Abstract
BACKGROUND: Stunting and underweight remain significant public health issues in many low- and middle-income countries, including Ghana. This study examined the trends and inequalities in stunting and underweight among children aged 0–59 months in Ghana between 1993 and 2022. METHODS: We utilised data from the Ghana Demographic Health Survey rounds conducted between 1993 and 2022, among mothers of children aged 0–59 months. The World Health Organisation Health Equity Assessment Toolkit software was used to calculate various inequality measures, including Difference (D), Ratio (R), Population Attributable Risk (PAR), and Population Attributable Fraction (PAR). An inequality assessment was conducted for six stratifiers: child’s age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national region. RESULTS: Stunting and underweight prevalence among children aged 0–59 months in Ghana both declined between 1993 and 2022, with stunting decreasing from 32.7 to 17.3% and underweight decreasing from 24.5 to 11.9%. Regarding children’s age, between 1998 and 2022, the difference in stunting prevalence between older children and younger children decreased from -29.5 to -0.9 percentage points, and underweight rates from -10.0 to -2.6 percentage points, indicating reduction in inequality. Economically, the disparity in stunting between children of the richest and poorest mothers declined from 27.2 to 15.3 percentage points, and underweight from 19.6 to 8.3 percentage points by 2022, highlighting reduction in inequality. With educational level, the stunting gap between children of mothers with high and low education reduced from 24.7 in 1993 to 10.5 percentage points in 2022, while underweight decreased from 23.3 to 5.6 percentage points between the same period, suggesting a reduction of inequality in stunting and underweight between of higher educated mothers and those of mothers with no formal education. Regarding place of residence, the difference between children from urban areas and those from rural areas decreased from 15.3 percentage points in 1993 to 4.5 percentage points for stunting in 2022, and from 11.8 percentage points in 1993 to 2.2 percentage points for underweight in 2022, indicating reduction in inequality. Finally, the subnational region difference was 19.1 percentage points for stunting in 2022, and 12.0 percentage points for underweight in 2022, revealing reduced regional disparities in both stunting and underweight rates among regions. CONCLUSION: Our findings on stunting and underweight prevalence among children aged 0–59 months in Ghana from 1993 to 2022 underscore notable progress and persistent inequalities. The inequalities observed across dimensions such as economic status, maternal education, and geographic region indicate the multifaceted nature of stunting and underweight. This situation calls for a continued concerted effort by Government and partner organisations in Ghana to address the underlying socioeconomic determinants of stunting and underweight, aligning with global commitments such as the Sustainable Development Goals.