ArticleBMJ paediatrics open2026
Estimating the risk of acute malnutrition among under-five children in Uganda: a distributional analysis of socioeconomic and structural inequalities.
Article in BMJ paediatrics open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundUnder-five undernutrition remains a critical public health challenge, but national averages frequently mask how acute vulnerabilities are socioeconomically and structurally distributed. A distributional epidemiology framework helps isolate actionable entry points for equity-oriented policy.
objectivesTo evaluate the socioeconomic and structural distribution of acute child undernutrition in Uganda and assess aetiological specificity across alternative nutritional outcomes.
designSecondary analysis of a nationally representative cross-sectional household survey.
settingCentral, Eastern, Northern and Western regions of Uganda (2019/2020 round).
participants815 children aged 24-59 months with complete anthropometric records sampled via a two-stage stratified systematic cluster design.
main outcome measuresChildhood wasting (weight-for-height z-score<-2SD) was the primary outcome; chronic stunting and underweight served as specificity checks. Socioeconomic inequalities were quantified using concentration indices. Predictors were modelled using Firth's penalised logistic regression to minimise small-sample bias.
resultsPrevalences for stunting, underweight and wasting were 16.9% (n=138), 11.8% (n=96) and 6.1% (n=50), respectively. Macrolevel socioeconomic inequality in wasting was modest and statistically non-significant (Relative Concentration Index=-0.0085, p=0.941). However, sharp structural barriers emerged: children residing ≥4 km from a health facility faced a more than threefold increase in the odds of wasting (adjusted OR (AOR)=3.42, 95% CI 1.01 to 11.54, p=0.048), reflecting an 8.2% absolute risk expansion. This geographic barrier was uniquely specific to wasting. Female children exhibited significantly higher wasting vulnerability (AOR=4.13, 95% CI 1.62 to 10.53, p=0.003; absolute risk increase: 5.0%). Household poverty showed an unexpected inverse trend bordering significance (AOR=0.48, 95% CI 0.21 to 1.09, p=0.080).
conclusionsChildhood wasting in Uganda is more closely linked to physical access barriers and demographic factors than household asset wealth. Mitigating acute undernutrition requires shifting from wealth-based targeting towards universal structural expansions, specifically prioritising decentralised primary healthcare and gender-sensitive community interventions.
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