Nutritional inequalities among under-five children: a geospatial analysis of hotspots and cold spots in 73 low- and middle-income countries

Child undernutrition is a severe health problem in the developing world, which affects children's development in the long term. This study analyses the extent and patterns of under-five child undernutrition using Demographic and Health Surveys (DHS) for 73 low- and middle-income countries (LMIC...

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Published in:	International journal for equity in health Vol. 21; no. 1; pp. 135 - 20
Main Authors:	Amir-Ud-Din, Rafi, Fawad, Sakina, Naz, Lubna, Zafar, Sameen, Kumar, Ramesh, Pongpanich, Sathirakorn
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 15-09-2022 BioMed Central BMC
Subjects:	Child Child Nutrition Disorders - epidemiology Children Children & youth Demographic aspects Developing Countries Disease Distribution Gender GNP Gross National Product Growth Disorders - epidemiology Health aspects Health disparities Households Humans Immune system Income Income inequality Indicators Inequality Kenya LISA Low income groups Malnutrition Malnutrition - epidemiology Medical screening Moran’s I Mortality Neoliberalism Outliers (statistics) Pediatric research Per capita Personal health Society Socioeconomic factors Spatial analysis Statistics Stunting Thinness - epidemiology Trends Undernutrition Underweight Wasting Womens health Kenya Middle East Northern Africa Pakistan Sub-Saharan Africa South Asia LISA Wasting Moran’s I Stunting Underweight Inequality
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Summary:	Child undernutrition is a severe health problem in the developing world, which affects children's development in the long term. This study analyses the extent and patterns of under-five child undernutrition using Demographic and Health Surveys (DHS) for 73 low- and middle-income countries (LMICs). First, we mapped the prevalence of undernutrition in the developing world. Second, using the LISA (a local indicator of spatial association) technique, we analyzed the geographical patterns in undernutrition to highlight the localized hotspots (regions with high undernutrition prevalence surrounded by similar other regions), cold spots (regions with low undernutrition prevalence surrounded by similar other regions), and outliers (regions with high undernutrition surrounded by low undernutrition and vice versa). Third, we used Moran's I to find global patterns in child undernutrition. We find that South Asia has the highest under-five child undernutrition rates. The intra-country nutritional inequalities are highest in Burundi (stunting), Kenya (wasting), and Madagascar (underweight). The local indicator of spatial association (LISA) analysis suggests that South Asia, Middle East and North Africa (MENA) region, and Sub-Saharan Africa are undernutrition hotspots and Europe and Central Asia and Latin America, and the Caribbean are undernutrition cold spots (regions with low undernutrition surrounded by similar other regions). Getis Ord-Gi* estimates generally support LISA analysis. Moran's I and Geary's C gave similar results about the global patterns of undernutrition. Geographically weighted regressions suggest that several socioeconomic indicators significantly explain child undernutrition. We found a significant within and across country variation in stunting, wasting and underweight rates among the under-five children's population. The geospatial analysis also suggested that stunting, wasting, and underweight patterns exhibit clear regional patterns, underscoring the need for coordinated interventions at the regional level.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1475-9276 1475-9276
DOI:	10.1186/s12939-022-01733-1