Urbanization and Child Malnutrition

We examine whether urbanization is associated with improved child nutrition in Ghana and whether the relationship operates through household wealth. Using four rounds of the Ghana Demographic and Health Survey from 2003, 2008, 2014, and 2022, we combine child anthropometric outcomes with harmonized satellite nighttime light data at the cluster level. Child nutrition is measured using height-for-age and weight-for-age z-scores, along with binary indicators for stunting and underweight. Nighttime light intensity serves as the main measure of local urban economic activity, while household electricity access is used as an alternative measure of urban-related infrastructure. We estimate mediation models that decompose the relationship between urbanization and child nutrition into a direct component and an indirect component operating through household wealth. To address potential endogeneity, current nighttime light intensity is instrumented with its five-year lag. We also extend the analysis to the community level using Foster-Greer-Thorbecke indices, which summarize the prevalence, depth, and severity of malnutrition across DHS clusters. The results show that nighttime light intensity has limited direct association with stunting and underweight but is strongly associated with household wealth. In the IV-corrected mediation models, household wealth accounts for about 65% of the total effect on stunting, 77% on underweight, 70% on height-for-age z-scores, and 92% on weight-for-age z-scores. Results using household electricity access are consistent with the importance of the wealth channel and suggest that household electrification may also be directly associated with stunting, HAZ, and WAZ. At the cluster level, urbanization is associated with reductions in stunting prevalence and depth, while the effects on stunting severity and all underweight FGT measures are statistically insignificant.