Journal Article

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

Zafar, Sameen, Pongpanich, Sathirakorn, Naz, Lubna, Amir-ud-Din, Rafi, Fawad, Sakina, Kumar, Ramesh

2022

Overview

Background 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). Methods 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. Results 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. Conclusions 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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Child / Child Nutrition Disorders - epidemiology / Children / Children & youth / Demographic aspects / Developing Countries / Disease / Distribution / Equality and Human Rights / Gender / GNP / Gross National Product / Growth Disorders - epidemiology / Health aspects / Health disparities / Health Policy / Health Promotion and Disease Prevention / Health Services Research / Households / Humans / Immune system / Income / Income inequality / Inequality / Kenya / LISA / Low income groups / Malnutrition / Malnutrition - epidemiology / Marginalized groups / Medical screening / Medicine / Medicine & Public Health / Moran’s I / Mortality / Neoliberalism / Outliers (statistics) / Pediatric research / Per capita / Personal health / Public Health / Social Justice / Social Policy / Society / Socioeconomic factors / Spatial analysis / Statistics / Stunting / Thinness - epidemiology / Trends / Undernutrition / Underweight / Wasting / Womens health