Objectives: To assess and quantify the magnitude of inequalities in under-five child malnutrition,
particularly those ascribable to socio-economic status and to consider the policy implications of
these findings.
Methods: Data on 3765 under-five children were derived from the Living Standards and
Development Survey. Household income, proxied by per capita household expenditure, was used
as the main indicator of socio-economic status. Socio-economic inequality in malnutrition (stunting,
underweight and wasting) was measured using the illness concentration index. The concentration
index was calculated for the whole sample, as well as for different population groups, areas of
residence (rural, urban and metropolitan) and for each province.
Results: Stunting was found to be the most prevalent form of malnutrition in South Africa.
Consistent with expectation, the rate of stunting is observed to be the highest in the Eastern Cape
and the Northern Province – provinces with the highest concentration of poverty. There are
considerable pro-rich inequalities in the distribution of stunting and underweight. However,
wasting does not manifest gradients related to socio-economic position. Among White children,
no inequities are observed in all three forms of malnutrition. The highest pro-rich inequalities in
stunting and underweight are found among Coloured children and metropolitan areas. There is a
tendency for high pro-rich concentration indices in those provinces with relatively lower rates of
stunting and underweight (Gauteng and the Western Cape).
Conclusion: There are significant differences in under-five child malnutrition (stunting and
underweight) that favour the richest of society. These are unnecessary, avoidable and unjust. It is
demonstrated that addressing such socio-economic gradients in ill-health, which perpetuate
inequalities in the future adult population requires a sound evidence base. Reliance on global
averages alone can be misleading. Thus there is a need for evaluating policies not only in terms of
improvements in averages, but also improvements in distribution. Furthermore, addressing
problems of stunting and underweight, which are found to be responsive to improvements in
household income status, requires initiatives that transcend the medical arena.