title: Ethnicity and child health in northern Tanzania: Maasai pastoralists are disadvantaged compared to neighbouring ethnic groups.
abstract: The Maasai of northern Tanzania, a semi-nomadic ethnic group predominantly reliant on pastoralism, face a number of challenges anticipated to have negative impacts on child health, including marginalisation, vulnerabilities to drought, substandard service provision and on-going land grabbing conflicts. Yet, stemming from a lack of appropriate national survey data, no large-scale comparative study of Maasai child health has been conducted. Savannas Forever Tanzania surveyed the health of over 3500 children from 56 villages in northern Tanzania between 2009 and 2011. The major ethnic groups sampled were the Maasai, Sukuma, Rangi, and the Meru. Using multilevel regression we compare each ethnic group on the basis of (i) measurements of child health, including anthropometric indicators of nutritional status and self-reported incidence of disease; and (ii) important proximate determinants of child health, including food insecurity, diet, breastfeeding behaviour and vaccination coverage. We then (iii) contrast households among the Maasai by the extent to which subsistence is reliant on livestock herding. Measures of both child nutritional status and disease confirm that the Maasai are substantially disadvantaged compared to neighbouring ethnic groups, Meru are relatively advantaged, and Rangi and Sukuma intermediate in most comparisons. However, Maasai children were less likely to report malaria and worm infections. Food insecurity was high throughout the study site, but particularly severe for the Maasai, and reflected in lower dietary intake of carbohydrate-rich staple foods, and fruits and vegetables. Breastfeeding was extended in the Maasai, despite higher reported consumption of cow's milk, a potential weaning food. Vaccination coverage was lowest in Maasai and Sukuma. Maasai who rely primarily on livestock herding showed signs of further disadvantage compared to Maasai relying primarily on agriculture. We discuss the potential ecological, socioeconomic, demographic and cultural factors responsible for these differences and the implications for population health research and policy.
authors.affiliation: Department of Population Health, London School of Hygiene and Tropical Medicine, London, England, United Kingdom.
authors.forename: David W
authors.initials: DW
authors.lastname: Lawson
authors.affiliation: Department of Anthropology, University of California Davis, Davis, California, United States of America; Savannas Forever Tanzania, Arusha, Tanzania.
authors.forename: Monique
authors.initials: M
authors.lastname: Borgerhoff Mulder
authors.affiliation: University of Minnesota, Minneapolis, Minnesota, United States of America.
authors.forename: Margherita E
authors.initials: ME
authors.lastname: Ghiselli
authors.affiliation: National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania.
authors.forename: Esther
authors.initials: E
authors.lastname: Ngadaya
authors.affiliation: National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania.
authors.forename: Bernard
authors.initials: B
authors.lastname: Ngowi
authors.affiliation: National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania.
authors.forename: Sayoki G M
authors.initials: SG
authors.lastname: Mfinanga
authors.affiliation: St. Catherine University, Minneapolis, Minnesota, United States of America.
authors.forename: Kari
authors.initials: K
authors.lastname: Hartwig
authors.affiliation: Savannas Forever Tanzania, Arusha, Tanzania.
authors.forename: Susan
authors.initials: S
authors.lastname: James
mesh_terms: D044383:Black People / Q000208:ethnology*; D002648:Child; D002669:Child Welfare / Q000208:ethnology*; D002675:Child, Preschool; D003469:Culture; D006801:Humans; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013636:Tanzania / Q000208:ethnology; D035862:Vulnerable Populations / Q000208:ethnology*