What Drives Child Health Inequality In Nigeria? Decomposing The Socioeconomic Gap In Children Nutritional Status

Abstract

Child undernutrition remains a critical public health challenge in Nigeria and despite policy efforts, evidence on the magnitude and drivers of inequality in child nutritional status using formal decomposition methods remains limited. This study quantifies and decomposes socioeconomic inequality in child nutritional status in Nigeria using three waves of the Nigeria Demographic and Health Survey (2008, 2013 and 2018). Socioeconomic inequality in weight-for-age z-scores (WAZ) was measured using the Concentration Index (CI) while Wagstaff and Oaxaca-Blinder decomposition methods were employed to quantify the contribution of each determinant to overall inequality. The result shows a persistent pro-poor inequality in child nutrition observed across all survey years. When ranked by wealth, the CI was -0.202 (2008), -0.150 (2013) and -0.171 (2018); when ranked by maternal education, the CI was -0.220, -0.167 and -0.188, respectively (all p<0.01). Decomposition analyses revealed that maternal secondary and tertiary education were the largest contributors to wealth-based inequality, while household wealth was the dominant driver of education-based inequality. Antenatal care visits contributed a mild 13–26% across models. On the side of Oaxaca–Blinder decomposition, the result showed that the mean WAZ gap between rich and poor children ranged from -0.635 to -0.778, with the explained component rising from 47.5% in 2008 to 60.0% in 2018, driven primarily by maternal education and antenatal care visits. The unexplained component increased markedly by 2018 (23.8%), suggesting growing disparities in the returns to endowments. The study concludes that socioeconomic inequality in child nutrition in Nigeria is persistent and structurally entrenched. Therefore, the study recommends, among others, that government should ensure girls complete secondary education through targeted scholarships and conditional transfers as well as ensure instituting and scaling up of nutrition-sensitive cash transfers for the poorest households.