Examining child health and nutrition inequalities in Tanzania

Thesis (PhD)--Stellenbosch University, 2022.ENGLISH SUMMARY: More than one-third of stunted children under the age of five reside in sub-Saharan Africa. Due to the multifaceted underlying causes of malnutrition, this has become a challenging situation to address. Tanzania is among the top five countries in Eastern and Southern Africa with unacceptably high prevalence and spatial inequality in malnutrition, making it an interesting case study for generating evidence to inform policies in sub-Saharan Africa. Over three chapters, this thesis attempted to explain the persistent malnutrition and inequality in malnutrition and highlight potential pathways to tackle it using data from Tanzania. Chapter 2 examines the impact of the maize price fluctuation on the growth of the children from households that produce foods and those which do not. Chapter 3 explored the impact of meat and milk consumption on child growth and how the effects are mediated by keeping homestead livestock. Chapter 4 estimates the inequality of opportunity in malnutrition and considers the contribution made by access to water and sanitation. Three major findings emerged from this thesis. The first relates to the heterogeneity impact of high maize prices on the growth of children from food-producing and food non-producing households. While a large body of research advocates for low food prices to protect children's nutrition, this thesis found that children from households that produce food could benefit from high prices. The negative impact of high maize price on growth is significantly more stronger on children from households that do not produce food than from food producing households. The results also show that girls from food non-producing households suffered more than boys from high maize prices. Across children of different ages, the study found that children aged 24-35 months who were no longer breastfeeding and began to eat from the same plate as older household members are more vulnerable to shock than other age groups. The mechanism through which the maize price affects child growth is by reducing micronutrient and diet diversity in food non-producing households and increasing consumption in the food producers. Second, the results show that the effects of milk are revealed after transitioning from breastfeeding, while the effects of meat is insignificant in all age groups. Specifically, milk significantly led to higher growth in children aged 24-35 months and 36-60 months living in households which own mixed but. Third, the findings reveal that 20 per cent of inequality of opportunity in Tanzania needs to be compensated in order for equality of opportunity to prevail. Strikingly, the results show that the circumstances affecting children in urban and rural areas are different. Water and sanitation contribute 42 per cent of the inequality of opportunity in rural areas. Intergenerational aspects, early life feeding practices and market volatility were found to be more important in urban areas than rural areas. Overall, the results suggest that for the effective reduction of malnutrition, public health interventions should consider the different underlying levels and causes of child malnutrition between subgroups and the impact that a range of interventions could have on children from rural and urban areas. Policies that address the needs of specific groups could effectively reduce malnutrition in Tanzania. A combination of nutrition and water and sanitation interventions has the potential to reduce both the prevalence of malnutrition and inequality of opportunity in Tanzania.AFRIKAANSE OPSOMMING: Meer as 'n derde van kinders jonger as vyf jaar oud met belemmerde groei woon in Afrika suid van die Sahara. Weens die veelvuldige onderliggende oorsake van wanvoeding is dit 'n baie uitdagende situasie om aan te pak. Tanzanie is een van die voorste vyf lande in Oos- en Suidelike Afrika met 'n onaanvaarbaar hoe voorkomssyfer en fisiese ongelykheid van wanvoeding, en kan dus as 'n interessante gevallestudie dien om inligting vir beleid in sub-Sahara-Afrika in te samel. In die drie hoofstukke van hierdie tesis word gepoog om hierdie voortdurende wanvoeding en ongelykheid in wanvoeding te verklaar en die potensiele maniere waarop die aangepak kan word, toe te lig, deur data van Tanzanie te gebruik. Hoofstuk 2 ondersoek die impak van die mielieprysskok op die groei van die kinders in huishoudings wat voedsel produseer teenoor die wat nie produseer nie. Hoofstuk 3 ondersoek die impak van vleis- en melkverbruik op kinders se groei en hoe die aanhou van vee die e_ek bemiddel. Hoofstuk 4 beraam die ongelykheid van geleenthede in wanvoeding en oorweeg die bydrae van toegang tot water en sanitasie. Drie hoofbevindings het in hierdie tesis na vore gekom. Die eerste hou verband met die heterogene impak van hoe mieliepryse op die groei van kinders in voedselproduserende huishoudings en huishoudings wat nie voedsel produseer nie. Alhoewel 'n groot deel van navorsingsinligting lae voedselpryse voorstaan om kinders se voeding te beskerm, is met hierdie tesis gevind dat kinders in huishoudings wat voedsel produseer by hoe pryse kan baat. Hoe mieliepryse het slegs 'n negatiewe effek op kinders in huishoudings wat nie voedsel produseer nie. Die resultate toon ook dat meisies in huishoudings wat nie produseer nie, meer as seuns weens die hoe mieliepryse gely het. By kinders van verskillende ouderdomme is bevind dat kinders tussen 24 en 35 maande wat nie meer geborsvoed word nie en dieselfde kos as ouer gesinslede begin eet het, meer kwesbaar was vir skok as ander ouderdomsgroepe. Die meganisme waardeur die mielieprys kinderontwikkeling a_ekteer is die vermindering van mikronutriente en verskeidenheid in die dieet van huishoudings wat nie produseer nie, en die verhoging van verbruik daarvan by voedselprodusente. Tweedens het die resultate getoon dat die e_ek van melk na vore kom nadat borsvoeding gestaak is, terwyl die effek van vleis eers op 'n later stadium van kinders se groei na vore kom. Melk spesi_ek het tot beduidende hoer groei gelei in kinders van 24 tot 35 maande en 36 tot 60 maande in huishoudings wat gemengde maar nie melkdiere besit het nie. Vir vleis was die e_ek beduidend in die ouderdomsgroep van 36 tot 60 maande van eienaars van vleisdiere. Derdens is bevind dat 20 persent van die ongelyke geleenthede in Tanzanie gekompenseer moet word om gelyke geleenthedete kan voorsien. Dit is opvallend dat die resultate getoon het dat die omstandighede wat kinders in stedelike en landelike gebied beinvloed, verskillend is. Water en sanitasie dra 42 persent by tot ongelyke geleenthede in landelike gebiede. Die tussengenerasie-aspekte, vroee voedingspraktyke en markvolatiliteit was belangriker in stedelike gebiede as in landelike gebiede. In die geheel gesien dui die resultate dat om wanvoeding e_ektief te verminder, openbare gesondheidsintervensies oorweging moet skenk aan onderliggende vlakke en oorsake van kinderwanvoeding tussen subgroepe en die impak wat 'n verskeidenheid van intervensies op kinders in landelike en stedelike gebiede kan he. Beleid wat op die behoeftes van spesi_eke groepe gemik is, kan wanvoeding in Tanzanie effektief verminder. 'n Kombinasie van intervensies vir voeding en water en sanitasie het die potensiaal om sowel die voorkoms van wanvoeding en ongelyke geleenthede in Tanzanie te verminder.Doctora