Spatial trends and projections of chronic malnutrition among children under 5 years of age in Ethiopia from 2011 to 2019: a geographically weighted regression analysis

Geographically weighted regression analysis to assess hotspots of early sexual initiation and associated factors in Ethiopia

Background

Early sexual initiation (ESI) causes unintended pregnancy, sexually transmitted infections (STI), high risk of depression and anxiety, developmental delays, lack of emotional maturity, and difficulty in pursuing education. This study aims to analyze the geographically weighted regression and associated factors of ESI of women in Ethiopia.

Methods

The study utilized data from the Ethiopian Demographic and Health Survey, 2016. It included a weighted sample of 11,775 women. Spatial regression was carried out to determine which factors are related to hotspots of ESI of women. To identify the factors associated with ESI, a multilevel Poisson regression model with robust variance was conducted. An adjusted prevalence ratio (APR) with its 95 % confidence interval was presented.

Results

The prevalence of ESI was 75.3 % (95%CI: 74.6 %, 76.1 %), showing notable spatial variation across different regions of Ethiopia. Areas of significant hotspots of ESI were identified in Western and Southern Tigray, most parts of Amhara, Southern, Central and Western Afar, Eastern Gambella, and North Western SNNPR. The significant variables for the spatial variation of ESI were; being single, rural residence, and having no formal education of the women. Factors including; wealth index, marital status, khat chewing, education level, residence, and region were associated significantly with ESI in the multilevel robust Poisson analysis.

Conclusion

A higher proportion of ESI in women was found. Public health interventions must be made by targeting hotspot areas of ESI through increasing health care access and education (specifically among rural residents), developing a comprehensive sexual education, implementing policies and laws that outlaw early marriage, and mass community-based programs to increase awareness about the importance of delaying sexual activity.

Multi-Level Mixed-Effects Analysis of Stunting Among 6 to 59 Months Children in Ethiopia: Evidenced from Analysis of Health and Demographic Survey, 2000 to 2019

Background. Stunting remains a major public health issue in developing countries like Ethiopia. It is termed as a chronic malnutrition which leads to morbidity and mortality among children. This study aimed to assess the prevalence and factors associated with stunting among 6 to 59 months children in Ethiopia. Methods. A total weighted sample of 34 930 children aged 6 to 59 months was included in this study. A Multilevel Mixed-Effect logistic regression was carried out. The Median Odds Ratio (MOR) and the Intra class Correlation Coefficient (ICC) were calculated. An adjusted odds ratio along with a 95% confidence interval was reported and statistical significance was declared at a P-value ≤ .05. Results. The weighted prevalence of stunting in Ethiopia was 48.3% (95% CI: 47.8%, 48.8%). Being male, increased in age, having multiple births (twin), having less than 2 years birth interval, history of diarrhea, anemia, lack of maternal and paternal formal education, having poor and middle-wealth status, and living in rural areas were significantly associated with stunting. Conclusions. The prevalence of stunting is high in Ethiopia. The risk factors mentioned above increase the likely hood of stunting among children. Therefore, we recommend that responsible bodies place a greater emphasis and priority on promoting parental education, awareness on the impact of the birth interval on child nutrition, the prevention of childhood diarrhea and anemia, improving household economic status, and reducing rural-urban disparities.

Modeling the Risk Factors of Undernutrition among Children below Five Years of Age in Uganda Using Generalized Structural Equation Models

INTRODUCTION

The prevalence of undernutrition among children below five years of age, in Uganda and the world over, remains very high. About 45% of all global deaths among children below five years of age are attributed to undernutrition. A number of studies using different statistical approaches affirm this effect, yet some factors indicate the influence of other factors within the system. This study, therefore, uses a method that demonstrates how different variables feed into each other.

AIM

The aim of this study was to establish the major factors associated with an increased likelihood of undernutrition and the paths showing how these risk factors influence undernutrition.

METHODS

Data from the Uganda Demographic and Health Survey (UDHS, 2016) were used for this study. A sample of 4530 children, whose age, height, and weight measurements were recorded, was considered for this study. Additionally, the study used generalized structural equation models to identify the multifaceted natures and paths of the risk factors that influence undernutrition among children below five years of age. The study relied on the UNICEF 2020 conceptual framework to identify and analyze the direct and indirect effects of these risk factors of undernutrition.

RESULTS

From the perspective of a male child, having a perceived small size at birth, a low birth weight, being breastfed for less than 6 months, having no formal education from mothers, limited income-generating opportunities, a low wealth status, and notable episodes of diarrhea were among the key factors associated with an increased likelihood of undernutrition. The identified paths were as follows: (i) Having no education, as this was associated with limited working opportunities and a low income, which increases the likelihood of low household wealth status, hence increasing the chances of undernutrition. (ii) Exposure to a rural setting was associated with an increased likelihood of undernutrition through association with poor and or low employment levels within the rural areas. (iii) A shorter duration of breastfeeding was associated with children in urban areas, resulting in an increased likelihood of undernutrition. (iv) Children aged between 6 and 47 months had a higher likelihood of undernutrition.

CONCLUSIONS

An approach that addresses and recognizes all these factors at different levels, along the established paths, should be implemented to effectively reduce undernutrition among children below five years of age.

Bayesian multilevel modelling of the association between socio-economic status and stunting among under-five-year children in Tanzania

BACKGROUND

Stunting is associated with socioeconomic status (SES) which is multidimensional. This study aimed to compare different SES indices in predicting stunting.

METHODS

This was the secondary data analysis using Tanzania Demographics and Health Surveys (TDHS). The study used 7492, 6668, and 8790 under-five-year children from TDHS 2004/5, 2010, and 2015/16, respectively. The Household Wealth Index (HWI); Water and Sanitation, Assets, Maternal education and Income (WAMI); Wealth Assets, Education, and Occupation (WEO); and the Multidimensional Poverty Index (MPI) indices were compared. The summated scores, principal component analysis (PCA), and random forest (RF) approaches were used to construct indices. The Bayesian and maximum likelihood multilevel generalized linear mixed models (MGLMM) were constructed to determine the association between each SES index and stunting.

RESULTS

The study revealed that 42.3%, 38.4%, and 32.4% of the studied under-five-year children were stunted in 2004/5, 2010, and 2015/16, respectively. Compared to other indicators of SES, the MPI had a better prediction of stunting for the TDHS 2004/5 and 2015/16, while the WAMI had a better prediction in 2010. For each score increase in WAMI, the odds of stunting were 64% [BPOR = 0.36; 95% CCI 0.3, 0.4] lower in 2010, while for each score increase in MPI there was 1 [BPOR = 1.1; 95% CCI 1.1, 1.2] times higher odds of stunting in 2015/16.

CONCLUSION

The MPI and WAMI under PCA were the best measures of SES that predict stunting. Because MPI was the best predictor of stunting for two surveys (TDHS 2004/5 and 2015/16), studies dealing with stunting should use MPI as a proxy measure of SES. Use of BE-MGLMM in modelling stunting is encouraged. Strengthened availability of items forming MPI is inevitable for child growth potentials. Further studies should investigate the determinants of stunting using Bayesian spatial models to take into account spatial heterogeneity.

Geospatial Overlap of Undernutrition and Tuberculosis in Ethiopia

Undernutrition is a key driver of the global tuberculosis (TB) epidemic, yet there is limited understanding regarding the spatial overlap of both diseases. This study aimed to determine the geographical co-distribution and socio-climatic factors of undernutrition and TB in Ethiopia. Data on undernutrition were found from the Ethiopian Demographic and Health Survey (EDHS). Data on TB were obtained from the Ethiopia national TB prevalence survey. We applied a geostatistical model using a Bayesian framework to predict the prevalence of undernutrition and TB. Spatial overlap of undernutrition and TB prevalence was detected in the Afar and Somali regions. Population density was associated with the spatial distribution of TB [β: 0.008; 95% CrI: 0.001, 0.014], wasting [β: -0.017; 95% CrI: -0.032, -0.004], underweight [β: -0.02; 95% CrI: -0.031, -0.011], stunting [β: -0.012; 95% CrI: -0.017, -0.006], and adult undernutrition [β: -0.007; 95% CrI: -0.01, -0.005]. Distance to a health facility was associated with the spatial distribution of stunting [β: 0.269; 95% CrI: 0.08, 0.46] and adult undernutrition [β: 0.176; 95% CrI: 0.044, 0.308]. Healthcare access and demographic factors were associated with the spatial distribution of TB and undernutrition. Therefore, geographically targeted service integration may be more effective than nationwide service integration.

Gender-specific disaggregated analysis of childhood undernutrition in Ethiopia: evidence from 2000-2016 nationwide survey

INTRODUCTION

Childhood undernutrition has been investigated extensively in previous literature but gender inequality detailing the burden of undernutrition has not been adequately addressed in scientific papers, especially in Ethiopia, where undernutrition is known to be a public health problem of high significance, necessitating increased efforts to address it and reduce this inequality. This study was carried out to: (1) explore gender differences in the prevalence of stunting, wasting, and underweight, and (2) compare the factors associated with childhood undernutrition between boys and girls in Ethiopia.

METHODS

The study used a dataset of more than 33,564 children aged under 5 years (boys: 17,078 and girls: 16,486) who were included in the nationally representative Ethiopia Demographic and Health Survey (EDHS) from 2000 to 2016. The outcome variables were anthropometric indices: stunting (height-for-age < -2 standard deviations), wasting (weight-for-height < -2 standard deviations), and underweight (weight-for-age < -2 standard deviations). Gender-specific multilevel analyses were used to examine and compare the factors associated with child undernutrition.

RESULTS

The overall prevalence of stunting (49.1% for boys vs 45.3% for girls, p < 0.001), wasting (11.9% for boys vs 9.9% for girls, p < 0.001), and underweight (33.1% for boys vs 29.8% for girls, p < 0.001) higher among boys compared to girls. Boys significantly had higher odds of stunting (aOR: 1.31, 95%CI: 1.21-1.42), wasting (aOR: 1.35, 1.23-1.48), and underweight (aOR: 1.38, 95%CI: 1.26-1.50) than girls. The common factors associated with childhood undernutrition for male and female children were the child's age, perceived size of the child at birth, breastfeeding status, maternal stature, maternal education, toilet facility, wealth index, and place of residence. Boys who were perceived by their mothers to be average sized at birth and were born to uneducated mothers had a higher likelihood of experiencing wasting, in contrast to girls. Among boys, birth order (firstborn), household size (1-4), and place of residence (urban) were associated with lower odds of being underweight. Boys living in cities had lower odds of being stunted. While girls born to mothers with no education and worked in agriculture were at a higher odd of being stunted.

CONCLUSION

Our study revealed that boys were more likely to be malnourished than girls, regardless of their age category, and there were variations in the factors determining undernutrition among boys and girls. The differences in the burden of undernutrition were significant and alarming, positioning Ethiopia to be questioned whether it will meet the set Sustainable Development Goals (SDGs), including SDG 2 of zero hunger by 2030. These findings call for more effort to address malnutrition as a significant public health issue in Ethiopia, and to urgently recognise the need for enhanced interventions that address the gender gap in childhood undernutrition.

Prevalence of enteric bacterial pathogens in diarrheic under-five children and their association with the nutritional status in Bahir Dar Zuria District, Northwest Ethiopia

BACKGROUND

Diarrheal disease is one of the leading causes of child mortality in low and middle-income countries. Low nutritional status and bacterial infections contribute to growth deficiency and death in children. But there is a gap in identifying the bacterial etiology of diarrheal diseases and their association with the nutritional status of under-five children. This study aimed to determine the bacterial etiology of diarrheal diseases and their association with the nutritional status of diarrheic under-five children.

METHODS

A cross-sectional study was carried out from February 2021 to March 2022 at seven Health Centers in Bahir Dar Zuria district, Ethiopia. A total of 196 diarrheic under-five children visiting the health centers were included in the study. Stool samples were collected from each child for the isolation of Salmonella, Shigella, and E.coli O157:H7. The demographic characteristics and symptoms of children were obtained from parents/guardians. The weight, height, and age of each child were recorded and anthropometric indices were determined by WHO Anthro version 3.2.2 software. The association between bacterial prevalence and the nutritional status of children was analyzed by SPSS version 26 software using Binary logistic regression. All analyses were conducted at a 95% confidence interval and significant association was determined using a p-value < 0.05.

RESULTS

Of the total children included in the study, 13.1% had either E.coli O157:H7, Shigella, or Salmonella. Watery diarrhea and fever were the most clinical characteristics observed in children who are positive for enteric bacteria. The prevalence of stunted, underweight, and wasted was 56.6%, 24.4%, and 13.2% respectively. Children with wasting were significantly associated with Salmonella detection (OR = 7.2, CI, 1.38-38.1, P = 0.02) whereas stunted and underweight were not associated with bacterial prevalence.

CONCLUSION

Overall, the prevalence of bacterial pathogens in the study area is high. Stunting, wasting, and being underweight are important nutritional deficits of diarrheic under-five children in the study site. Further studies targeting possible sources of bacteria and determinants of malnutrition in children are suggested. Health sectors found in the district should increase their effort to enhance good nutritional practice through health education and treatment of malnourished children by the provision of micronutrients.

Spatial Distribution and Temporal Trends of Dietary Niacin Intake in Chinese Residents ≥ 5 Years of Age between 1991 and 2018

Limited knowledge exists on trends in niacin consumption and the prevalence of inadequate intakes in China. Understanding trends and the spatial distribution of the prevalence of inadequate niacin intake is crucial to identifying high-risk areas and sub-populations. The dietary intakes of niacin between 1991 and 2018 were analyzed using the China Health and Nutrition Survey (CHNS) data. The estimated average requirement cut point was applied to estimate inadequacy. The geographic information system's ordinary kriging method was used to estimate the spatial distribution of the prevalence of inadequate niacin intakes. However, between 1991 and 2018, the prevalence of inadequate niacin intake increased from 13.00% to 28.40% in females and from 17.75% to 29.46% in males. Additionally, the geographically significant clusters of high and low prevalence were identified and remained stable over almost three decades. The high prevalence of insufficient niacin intake was more pronounced in Henan and Shandong over 27 years. Further, effective and tailored nutrition interventions are required to address inadequate niacin intake in China.