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      Exploring Spatial Variations and Determinants of Dietary Diversity Among Children in Ethiopia: Spatial and Multilevel Analysis Using EDHS (2011–2016)

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          Abstract

          Introduction

          Dietary diversity has a significant impact on children’s nutritional health. For developing and implementing interventions, it is critical to understand the regional distribution of dietary diversity and underlying factors. However, the application of spatial techniques in dietary studies has not been well documented. The study’s goal was to look into the regional variances and factors that influence children’s dietary diversity. Further, we have discussed the spatial correlation of dietary diversity with nutritional status.

          Methods

          Data from the National Demographic and Health Survey were used during analyses. This work evaluated the overall dietary diversity of children aged 6–23 months based on the 2017 WHO and UNICEF classification of minimum dietary diversity (MDD). The Local Anselin Moran’s I was estimated to look into the regional variation of dietary diversity and hotspot and cold spot areas. Further, multivariate multilevel logistic regression was used for factor analyses.

          Results

          Overall, only 13.3% (95% CI: 10.2–14.7%) of children in 2011 and 24% (95% CI: 15.5–26.5%) in 2016 achieved MDD. We identified statistically significant clusters of high inadequate dietary diversity (hotspots) in the districts of northern Ethiopia, notably in the Amhara, Tigray, and Afar regions, and clusters of low inadequate dietary diversity (cold spots) in the country’s central and western regions. In both studies, the frequency of dietary diversity was significantly higher among older children, those who had media exposure, and mothers and fathers who had received formal education.

          Conclusion

          According to our findings, the MDD of children in Ethiopia, as measured by WHO dietary assessment, slightly increased from 2011 to 2016. The dietary diversity of children was distributed non-randomly in different districts across regions of Ethiopia. Localized intervention and preventative methods to improve dietary patterns and culture can be developed using existing socio-demographic factors and districts with a larger distribution of inadequate dietary diversity.

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          Most cited references31

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          Minimum dietary diversity and associated factors among children aged 6–23 months in Addis Ababa, Ethiopia

          Background Dietary diversity has long been recognized as a key element of high quality diets. Minimum Dietary Diversity (MDD) is the consumption of four or more food groups from the seven food groups. Globally, only few children are receiving nutritionally adequate and diversified foods. More than two-thirds of malnutrition related child deaths are associated with inappropriate feeding practice during the first two years of life. In Ethiopia, only 7 % of children age 6–23 months had received the minimum acceptable diet. Therefore, the main aim of this study was to determine the level of minimum dietary diversity practice and identify the associated factors among children aged 6–23 months in Addis Ababa, Ethiopia. Methods A health facility based cross sectional study was undertaken in the three sub-cities of Addis Ababa from 26th February to 28th April, 2016. A multi-stage sampling technique was used to sample the 352 study participants or mothers who had children aged 6–23 months. Data were collected by using a structured and pretested questionnaire, cleaned and entered into Epi info 7 and analyzed using SPSS 24 software. Logistic regression was fitted and odds ratio with 95% confidence interval (CI) with p-value less than 0.05 was used to identify factors associated with minimum dietary diversity. Result In this study, the overall children with minimum dietary diversity score were found to be 59.9%. Mother’s educational attainment and a higher household monthly income were positively associated with the minimum dietary diversity practice. Similarly, mothers’ knowledge on dietary diversity and child feeding was positively associated with minimum dietary diversity child feeding practice, with an adjusted odds ratio of 1.98 (95% CI: 1.11–3.53). Conclusion In this study, the consumption of minimum dietary diversity was found to be high. In spite of this, more efforts need to be done to achieve the recommended minimum dietary diversity intake for all children aged between 6 and 23 months.
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            A brief conceptual tutorial on multilevel analysis in social epidemiology: investigating contextual phenomena in different groups of people.

            (1) To provide a didactic and conceptual (rather than mathematical) link between multilevel regression analysis (MLRA) and social epidemiological concepts. (2) To develop an epidemiological vision of MLRA focused on measures of health variation and clustering of individual health status within areas, which is useful to operationalise the notion of "contextual phenomenon". The paper shows how to investigate (1) whether there is clustering within neighbourhoods, (2) to which extent neighbourhood level differences are explained by the individual composition of the neighbourhoods, (3) whether the contextual phenomenon differs in magnitude for different groups of people, and whether neighbourhood context modifies individual level associations, and (4) whether variations in health status are dependent on individual level characteristics. Simulated data are used on systolic blood pressure (SBP), age, body mass index (BMI), and antihypertensive medication (AHM) ascribed to 25 000 subjects in 39 neighbourhoods of an imaginary city. Rather than assessing neighbourhood variables, the paper concentrated on SBP variance between individuals and neighbourhoods as a function of individual BMI. The variance partition coefficient (VPC) showed that clustering of SBP within neighbourhoods was greater for people with a higher BMI. The composition of the neighbourhoods with respect to age, AHM use, and BMI explained about one fourth of the neighbourhood differences in SBP. Neighbourhood context modified the individual level association between BMI and SBP. Individual level differences in SBP within neighbourhoods were larger for people with a higher BMI. Statistical measures of multilevel variations can effectively quantify contextual effects in different groups of people, which is a relevant issue for understanding health inequalities.
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              Exploring spatial variations and factors associated with childhood stunting in Ethiopia: spatial and multilevel analysis

              Background Stunting reflects a failure to receive adequate nutrition over a long period of time. Stunting is associated with adverse functional consequences including poor cognition, low educational performance, low adult wages, and poor reproductive outcomes. The objective of the study was to investigate spatial variations and factors associated with childhood stunting in Ethiopia. Methods This study is a secondary data analysis of the 2011 Ethiopian Demographic and Health Survey (EDHS). A total of 9893 children aged 0–59 months were included in the analysis. The Getis-Ord spatial statistical tool was used to identify high and low hotspots areas of stunting. A multilevel multivariable logistic regression was used to identify factors associated with stunting. Results Statistically significant hotspots of stunting were found in northern parts of the country whereas low hotspots where there was less stunting than expected were found in the central, eastern, and western parts of the country. In the final model of multilevel logistic regression analysis, individual and community level factors accounted for 36.6 % of childhood stunting. Short birth interval [AOR = 1.68; 95%CI: (1.46–1.93)], being male [AOR = 1.20; 95%CI: (1.08–1.33)], and being from a male-headed household [AOR = 1.18; 95 % CI: (1.01–1.38)] were the factors that increased the odds of stunting at the individual level. Children in the age group between 24–35 months were more likely to be stunted than children whose age was less than one year [AOR = 6.61; 95 % CI: (5.17–8.44)]. The odds of stunting among children with severe anemia were higher than children with no anemia [AOR = 3.23; 95%CI: (2.35–4.43)]. Children with mothers who had completed higher education had lower odds of being stunted compared to children whose mothers had no formal education [AOR = 0.42; 95%CI: (0.18–0.94)]. The odds of being stunted were lower among children whose fathers completed higher education [AOR = 0.58; 95%CI: (0.38–0.89)] compared to children whose fathers had no formal education. Children whose mothers who had high a Body Mass Index (BMI) (≥25.0 kg/m2) were less likely to be stunted compared with children whose mothers had a normal BMI (18.5 kg/m2-24.9 kg/m2)[AOR = 0.69; 95%CI: (0.52–0.90)]. Children from the poorest wealth quintile had higher odds of being stunted compared to children from the richest wealth quintiles [AOR = 1.43; 95 % CI: (1.08–1.88)]. Unavailability of improved latrine facilities and living in the northern parts of the country (Tigray, Affar, Amhara and Benishangul-Gumuzregions) were factors associated with higher odds of stunting from the community-level factors. Conclusion Stunting in children under five years old is not random in Ethiopia, with hotspots of higher stunting in the northern part of Ethiopia. Both individual and community-level factors were significant determinants of childhood stunting. The regions with high hotspots of child stunting should be targeted with additional resources, and the identified factors should be considered for nutritional interventions.
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                Author and article information

                Journal
                J Multidiscip Healthc
                J Multidiscip Healthc
                jmdh
                jmulthealth
                Journal of Multidisciplinary Healthcare
                Dove
                1178-2390
                21 September 2021
                2021
                : 14
                : 2633-2650
                Affiliations
                [1 ]School of Public Health, Dilla University , Dilla, Ethiopia
                [2 ]Department of Health Informatics, Arba Minch University , Arba Minch, Ethiopia
                [3 ]Department of Nursing, Dilla University , Dilla, Ethiopia
                [4 ]Department of Psychiatry, Dilla University , Dilla, Ethiopia
                Author notes
                Correspondence: Binyam Tariku Seboka School of Public Health, Dilla University , P.O Box: 419, Dilla, EthiopiaTel +251 920612180Fax +251 46-331-2568 Email bini555tar@gmail.com
                Author information
                http://orcid.org/0000-0002-8309-5986
                http://orcid.org/0000-0003-0887-7803
                http://orcid.org/0000-0001-9899-555X
                http://orcid.org/0000-0002-5847-1425
                http://orcid.org/0000-0002-2600-243X
                http://orcid.org/0000-0003-2115-1337
                Article
                327456
                10.2147/JMDH.S327456
                8464345
                34584420
                246189c5-7dc0-4959-8ebc-5a7f2042243a
                © 2021 Seboka et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 11 July 2021
                : 03 September 2021
                Page count
                Figures: 11, Tables: 13, References: 38, Pages: 18
                Funding
                Funded by: No funding;
                No funding was obtained for this study.
                Categories
                Original Research

                Medicine
                dietary diversity,dd,minimum dietary diversity,mdd,under-five children,spatial,multilevel,ethiopia
                Medicine
                dietary diversity, dd, minimum dietary diversity, mdd, under-five children, spatial, multilevel, ethiopia

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