Socioeconomic inequalities in early childhood malnutrition and morbidity: modification of the household-level effects by the community SES

This paper examines variations among communities in childhood malnutrition and diarrhea morbidity, explores the influences of socioeconomic status (SES) on child health, and investigates how the SES of families and that of communities interact in this process. Using multilevel modelling and data from Demographic and Health Surveys of five African countries, it shows evidence of contextual effects and a strong patterning in childhood malnutrition and morbidity along SES lines, with community SES having an independent effect in some instances. It also reveals that living in poorest conditions increases the odds of suffering from both malnutrition and diarrhea, as opposed to experiencing only one of the two outcomes. Importantly, community SES significantly modifies the effects of the household SES, suggesting that measures to improve access of mothers and children to basic community resources may be necessary preconditions for higher levels of familial socioeconomic situation to contribute to improved child health. (c) 2004 Elsevier Ltd. All rights reserved.