Child nutritional well-being in Ghana: an analysis of associated individual, household, and contextual health indicators and socioeconomic and biophysical environmental variables.

Abstract

Depriving children of the nutrients needed for growth sets them up to fail in life. When children are well nourished and cared for, they are more likely to survive, thrive, and to meaningfully contribute to society. This study assesses the association of characteristics of individual children under age five in Ghana, their mothers, and their households—as well as socioeconomic and environmental characteristics of the places where they live—with differential nutritional well-being. What distinguishes this study from most research on young children’s nutritional status in the Global South is its analysis of data for individual children, made possible by use of Demographic and Health Surveys (DHS), and assignation of district variables that capture characteristics of their places of residence to individual children as cases. This enables assessment of the relative explanatory role of variables that describe the socioeconomic and biophysical environments. This study implements a three-level multivariate logistic regression analysis with separate models for each of the nutritional outcome variables—height-for-age, weightfor- age and hemoglobin—at each level. Descriptive statistics summarize the prevalence of stunting, underweight, and hemoglobin and delineate frequencies and proportions for selected independent variables at each level. Further statistical analysis relies on chisquared (χ2) tests to determine significant bivariate associations. All significantly associated variables in the bivariate analysis are subjected to binary logistic regression analysis. The results of fixed effects are reported with odds ratios (ORs) along with confidence intervals for p<.05. The following variables were found to be significantly associated with at least one of the three nutritional outcomes in multivariate analyses at the child and district levels: child’s age, months of breastfeeding, fever, mother’s health status, prenatal care, mother’s occupation, mother’s ethnicity, household water supply, household wealth status, population density, percent literate (vs. illiterate) in district, percent in rural (vs. urban) locations, wealth status of district residents, and ecological zone of residence. As found in much previous research, mother’s education and occupation, father’s education and occupation, household size and structure, and sanitation were significantly associated with children’s nutritional status in bivariate analysis but not in multivariate analysis. After controlling for the characteristics of children, mothers and households, significant associastions with children’s nutritional status were found for population density, percentage of literate (vs. illiterate) residents in a district, wealth status of district residents, and residence in the Guinea Forest-Savanna Mosaic and Central African Mangrove ecological zones. Other significantly associated variables in the final models were the age of the child, months of breastfeeding, whether the child’s mother has health insurance and the wealth status of a child’s household. Notwithstanding the shortcomings of this study, its findings can potentially assist stakeholders by providing a better understanding of the diverse set of factors that influence children’s nutritional status and some explanation for differences in nutritional status among places within Ghana.