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

Background 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. Methods This is a secondary data analysis of harmonised Joint Child Malnutrition Estimates from nine nationally representative Demographic and Health Surveys (1988, 1998, 2003, 2008, 2014, 2022) and Multiple Indicator Cluster Surveys (2006, 2011, 2017) in Ghana (n = 1,980–8,776 children aged 0–59 months per round). Weighted prevalence estimates with 95% CIs were generated using standardised anthropometric definitions and design-based methods accounting for clustering and stratification. Trends and inequalities were descriptively assessed by sex, age group, residence, household wealth quintile, maternal education, and subnational region. Results National severe wasting prevalence declined overall from 2.1% (1988) to 1.2% (2022), with variation across survey rounds (range 0.7% (2014)–2.8% (2003)). Across most surveys, persistent inequalities were observed by sex, residence, age, household wealth, maternal education, and region. Prevalence was generally higher among male compared with female children, rural compared with urban populations, and infants aged 6–11 months, and among children from poorer households and those whose mothers had no formal education, with northern regions consistently showing higher prevalence than southern regions. Illustrative differences include males vs females in 2022 (1.4% vs 0.9%), rural vs urban in 2022 (1.5% vs 0.8%), poorest vs richest households in 2017 (1.9% vs 0.4%), and non-educated vs educated mothers in 2008 (3.9% vs 2.2%), with higher prevalence among infants aged 6–11 months (up to 6.7% in 2003) and in Upper East (6.6% in 2003). Conclusions 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.