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 impairments. 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 childhood 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 distribution and determinants of stunting among children aged <5 y in 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 Ethiopia. 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 spatial clustering of stunting. Kriging interpolation was used to predict stunting in an unsampled area. A multilevel 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 variations across Ethiopia. Spatial clustering of stunting was detected in the northern, northwestern, northeastern, 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 determinants 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 empowerment strategies in the hot spot areas.