Abstract
BackgroundAlthough there are inequalities in child health and survival in the Democratic Republic of Congo (DRC), the influence of distal determinants such as geographic location on children's nutritional status is still unclear. We investigate the impact of geographic location on child nutritional status by mapping the residual net effect of malnutrition while accounting for important risk factors.MethodsWe examine spatial variation in under-five malnutrition with flexible geo-additive semi-parametric mixed model while simultaneously controlling for spatial dependence and possibly nonlinear effects of covariates within a simultaneous, coherent regression framework based on Markov Chain Monte Carlo techniques. Individual data records were constructed for children. Each record represents a child and consists of nutritional status information and a list of covariates. For the 8,992 children born within the last five years before the survey, 3,663 children have information on anthropometric measures.Our novel empirical approach is able to flexibly determine to what extent the substantial spatial pattern of malnutrition is driven by detectable factors such as socioeconomic factors and can be attributable to unmeasured factors such as conflicts, political, environmental and cultural factors.ResultsAlthough childhood malnutrition was more pronounced in all provinces of the DRC, after accounting for the location's effects, geographic differences were significant: malnutrition was significantly higher in rural areas compared to urban centres and this difference persisted after multiple adjustments. The findings suggest that models of nutritional intervention must be carefully specified with regard to residential location.ConclusionChildhood malnutrition is spatially structured and rates remain very high in the provinces that rely on the mining industry and comparable to the level seen in Eastern provinces under conflicts. Even in provinces such as Bas-Congo that produce foods, childhood malnutrition is higher probably because of the economic decision to sell more than the population consumes. Improving maternal and child nutritional status is a prerequisite for achieving MDG 4, to reduce child mortality rate in the DRC.
Highlights
There are inequalities in child health and survival in the Democratic Republic of Congo (DRC), the influence of distal determinants such as geographic location on children’s nutritional status is still unclear
The major finding of this study is that malnutrition rates remain very high in the provinces that rely on the mining industry comparable to the level seen in Eastern provinces under war
This study has been able to determine that in the DRC, childhood malnutrition is spatially structured and rates remain very high in the provinces that rely on the mining industry and comparable to the level seen in Eastern provinces under war
Summary
There are inequalities in child health and survival in the Democratic Republic of Congo (DRC), the influence of distal determinants such as geographic location on children’s nutritional status is still unclear. Our study aims to investigate the impact of geographic location as a proxy for distal factors and their influences on nutritional status of children. Four reasons justify the interest of this study: first, geographic location is an important modifier of known predictors of malnutrition and is associated with food security and accessibility, especially in the context of conflict affected country such as the DRC. DRC is the third largest country (by area: 2,344,858 km2) in Africa and with immense natural resources distributed across its 11 provinces It is, with the population of more than 68 million, the eighteenth most populous nation in the world, and the fourth most populous nation in Africa, 62 percent of which are under the age of fifteen. The accumulated debt and severe economic decline are due to both recent war and decades of corruption and economic mismanagement [8,9]
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