Abstract
INTRODUCTION: Adolescent undernutrition is a key factor influencing health outcomes. An undernourished adolescent girl who begins pregnancy with inadequate nutrient reserves often delivers low birth weight or growth-restricted infants, who is more prone to metabolic disorders in adulthood and faces higher risks of infant mortality and lower chances of survival. There is limited information on socioeconomic inequality in undernutrition among late female adolescent girls in sub-Saharan Africa. Therefore, this study aimed to assess the presence of socioeconomic inequality in undernutrition and its contributors in sub-Saharan African countries. METHODS: This study was based on recent Demographic and Health Survey of 30 Sub-Saharan African countries from 2010 to 2020. A total weighted sample of 45,598 late female adolescents was included. The Erreygers normalized concentration index and its concentration curve were applied to assess socioeconomic-related inequality in undernutrition. Decomposition analysis was conducted to identify factors contributing to socioeconomic related inequality. RESULTS: The weighted Erreygers normalized concentration index for undernutrition was - 0.070 with Standard error = 0.0053 (P value < 0.0001); this revealed that undernutrition was disproportionately concentrated among the poor (pro-poor). The weighted ECI values for each country ranged from - 0.0356 in Liberia to -0.1981 in Burkina Faso, with Kenya (-0.1343), Namibia (-0.1207), and Nigeria (-0.1161) exhibiting the highest levels of inequality after Burkina Faso. The decomposition analysis revealed that wealth index (62.79%), educational level (55.84%), media exposure (40.53%) and place of residence (17.00%) were the major contributors for the pro-poor socioeconomic inequalities in undernutrition. CONCLUSION AND RECOMMENDATION: This study revealed a small but statistically significant pro-poor inequality in undernutrition among late female adolescents. Therefore, interventions should be prioritized in countries with high pro-poor inequality in undernutrition, such as Burkina Faso, Kenya, Nigeria, Namibia, and Burundi. Targeting disadvantaged late female adolescents in these countries through measures like women's economic empowerment and mass media awareness campaigns can help reduce these inequalities and contribute to achieving universal health coverage.