Girma Bekahegn, Sasahu Lealem Dibku, Rahman Azizur
School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
Department of Natural Resource Management, College of Agriculture and Natural Resource, Dilla University, Dilla, Ethiopia.
PLoS One. 2025 Jun 13;20(6):e0325812. doi: 10.1371/journal.pone.0325812. eCollection 2025.
Malnutrition is still a major global public health issue, especially in Sub-Saharan Africa (SSA), where millions of children suffer from stunting, a chronic form of the disease. In addition to limiting physical growth, stunting also impedes social and cognitive development, which frequently has long-term effects. Stunting is still incredibly common in SSA, with notable regional variations, despite international efforts to address hunger. Moreover, no studies have been conducted to assess the spatial distribution of stunting at the SSA level. Therefore, to pinpoint high-burden areas and guide focused treatments; this study intends to investigate the spatial distribution of stunting among breastfeeding children in SSA.
The demographic and Health Survey data from 31 SSA nations were used for this study. The investigation included a total of 174,586 breastfeeding children. Stunting clustering and geographic patterns were evaluated using Geographic Information Systems and spatial analytic methods such as Getis-Ord Gi* and Global Moran's I. Stunting prevalence in unsampled areas was predicted using spatial interpolation (Kriging techniques). For the participants, descriptive statistics were calculated.
Stunting prevalence in SSA varied from 17.63% to 53.68%, with Madagascar (39.43%), Burundi (42.40%), and the Democratic Republic of the Congo (53.68%) having the highest rates. Significant clustering of stunting was found by spatial analysis (Moran's I: 0.639, p < 0.001), with hotspots primarily located in Central and Eastern Africa, such as Ethiopia, and the Democratic Republic of the Congo. In Southern Africa, cold locations like Namibia and South Africa were found to have lower stunting rates.
The significant regional variability in the prevalence of stunting among nursing children in SSA was highlighted by this study. In order to address underlying variables including poverty, food insecurity, and limited access to healthcare, the findings highlighted the necessity of region-specific public health initiatives. To lessen the burden of stunting and its long-term effects, improved geospatial surveillance systems are crucial for locating high-risk locations and directing the distribution of resources.
营养不良仍然是一个重大的全球公共卫生问题，特别是在撒哈拉以南非洲地区（SSA），数以百万计的儿童患有发育迟缓这种慢性疾病形式。发育迟缓除了限制身体生长外，还会阻碍社会和认知发展，且这种影响常常具有长期效应。尽管国际社会为解决饥饿问题做出了努力，但发育迟缓在SSA地区仍然极其普遍，且存在显著的区域差异。此外，尚未有研究对SSA地区发育迟缓的空间分布进行评估。因此，为了确定高负担地区并指导针对性治疗，本研究旨在调查SSA地区母乳喂养儿童中发育迟缓的空间分布情况。
本研究使用了来自31个SSA国家的人口与健康调查数据。调查共纳入了174,586名母乳喂养儿童。使用地理信息系统和诸如Getis-Ord Gi*和全局莫兰指数（Global Moran's I）等空间分析方法评估发育迟缓的聚集情况和地理模式。利用空间插值法（克里金技术）预测未抽样地区的发育迟缓患病率。对参与者进行了描述性统计分析。
SSA地区的发育迟缓患病率在17.63%至53.68%之间，其中马达加斯加（39.43%）、布隆迪（42.40%）和刚果民主共和国（53.68%）的患病率最高。通过空间分析发现发育迟缓存在显著聚集现象（莫兰指数：0.639，p < 0.001），热点地区主要位于中非和东非，如埃塞俄比亚和刚果民主共和国。在南部非洲，纳米比亚和南非等冷点地区的发育迟缓率较低。
本研究突出了SSA地区哺乳儿童发育迟缓患病率存在显著的区域差异。研究结果强调了针对特定区域开展公共卫生举措的必要性，以解决包括贫困、粮食不安全和医疗服务可及性有限等潜在变量。为了减轻发育迟缓的负担及其长期影响，改进地理空间监测系统对于确定高风险地区和指导资源分配至关重要。
