Abstract
Childhood stunting remains a major public health issue in many low- and middle-income countries. In Ghana, the progress made is insufficient to reach the targets set by the 2025 World Health Assembly and the 2030 United Nations Sustainable Development Goals. Although studies have examined the socio-demographic determinants of childhood stunting, there has not been any systematic study to examine the spatial associative effects of the socio-demographic and socio-ecological factors at the district level, where health programmes are implemented and monitored. Bayesian geo-additive semiparametric regression technique was used to analyse five conservative rounds of Demographic and Health Surveys in Ghana, with socio-ecological covariates derived from the Demographic and Health Survey Program Geospatial Covariate datasets to examine the temporal trends in childhood stunting, the extent of geospatial clustering at the district level and their associative relationships with socio-demographic and socio-ecological factors. The findings show that childhood stunting in Ghana is not spatially randomly distributed but clustered. Clustering of high childhood stunting was observed amongst districts in the Upper West, Upper East, Northern, North East, Savannah, and Western North regions, whilst clustering of low childhood stunting was observed in districts in the Greater Accra, Volta, Bono and the Eastern regions. Whist socio-demographic factors were predominantly associated with clustering of districts with high childhood stunting, the socio-ecological factors were mainly associated with clustering of districts with low childhood stunting. The socio-ecological factors identified to have a nonlinear associative effect with childhood stunting were Insecticide Treated Net (ITN) coverage, nightlight composite, travel time to a main settlement and population density. The findings suggest that targeted interventions at the district level are essential to reducing childhood stunting in Ghana.
Highlights
This study examined the spatiotemporal clustering and socio-demographic and socio-ecological factors associated with district-level spatial patterns of childhood stunting in Ghana
The results further show that maternal age was significantly lower for mothers whose children were stunted when compared to those whose children were not stunted, with statistically significant effects in the 1993, 2008, and 2014 Ghana Demographic and Health Survey (GDHS)
The results further show that the mean number of household members and the number of living children were significantly associated with childhood stunting
Summary
Often measured by stunting (low height-for-age) and wasting (low weight-for-height), is a reflection of social inequalities and a major public health challenge in many low- and middle-income countries [1]. The number of children with faltered growth has declined since 2000 (199.5 million children were estimated to be stunted in 2000), the progress made is insufficient to reach the targets set by the 2025 World Health Assembly (WHA) and the 2030 United Nations (UN) Sustainable Development Goals (SDGs) [2]. The global nutrition target set by the 2025 WHA and 2030 UN SDG is to achieve by 2025 a 40% reduction in the number of children under-five who are stunted [2]. Global and regional estimates confirm that stunting remains the most prevalent form of childhood malnutrition, whilst wasting is generally low even in developing countries, except in situations of severe food shortage [1, 2, 4]
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