Geo-spatial pattern and determinants of composite index of anthropometric failure among children under five in Ethiopia.

Despite significant efforts, undernutrition remains a critical public health issue, particularly in developing countries like Ethiopia. Anthropometric failure, which indicates inadequate child growth and development, has severe consequences. Analyzing the spatial distribution and determinants of anthropometric failure is crucial for evaluating and improving nutritional programs. Understanding these spatial patterns can enhance targeted resource allocation, thereby accelerating progress toward optimal child growth. This study utilized a spatial analysis of anthropometric failure using data from the EMDHS 2019, focusing on a weighted sample of 3,659 children under five. The survey was conducted from March 21, 2019, to June 28, 2019, following a two-stage stratified sampling. Non-spatial analysis was conducted using STATA version 17, while ArcGIS Pro and SatScan version 9.6 were used for spatial visualization. Multiscale geographically weighted regression analysis identified significant determinants, with statistical significance set at a p-value of less than 0.05. The prevalence of anthropometric failure among the sampled children was 36.79% (95% CI 35.22%-38.37%). A clustered distribution was observed (Moran's I = 0.249, p < 0.001), with significant clustering in the Amhara, Tigray, Afar, and Somali regions. Children in these clusters were twice as likely to experience anthropometric failure (RR = 2.01, p < 0.001). Key determinants of spatial variation included mothers with no formal education (Mean = 0.1402, p < 0.001), low household wealth (Mean = 0.1651, p = 0.002), short birth intervals (Mean = 0.1165, p = 0.014), and insufficient postnatal care (Mean = 0.0589, p = 0.004). With a prevalence of 36.79%, anthropometric failure among children under five in Ethiopia is a major concern. The observed clustering highlights the need for targeted interventions, including improving maternal education, increasing household wealth, and enhancing access to family planning and postnatal care. Special emphasis should be placed on hotspot areas to effectively address and reduce undernutrition.