Does location matter? A study of malnutrition amongst Ethiopian children

Village in Ethiopia

The Nutrition Society Paper of the Month for March is from Public Health Nutrition and is entitled: ‘Local spatial clustering of stunting and wasting among children under the age of 5 years: implications for intervention strategies’.  Lead author, Seifu Hagos Gebreyesus, discusses the effects of location on malnutrition in Ethiopia.

As malnutrition is a major public health problem in Ethiopia, we aimed to find out how the acute and chronic forms of undernutrition occur in the districts and kebeles (a kebele is the smallest administrative unit) in Ethiopia. Such knowledge could be helpful in improving our understanding of the distribution of undernutrition on a local scale, as well as designing targeted nutrition intervention programmes.  

For this purpose, we surveyed children under five years old from 1744 households across six villages in Ethiopia. We measured children’s height, weight, and the geographic locations (latitudes and longitudes) of households. Using data from 2371 children, we evaluated how malnutrition is distributed within a district and its kebeles.

Although many believe that undernutrition is equally distributed within an area, we found that children living in certain locations within a district were more susceptible to undernutrition than those living in different locations within the same district.  Children living within these vulnerable locations were 1.5 times more likely to be stunted, and 1.7 times more likely to be severely stunted than children living in other locations within the district. Similarly, in some kebeles we were able to identify distinct areas within and between villages where children had a higher risk of acute malnutrition (wasting and severe wasting).

Our finding has important implications to nutritional intervention strategies. Stunting and wasting are not equally distributed, suggesting that when planning nutrition interventions, consideration should be given to variations in vulnerability due to location.  To help accelerate the reduction of malnutrition, it could be important to consider targeting locations where more susceptible children live. The approach would help reach children who are most likely to benefit from intervention programmes. 
We recommend that this research needs to be repeated in other areas of Ethiopia and other developing countries. We also would like to recommend further studies, possibly using an implementation research approach, to evaluate the feasibility, advantages and effectiveness of targeting nutritional interventions.  

Click here to read the paper in full.