Inequalities in Child Health in Tanzania: Evidence on Structural and Systemic Determinants of Stunting

Child stunting remains a persistent public health and development challenge in Tanzania, with approximately one in three children under five affected. While nutrition-specific interventions have traditionally dominated, progress remains slow. This study adopts a multidimensional approach to examine the systemic and structural determinants of under-five child stunting inequalities, focusing on three interrelated pathways related to social and nutrition-sensitive aspects of maternal care: antenatal care (ANC) utilisation, child vaccination and maternal autonomy. Grounded in Grossman’s health production model and Sen’s capability approach, the research conceptualises stunting as a product of both inequities in public health service delivery and intra-household behavioural dynamics. The study employs a robust econometric design using nationally representative data from the Tanzania Demographic and Health Survey (TDHS) to examine systemic and structural factors of child stunting. Three analytical strategies are used: (i) a reweighted recentered influence function (RIF)-Oaxaca decomposition to quantify ANC-related rural-urban socioeconomic disparities in child stunting; (ii) a reduced-form regression discontinuity design (RDD) complemented by interrupted time series analysis (ITSA) to estimate the intent-to-treat (ITT) effect of Tanzania’s 2013 rotavirus vaccine introduction on child stunting; and (iii) an instrumental variable (IV) twostage least squares (2SLS) approach, which instruments maternal autonomy using distance from matrilineal borders to identify its causal relationship with child stunting. The findings show that: (i) disparities in ANC access account for more than 40% of rural-urban socioeconomic inequalities in child stunting, highlighting the need for equitable maternal healthcare delivery; (ii) the rotavirus vaccine rollout had a positive and statistically significant effect on child height-for-age z-score (HAZ), confirming long-term benefits beyond diarrheal disease prevention; and (iii) higher levels of maternal autonomy or empowerment are significantly associated to better child growth outcomes. These results affirm that stunting in Tanzania is not solely a nutrition issue but a broader issue of structural and systemic inequalities. Addressing stunting effectively requires a shift toward integrated, equity-driven interventions that target behavioural, social and institutional drivers of child health. Specifically, the study recommends: (i) utilising community health worker (CHW) networks, digital technologies and mobile outreach strategies to reduce geographic and financial barriers to ANC access in underserved and rural settings; (ii) investing in innovative immunisation delivery platforms – such as drone-based vaccine distribution and digital tracking systems – to reach zero-dose and under-immunised children that will close immunisation gaps and sustain child health gains; and (iii) scaling up gender-transformative interventions and localised maternal empowerment initiatives that challenge harmful norms and expand decisionmaking autonomy in the household. These recommendations are aligned with Tanzania’s Five-Year Development Plans (FYDPs), the National Multisectoral Nutrition Action Plan (NMNAP) and global targets under the Sustainable Development Goals (SDGs), particularly SDG 2 (zero hunger) and SDG 3 (good health and well-being). By prioritising inclusive service delivery, gender equity, and preventive care, this research provides a practical roadmap for accelerating progress in the fight against child stunting and advancing human capital and economic development goals.

Grantor dc:publisher

Stellenbosch : Stellenbosch University

Year dc:date.issued

2026

Author dc:creator

• Mwaseba, Steven Lee

Advisors dc:contributor.advisor

• Burger, Ronelle
• Von Fintel, Dieter

Language dc:language.iso

en

Repository record dc:identifier.uri

https://scholar.sun.ac.za/handle/10019.1/136121

OAI identifier oai:identifier

oai:scholar.sun.ac.za:10019.1/136121