Geographical variation in hotspots of stunting among under-five children in Ethiopia: A geographically weighted regression and multilevel robust Poisson regression analysis.
Childhood stunting is a global public health concern, associated with both short and long-term consequences, including high child morbidity and mortality, poor development and learning capacity, increased vulnerability for infectious and non-infectious disease. The prevalence of stunting varies significantly throughout Ethiopian regions. Therefore, this study aimed to assess the geographical variation in predictors of stunting among children under the age of five in Ethiopia using 2019 Ethiopian Demographic and Health Survey.
The current analysis was based on data from the 2019 mini Ethiopian Demographic and Health Survey (EDHS). A total of 5,490 children under the age of five were included in the weighted sample. Descriptive and inferential analysis was done using STATA 17. For the spatial analysis, ArcGIS 10.7 were used. Spatial regression was used to identify the variables associated with stunting hotspots, and adjusted R2 and Corrected Akaike Information Criteria (AICc) were used to compare the models. As the prevalence of stunting was over 10%, a multilevel robust Poisson regression was conducted. In the bivariable analysis, variables having a p-value < 0.2 were considered for the multivariable analysis. In the multivariable multilevel robust Poisson regression analysis, the adjusted prevalence ratio with the 95% confidence interval is presented to show the statistical significance and strength of the association.
The prevalence of stunting was 33.58% (95%CI: 32.34%, 34.84%) with a clustered geographic pattern (Moran's I = 0.40, p<0.001). significant hotspot areas of stunting were identified in the west and south Afar, Tigray, Amhara and east SNNPR regions. In the local model, no maternal education, poverty, child age 6-23 months and male headed household were predictors associated with spatial variation of stunting among under five children in Ethiopia. In the multivariable multilevel robust Poisson regression the prevalence of stunting among children whose mother's age is >40 (APR = 0.74, 95%CI: 0.55, 0.99). Children whose mother had secondary (APR = 0.74, 95%CI: 0.60, 0.91) and higher (APR = 0.61, 95%CI: 0.44, 0.84) educational status, household wealth status (APR = 0.87, 95%CI: 0.76, 0.99), child aged 6-23 months (APR = 1.87, 95%CI: 1.53, 2.28) were all significantly associated with stunting.
In Ethiopia, under-five children suffering from stunting have been found to exhibit a spatially clustered pattern. Maternal education, wealth index, birth interval and child age were determining factors of spatial variation of stunting. As a result, a detailed map of stunting hotspots and determinants among children under the age of five aid program planners and decision-makers in designing targeted public health measures.
Seifu BL
，Tesema GA
，Fentie BM
，Yehuala TZ
，Moloro AH
，Mare KU
... -
《PLoS One》
Exploring the spatial variation and associated factors of childhood febrile illness among under-five children in Ethiopia: Geographically weighted regression analysis.
The global burden of febrile illness and the contribution of many fever inducing pathogens have been difficult to quantify and characterize. However, in sub-Saharan Africa it is clear that febrile illness is a common cause of hospital admission, illness and death including in Ethiopia. Therefore the major aim of this study is to explore the spatial variation and associated factors of childhood febrile illness among under-five children in Ethiopia.
This study were based on the 2016 Ethiopian Demographic health survey data. A total weighted sample of 10,127 under- five children was included. Data management was done using Stata version-14, Arc-GIS version-10.8 and SatsScan version- 9.6 statistical software. Multi-level log binomial model was fitted to identify factors associated with childhood febrile illness. Variables with a p-value < 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable multilevel log binomial regression analysis p-value< 0.05, the APR with the 95% CI was reported. Global spatial autocorrelation was done to assess the spatial pattern of childhood febrile illness. Spatial regression was done to identify factors associated with the spatial variations of childhood febrile illness and model comparison was based on adjusted R2 and AICc.
The prevalence of febrile illness among under-five children was 13.6% (95% CI: 12.6%, 14 .7%) with significant spatial variation across regions of Ethiopia with Moran's I value of 0.148. The significant hotspot areas of childhood febrile illness were identified in the Tigray, Southeast of Amhara, and North SNPPR. In the GWR analysis, the proportion of PNC, children who had diarrhea, ARI, being 1st birth order, were significant explanatory variables. In the multilevel log binomial regression age of children 7-24 months(APR = 1.33, 95% CI: (1.03, 1.72)), maternal age 30-39 years (APR = 1.36 95% CI: 1.02, 1.80)), number of children (APR = 1.78, 95% CI: 0.96, 3.3), diarrhea(APR = 5.3% 95% CI: (4.09, 6.06)), ARI (APR = 11.5, 95% CI: (9.2, 14.2)) and stunting(APR = 1.21; 95% CI: (0.98, 1.49) were significantly associated with childhood febrile illness.
Childhood febrile illness remains public health problem in Ethiopia. On spatial regression analysis proportion of women who had PNC, proportion of children who had diarrhea, proportion of children who had ARI, and proportion of children who had being 1st birth order were associated factors. The detailed map of childhood febrile illness and its predictors could assist health program planners and policy makers to design targeted public health interventions for febrile illness.
Gelaw NB
，Tessema GA
，Gelaye KA
，Tessema ZT
，Ferede TA
，Tewelde AW
... -
《PLoS One》
Geographic weighted regression analysis of hot spots of modern contraceptive utilization and its associated factors in Ethiopia.
Utilization of modern contraceptives is a common healthcare challenge in Ethiopia. Prevalence of modern contraception utilization is varying across different regions. Therefore, this study aimed to investigate Geographic weighted regression analysis of hotspots of modern contraceptive utilization and its associated factors in Ethiopia, using Ethiopian Demographic and Health Survey 2016 data.
Based on the 2016 Ethiopian Demographic Health Survey data, a total weighted sample of 8,673 women was included in this study. For the Geographic Weighted Regression analysis, Arc-GIS version 10.7 and SaTScan version 9.6, statistical software was used. Spatial regression was done to identify factors associated with the hotspots of modern contraceptive utilization and model comparison was carried out using adjusted R2 and AICc. Variables with a p-value < 0.25 in the bi-variable analysis were considered for the multivariable analysis. Multilevel robust Poisson regression analysis was fitted for associated factors since the prevalence of modern contraceptive was >10%. In the multilevel robust Poisson regression analysis, the adjusted prevalence ratio with the 95% confidence interval was reported to declare the statistical significance and strength of association.
The prevalence of modern contraceptive utilization in Ethiopia was 37.25% (95% CI: 36.23%, 38.27%). Most of the hotspot areas were located in Oromia and Amhara regions, followed by the SNNPR region and Addis Ababa City administration. Single Women, poor Women, and more fertility preference were significant predictors of hotspots areas of modern contraceptive utilization. In the multivariable multilevel robust Poisson regression analysis, Women aged 25-34 years (APR = 0.88, 95% CI: 0.79, 0.98), 35-49 years (APR = 0.71, 95% CI: 0.61, 0.83), married marital status (APR = 2.59, 95% CI: 2.18, 3.08), Others religions (APR = 0.76, 95% CI: 0.65, 0.89), number of children 1-4 (APR = 1.18, 95% CI: 1.02, 1.37), no more fertility preference (APR = 1.21, 95% CI: 1.11, 1.32), Afar, Somali, Harari, and Dire Dawa: (APR = 0.42, 95% CI: 0.27, 0.67), (APR = 0.06, 95% CI: 0.03, 0.12), (APR = 0.78, 95% CI: 0.62, 0.98), and (APR = 0.75, 95% CI: 0.58, 0.98), respectively. Amhara region (APR = 1.34, 95% CI: 1.13, 1.57), rural residence (APR = 0.80, 95% CI: 0.67, 0.95) High community wealth index (APR = 0.78, 95% CI: 0.67, 0.91) were significantly associated with modern contraceptive utilization.
There were significant spatial variations of factors affecting modern contraceptive use across regions in Ethiopia. Therefore, public health interventions targeting areas with low modern contraceptive utilization will help to increase modern contraception use considering significant factors at individual and community levels.The detailed map of modern contraceptive use cold spots among reproductive age group and its predictors could assist program planners and decision-makers to design targeted public health interventions.Government of Ethiopia must develop more geographic targeted strategies for improving socioeconomic status of women and availability & accessibility of health facilities in rural areas of the countries.
Chekol YM
，Jemberie SB
，Goshe BT
，Tesema GA
，Tessema ZT
，Gebrehewet LG
... -
《PLoS One》
ResearchGate
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