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Birth registration and child undernutrition in sub-Saharan Africa
Authors: Ornella Comandini, Stefano Cabras, and Elisabetta Marini
Source: Public Health Nutrition, 16:1-11, doi:10.1017/S136898001500333X
Topic(s): Child health
Nutrition
Country: Africa
   Multiple African Countries
Published: DEC 2015
Abstract: Objective: In many countries of the world millions of people are not registered at birth. However, in order to assess children's nutritional status it is necessary to have an exact knowledge of their age. In this paper we discuss the effects of insufficient or imprecise age data on estimates of undernutrition prevalence. Design: Birth registration (BR) rates and levels of stunting, underweight, and wasting were retrieved from MICS and DHS surveys of 37 sub-Saharan African countries, considering the subdivision in wealth quintiles. The composition of the cross-sectional sample used for nutritional evaluation was analysed using a permutation test. Logistic regression was applied to analyse the relationship between BR and undernutrition. The 95% probability intervals and Student’s t-test were used to evaluate the effect of age bias and error. Results: Heterogeneous sampling designs have been detected among countries, with different percentages of children selected for anthropometry. Further, registered children were slightly more represented within samples used for nutritional analysis than in the total sample. A negative relationship between BR and undernutrition was recognised, with registered children showing a better nutritional status than unregistered ones, even within each wealth quintile. The over- or underestimation of undernutrition in case of systematic over- or under-estimation of age, respectively, the latter being more probable, was quantified up to 28%. Age imprecision showed to slightly overestimate undernutrition. Conclusions: Selection bias toward registered children and under-estimation of children’s age can lead to an underestimation of the prevalence of undernutrition. Keywords: stunting, wasting, underweight, DHS, MICS