Applied nutritional investigation spatial variation and determinants of stunting among children aged less than 5 y in Ethiopia: A spatial and multilevel analysis of Ethiopian Demographic and Health Survey 2019

Objectives: Stunting is a major global public health problem, associated with physical and cognitive impair-ments. Spatial variations in childhood stunting were observed due to changes in contextual variables from area to area, implying that geography is a crucial component in the development of strategies against child-hood stunting. However, to our knowledge, there are no up-to-date studies on the distribution of childhood stunting and its determinants in Ethiopia. Thus, the aim of this study was to investigate the spatial distribu-tion and determinants of stunting among children aged <5 yin Ethiopia.Methods: Geospatial and multilevel analysis of the Ethiopia Demographic and Health Survey 2019 data was done to investigate the spatial distribution and determinants of stunting among children aged <5 y in Ethio-pia. The analysis included 5753 weighted children aged <5. Spatial autocorrelations analysis was done to assess the spatial dependency of stunting. Hot spot and cluster outlier analysis was used to observe the spa-tial clustering of stunting. Kriging interpolation was used to predict stunting in an unsampled area. A multi-level logistic regression model was fitted to identify determinants of stunting. Adjusted odds ratio with 95% confidence interval (CI) was calculated and variables having a P < 0.05 were declared statistically significant.Result: The national prevalence of stunting was 36.81% (95% CI, 35.48%-38.15%), with significant spatial var-iations across Ethiopia. Spatial clustering of stunting was detected in the northern, northwestern, northeast-ern, and southwestern parts of Ethiopia. Age and sex of the child, birth interval, birth type, household wealth status, maternal education, region, and community-level illiteracy were factors significantly associated with stunting.Conclusion: Stunting significantly varies across Ethiopia, with the highest prevalence in Northern Ethiopia. Older age, poor family wealth, maternal illiteracy, and community illiteracy level were the significant deter-minants of stunting in children aged <5 y in this study. Policymakers should design interventions to reduce stunting among children aged <5 y through accessing education for women and applying economic empow-erment strategies in the hot spot areas.(c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)