Spatial epidemiology of child malnutrition in Ethiopia: further analysis of 2011 Ethiopian demographic and health survey

Objectives

General objectiveThe main objective of this study is to assess hotspot clusters/geographical areas/ and map the epidemiological distribution of child malnutrition in Ethiopia.Specific objectives· To Identify the spatial distribution of child malnutrition using map in Ethiopia.· To identify the most likely high rates of child malnutrition in Ethiopia.

Methods

The nutritional indices of children (0-59 months) with GPS location data were accessed from EDHS 2011 after getting permission from the DHS measures. The child cluster level geographical’ addresses and nutritional data were cross linked with the cluster. Malnourished children were taken as cases and children who were not malnourished were taken as controls to fit the Bernoulli model. SaTScan™ software, version 9.4. using the Bernoulli Kulldorf method was used to for cluster analysis. Clusters geographical location was mapped using geographical information system (Arc GIS 10) on the Ethiopian shape file. The likelihood ratio test was used for each location and size of the scanning window to test the alternative hypothesis that there is an elevated risk within the window as compared to outside the window. P value less than 0.05 for LLR is considered as statistically significant level.

Results

The SaTScan spatial analysis result detected Liben, Afder and Borena administrative zones as the most likely primary spatial clusters (LLR = 28.98, p<0.001) for wasting. All administrative zones of Amhara, Tigray, Affar, Ben. Gumz regional states and East Welega and North showa zones from Oromiya regional state (LLR = 60.27, p<0.0001) were detected as the most likely primary clusters for child underweight. Also all administrative zones of Tigray, Amhara, Ben.Gumz and Affar regional states and West and North Showa and East Welega from Oromiya regional states (LLR = 97.28, P < 0.0001) were primary clusters for child stunting.

Conclusions

This study have tried to identify the hot-spots areas and showed geographical variability of child stunting, underweight and wasting in the country. Therefore, especial emphasis to the identified hotspot areas should be given to develop a local based nutritional interventional. Also further study is recommended to investigate the causes of child malnutrition on these areas.