight of the fact that the worsening under-nutrition in the urban settings is worrying and needs an urgent attention.

Similarly, under-nutrition is getting worse among children of mothers with higher than primary education and better among children of mothers with no education. For the period, 1993 to 2008, stunting prevalence increased from 15% to 26% for boys and 10% to 23% for girls of mothers with higher than primary education, while decreased from 44% to 29% for boys and 33% to 20% for girls of mothers with no formal education. There may be plausible explanations for this trend but space will not allow me to dwell on those.

It is important to point out that further analysis to take care of the effect of place of resident on maternal education did not yield different results from the above. Consequently, these results can be said to be a true reflection of what is on the ground. Relating these results to the worsening under-nutrition in the urban settings and improving trend in the rural settings, one can conclude that the so-called advantaged groups (urban and educated) in Ghana are becoming disadvantaged. This also elucidates the fact that national level trends conceal important differences in the various segments of the economy—looking at the problem with a national lens can be misleading.

In conclusion, Ghana has made some modest gains in the reduction of under-nutrition among children under-five years. However, there is a need for programs that will effectively address stunting and wasting which still remain high among children in the country. Additionally, child under-nutrition in the so-called advantaged groups is getting worse in Ghana, therefore targeted interventions are needed to address this trend.

The author (Dickson Amugsi) of this article is a final year PhD student at the University of Bergen, Norway.

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