Trends and inequalities in severe wasting among children under five in Ghana based on a secondary analysis of national surveys 1988–2022

Abstract

Severe wasting, defined as weight-for-height z-score below − 3 standard deviations according to the WHO Child Growth Standards, reflects acute undernutrition and is associated with a substantially elevated risk of mortality among children under five years. In Ghana, most studies of child undernutrition focus on stunting and single survey rounds. Evidence on long-term trends and inequalities in severe wasting remains limited. This secondary analysis used harmonised data from nine nationally representative Demographic and Health Surveys (1988, 1998, 2003, 2008, 2014, 2022) and Multiple Indicator Cluster Surveys (2006, 2011, 2017) conducted in Ghana. Survey-weighted prevalence estimates and 95% confidence intervals (CIs) were generated using design-based methods accounting for clustering, stratification, and unequal sampling probabilities. Temporal trends and inequalities were examined descriptively by sex, age group, place of residence, household wealth, maternal education, and region. A weighted linear regression model, with survey year as the predictor and weights proportional to survey sample size, was used to assess the temporal trend in national severe wasting prevalence. National severe wasting prevalence declined overall from 2.1% in 1988 to 1.2% in 2022, although prevalence fluctuated across survey rounds, ranging from 2.8% in 2003 to 0.7% in 2014. Weighted linear regression demonstrated a statistically significant decline in severe wasting over time (R² = 0.56; F(1,7) = 8.99; p = 0.020), corresponding to an average reduction of 0.056% points per year (95% CI: −0.099 to − 0.012), or approximately 0.56% points per decade. Persistent inequalities were observed across survey rounds, with generally higher prevalence among male children, those living in rural areas, infants aged 6–11 months, children from poorer households, those whose mothers had no formal education, and children residing in northern regions. Regional disparities persisted over time, with Northern, Upper East, and Upper West regions frequently recording higher prevalence than other regions. Despite an overall national decline, persistent socioeconomic and geographic inequalities in severe wasting remain in Ghana. Strengthening harmonised and disaggregated nutrition surveillance is essential to guide equity-focused interventions and accelerate progress towards World Health Organization and Sustainable Development Goal nutrition targets.