Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Nutrition. 2022 Nov-Dec;103-104:111786. doi: 10.1016/j.nut.2022.111786. Epub 2022 Jul 1.
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.
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.
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.
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.
发育迟缓是一个全球性的主要公共卫生问题，与身体和认知障碍有关。由于各地区的背景变量发生变化，儿童发育迟缓存在空间差异，这意味着地理是制定针对儿童发育迟缓策略的关键组成部分。然而，据我们所知，目前还没有关于埃塞俄比亚儿童发育迟缓及其决定因素的最新研究。因此，本研究旨在调查埃塞俄比亚 5 岁以下儿童发育迟缓的空间分布及其决定因素。
对 2019 年埃塞俄比亚人口与健康调查数据进行地理空间和多层次分析，以调查埃塞俄比亚 5 岁以下儿童发育迟缓的空间分布及其决定因素。分析包括 5753 名加权 5 岁以下儿童。进行空间自相关分析以评估发育迟缓的空间依赖性。使用热点和聚类异常值分析观察发育迟缓的空间聚类。使用克里金插值法预测未采样区域的发育迟缓。拟合多水平逻辑回归模型以确定发育迟缓的决定因素。计算调整后的优势比及其 95%置信区间（CI），并宣布 P 值小于 0.05 的变量具有统计学意义。
全国发育迟缓患病率为 36.81%（95%CI，35.48%-38.15%），埃塞俄比亚各地存在显著的空间差异。在埃塞俄比亚北部、西北部、东北部和西南部地区检测到发育迟缓的空间聚类。儿童的年龄和性别、出生间隔、出生类型、家庭财富状况、母亲教育程度、地区和社区文盲率是与发育迟缓显著相关的因素。
发育迟缓在埃塞俄比亚各地差异显著，北部地区患病率最高。在本研究中，年龄较大、家庭财富状况较差、母亲文盲率和社区文盲水平是 5 岁以下儿童发育迟缓的显著决定因素。决策者应设计干预措施，通过为妇女提供教育并在热点地区实施经济赋权战略，减少 5 岁以下儿童的发育迟缓。
