Geospatial analysis of diarrhoea determinants among children under five in Pakistan using Multiscale Geographically Weighted Regression (MGWR)

Abstract

Diarrhoea is the second most common cause of death among children under five worldwide. About 90 percent of diarrhoeal diseases occur in South Asia and sub-Saharan countries. In Pakistan, it causes almost 53,000 children to die every year. Against this background, this study aimed to analyze the geographical variations in the socio-economic and climatic determinants of under-five diarrhoea cases in districts of Pakistan. We used Generalized Linear Regression (GLR) and Multiscale Geographically Weighted Regression (MGWR) to explore the spatial variation of diarrhoea and its associated determinants. The MGWR model with 10 independent variables outperforms the GLR model (R2 = 0.72) with an adjusted R2 of 0.86. The local accuracy of the MGWR model increases from southwest to northeast. Furthermore among ten selected regressors, significant geographic diversity was found in the determinants of diarrhoea, including altitude, temperature, fever, ARI, and sanitation practices. These insights demand the need for targeted public health interventions, such as immunization campaigns, improved sanitation, and access to clean water and nutritional supplements, poverty eradication, especially in rural and high-risk regions. Future research should employ longitudinal designs and advanced spatial modeling to evaluate the impact of strategies and inform evidence-based policies to reduce the burden of childhood diarrhoea in Pakistan.