Spatiotemporal Patterns and Determinants of Undernutrition Among Late Adolescent Girls in Ethiopia Using Ethiopian Demographic and Health Surveys 2000 to 2016: Spatiotemporal and Multilevel Approach.

Introduction: Under-nutrition of late adolescent girls in Ethiopia is the highest among Southern and Eastern African countries. However, the spatial and temporal variations of under-nutrition as a national context is not well understood. This study aimed the spatiotemporal patterns and determinants of under-nutrition among Late Adolescent Girls in Ethiopia. Methods: An in-depth secondary data analysis was conducted from women’s data of four consecutive Ethiopian Demographic and Health Surveys (EDHS) 2000 to 2016. A total of 12,056 late adolescent girls were included in this study. The global spatial autocorrelation was assessed using the Global Moran’s I statistic to evaluate the presence of geographical clustering and variability of undernutrition. The significant cluster scan statistics using Bernoulli model to detect local clusters of significant high rate and low rates of under-nutrition was explored. Multilevel binary logistic regression model with cluster level random effects was fitted to determine factors associated with under-nutrition among Late Adolescent girls in Ethiopia. Results: : undernutrition was clustered nationally during each survey (Global Moran’s I=0.009-0.045, Z-score= 5.55-27.24, p value < 0.001). In the final model, individual and community level factors accounted about 31.67% of the variations for under-nutrition. The odds of being under-nourished girls in the age groups of 18 -19 years were 57 % (AOR = 0.43; 95 % CI: 0.35 - 0.53) less likely than those from 15-17 years old. Being in higher educational status was 4.50 times (AOR= 4.50; 95% CI: 2.33–8.69) more likely to be under-nourished compared with no educational status. Undernutrition with occupation of sales was 40% (AOR=0.60; 95% CI: 0.43 – 0.84) lower than those with not working. The odds of being undernourished adolescents were 1.77 times (AOR=1.77; 95% CI: 1.24 - 2.53) higher than participants with unimproved latrine type. Rural residents were 2. 35 times (AOR=2.35; 95% CI: 1.41 - 3.92) more likely to be under nourish compared with urban residents. Conclusion: undernutrition among late adolescent girls was spatially clustered in Ethiopia. The significant high rate of undernutrition was observed in Northern and Eastern Ethiopia. Those regions with high rates of under-nutrition should design interventions to combat under-nutrition.