Modelling Spatial Pattern of Anemia and Malnutrition Co-occurrence Among Under-five Children in Ethiopia: A Bayesian Geostatistical Approach

Background: Anemia and Malnutrition among under-five children are one of the major challenges to public health in Ethiopia. While anemia is responsible for delayed child development and growth, malnutrition is associated with the high infant mortality rate in Ethiopia. Method: This study aims to determine the socioeconomic, demographic, and geographical risk factors that simultaneously increase the co-occurrence of anemia and malnutrition among under-five children in Ethiopia. Geostatistical data was obtained from the Ethiopia Demographic and Health Survey for 2011 and 2016. A Bayesian hierarchical linear mixed model was adopted using the stochastic partial differential equation to estimate the spatial pattern of the co-occurrence of anemia and malnutrition in Ethiopia. Result: The findings revealed that gender, maternal education, number of children under five, birth order, preceding birth, contraceptive use, vaccination, marital status, birth weight, diarrhea, and fever are significant risk factors of the co-occurrence of anemia and malnutrition. The findings also reveal the vulnerability of under-five children to the co-occurrence of anemia and malnutrition within the first twenty months after birth and young maternal age. Regarding the geographical aspect, this study found a geographical disparity in the prevalence of anemia and malnutrition in Ethiopia. The highest burden of the co-occurrence of anemia and malnutrition lies in the Northern Gambela, Western Oromia, Northeast Benishangul-gumuz, Central and Northern Amhara, Southern Afar, and parts of Somali. Conclusion: These findings could be utilized by policymakers and intervention programs to simultaneously tackle and contain the prevalence of both anemia and malnutrition. For cost-effective intervention, policies and programs that improve individual-level risk factors of parents and caregivers are a more promising approach to tackle high prevalent regions than the ones on the children and should be considered as an utmost priority in the country.