Background: Food insecurity and malnutrition in children are pervasive public health concerns in Zimbabwe. Previous studies only identified determinants of food insecurity and malnutrition with very little efforts done in assessing related inequalities and decomposing the inequalities across household characteristics in Zimbabwe. This study explored socioeconomic inequalities trend in child health using regression decomposition approach to compare within and between group inequalities. Methods: The study used Demographic Health Survey (DHS) data sets of 2010\11 and 2015. Food insecurity in under-five children was determined based on the WHO dietary diversity score. Minimum dietary diversity was defined by a cut- off point of > 4 therefore, children with at least 3 of the 13 food groups were defined as food insecure. Malnutrition was assessed using weight for age (both acute and chronic under-nutrition) Z-scores. Children whose weight-for-age Z-score below minus two standard deviations (− 2 SD) from the median were considered malnourished. Concentration curves and indices were computed to understand if malnutrition was dominant among the poor or rich. The study used the Theil index and decomposed the index by population subgroups (place of residence and socioeconomic status). Results: Over the study period, malnutrition prevalence increased by 1.03 percentage points, while food insecurity prevalence decreased by 4.35 percentage points. Prevalence of malnutrition and food insecurity increased among poor rural children. Theil indices for nutrition status showed socioeconomic inequality gaps to have widened, while food security status socioeconomic inequality gaps contracted for the period under review. Conclusion: The study concluded that unequal distribution of household wealth and residence status play critical roles in driving socioeconomic inequalities in child food insecurity and malnutrition. Therefore, child food insecurity and malnutrition are greatly influenced by where a child lives (rural/urban) and parental wealth.

Background: Africa is unlikely to end hunger and all forms of malnutrition by 2030 due to public health problems such as the double burden of malnutrition (DBM). Thus, the aim of this study is to determine the prevalence of DBM and degree of socio-economic inequality in double burden of malnutrition among children under 5 years in sub-Saharan Africa. Methods: This study used multi-country data collected by the Demographic and Health Surveys (DHS) Program. Data for this analysis were drawn from the DHS women’s questionnaire focusing on children under 5 years. The outcome variable for this study was the double burden of malnutrition (DBM). This variable was computed from four indicators: stunting, wasting, underweight and overweight. Inequalities in DBM among children under 5 years were measured using concentration indices (CI). Results: The total number of children included in this analysis was 55,285. DBM was highest in Burundi (26.74%) and lowest in Senegal (8.80%). The computed adjusted Erreygers Concentration Indices showed pro-poor socio-economic child health inequalities relative to the double burden of malnutrition. The DBM pro-poor inequalities were most intense in Zimbabwe (−0.0294) and least intense in Burundi (−0.2206). Conclusions: This study has shown that across SSA, among under-five children, the poor suffer more from the DBM relative to the wealthy. If we are not to leave any child behind, we must address these socio-economic inequalities in sub-Saharan Africa.

This narrative review aimed to identify if roles of common informal savings groups known as Accumulating Savings and Credit Associations (ASCAs) or Rotating Savings and Credit Associations (ROSCAs) can play a significant role in mitigating food insecurity, socioeconomic inequality, promoting health, and/or increasing agency in women in urban sub-Saharan Africa (SSA). These organizations exist in most low- and middle-income countries (LMICs) worldwide under various names. A comprehensive search of scholarly outputs across six electronic databases (Pub-Med, Google Scholar, EBSCOhost, Scopus, Sabinet, and Cochrane) from 2000 to 2021 was completed. Twenty-eight (28) records met our inclusion criteria, and their quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative checklist. We identified through thematic analysis that ROSCAs/ASCAs play a crucial role in advancing social, economic, and health transformations, especially among women in urban SSA. However, while ROSCAs/ACSAs played important roles in food security, it was often not the primary motivation for participation. None of the selected studies identified the importance of dietary quality or access to healthy food in relation to food security. This review suggests a window of opportunity to promote partnerships and collaborations of ROSCAs/ASCAs with relevant stakeholders to leverage the functionalities of ROSCAs/ASCAs as vehicles for re-alignment of priorities, increased knowledge, and opportunities to encourage affordable healthy diets in urban SSA.

Background: Several studies in the literature have shown the existence of large disparities in the use of maternal health services by socioeconomic status (SES) in developing countries. The persistence of the socioeconomic disparities is problematic, as the global community is currently advocating for not leaving anyone behind in attaining Sustainable Development Goals (SDGs). However, health care facilities in developing countries continue to report high maternal deaths. Improved accessibility and strengthening of quality in the uptake of maternal health services (skilled birth attendance, antenatal care, and postnatal care) plays an important role in reducing maternal deaths which eventually leads to the attainment of SDG 3, Good Health, and Well-being. Methods: This study used the Zimbabwe Demographic Health Survey (ZDHS) of 2015. The ZDHS survey used the principal components analysis in estimating the economic status of households. We computed binary logistic regressions on maternal health services attributes (skilled birth attendance, antenatal care, and postnatal care) against demographic characteristics. Furthermore, concentration indices were then used to measure of socio-economic inequalities in the use of maternal health services, and the Erreygers decomposable concentration index was then used to identify the factors that contributed to the socio-economic inequalities in maternal health utilization in Zimbabwe. Results: Overall maternal health utilization was skilled birth attendance (SBA), 93.63%; antenatal-care (ANC) 76.33% and postnatal-care (PNC) 84.27%. SBA and PNC utilization rates were significantly higher than the rates reported in the 2015 Zimbabwe Demographic Health Survey. Residence status was a significant determinant for antenatal care with rural women 2.25 times (CI: 1.55–3.27) more likely to utilize ANC. Richer women were less likely to utilize skilled birth attendance services [OR: 0.20 (CI: 0.08–0.50)] compared to women from the poorest households. While women from middle-income households [OR: 1.40 (CI: 1.03–1.90)] and richest households [OR: 2.36 (CI: 1.39–3.99)] were more likely to utilize antenatal care services compared to women from the poorest households. Maternal service utilization among women in Zimbabwe was pro-rich, meaning that maternal health utilization favoured women from wealthy households [SBA (0.05), ANC (0.09), PNC (0.08)]. Wealthy women were more likely to be assisted by a doctor, while midwives were more likely to assist women from poor households [Doctor (0.22), Midwife (− 0.10)]. Conclusion: Decomposition analysis showed household wealth, husband’s education, women’s education, and residence status as important positive contributors of the three maternal health service (skilled birth attendance, antenatal care, and postnatal care) utilization outcomes. Educating women and their spouses on the importance of maternal health services usage is significant to increase maternal health service utilization and consequently reduce maternal mortality.

Background: Malaria remains a major tropical vector-borne disease of immense public health concern owing to its debilitating effects in sub-Saharan Africa. Over the past 30 years, the high altitude areas in Eastern Africa have been reported to experience increased cases of malaria. Governments including that of the Republic of Uganda have responded through intensifying programs that can potentially minimize malaria transmission while reducing associated fatalities. However, malaria patterns following these intensified control and prevention interventions in the changing climate remains widely unexplored in East African highland regions. This study thus analyzed malaria patterns across altitudinal zones of Mount Elgon, Uganda.Methods: Times-series data on malaria cases (2011–2017) from five level III local health centers occurring across three altitudinal zones; low, mid and high altitude was utilized. Inverse Distance Weighted (IDW) interpolation regression and Mann Kendall trend test were used to analyze malaria patterns. Vegetation attributes from the three altitudinal zones were analyzed using Normalized Difference Vegetation Index (NDVI) was used to determine the Autoregressive Integrated Moving Average (ARIMA) model was used to project malaria patterns for a 7 year period.Results: Malaria across the three zones declined over the study period. The hotspots for malaria were highly variable over time in all the three zones. Rainfall played a significant role in influencing malaria burdens across the three zones. Vegetation had a significant influence on malaria in the higher altitudes. Meanwhile, in the lower altitude, human population had a significant positive correlation with malaria cases.Conclusions: Despite observed decline in malaria cases across the three altitudinal zones, the high altitude zone became a malaria hotspot as cases variably occurred in the zone. Rainfall played the biggest role in malaria trends. Human population appeared to influence malaria incidences in the low altitude areas partly due to population concentration in this zone. Malaria control interventions ought to be strengthened and strategically designed to achieve no malaria cases across all the altitudinal zones. Integration of climate information within malaria interventions can also strengthen eradication strategies of malaria in such differentiated altitudinal zones.

Background: Malaria remains a public health challenge in low- and middle-income countries (LMICs). Despite gains from strategies like Insecticide-Treated Nets (ITNs) and Intermittent Preventive Treatment during pregnancy (IPTp), significant socioeconomic inequalities persist, particularly among pregnant women and children under five. This study analyzed temporal and socioeconomic inequalities in malaria prevention in sub-Saharan Africa (SSA). Methods: Nationally representative Demographic Health Surveys from 10 SSA countries (Mozambique, Burkina Faso, Tanzania, Côte d’Ivoire, Madagascar Kenya, Rwanda, Nigeria, Uganda, and Cameroon) were used, comparing two time periods. Changes in ITN use by pregnant women and children under five, as well as IPTp coverage, were assessed. Inequalities based on socioeconomic status (SES) and residence were analyzed using the Erreygers Normalized Concentration Index and Theil index. Results: The results revealed significant variability in ITN use and IPTp coverage within countries. Eight countries showed improvements in ITN use during pregnancy, with Nigeria seeing a 173.9% increase over five years. Burkina Faso and Tanzania consistently reported high ITN use (~87%) in children under five. IPTp coverage increased in all countries except Kenya. Decomposition using the Theil index indicated that within-group inequalities, particularly based on SES and residence, were the primary drivers of disparities. Conclusions: To ensure progress toward universal health coverage, malaria prevention programs must prioritize vulnerable populations and be continuously evaluated.