TY - JOUR
T1 - Bayesian geostatistical modelling of stunting in Rwanda
T2 - risk factors and spatially explicit residual stunting burden
AU - Uwiringiyimana, V.
AU - Osei, F.
AU - Amer, S.
AU - Veldkamp, A.
N1 - Funding Information:
This work was done under a doctoral research fellowship funded by a Nuffic funded NICHE project in collaboration with the Faculty of Geo-Information Science and Earth Observation (ITC) of the University of Twente, and the Centre for Geographic Information Systems and Remote Sensing (CGIS), University of Rwanda. There was no involvement of NICHE neither in the study design, analysis or interpretation of results, nor in the writing of the manuscript.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/1/24
Y1 - 2022/1/24
N2 - Background: Stunting remains a significant public health issue in Rwanda and its prevalence exhibits considerable geographical variation. We apply Bayesian geostatistical modelling to study the spatial pattern of stunting in children less than five years considering anthropometric, socioeconomic and demographic risk factors in Rwanda. In addition, we predict the spatial residuals effects to quantify the burden of stunting not accounted for by our geostatistical model. Methods: We used the data from the 2015 Rwanda Demographic and Health Survey. We fitted two spatial logistic models with similar structures, only differentiated by the inclusion or exclusion of spatially structured random effects. Results: The risk factors of stunting identified in the geostatistical model were being male (OR = 1.32, 95% CI: 1.16, 1.47), lower birthweight (kg) (OR = 0.96, 95% CI: 0.95, 0.97), non-exclusive breastfeeding (OR = 1.24, 95% CI: 1.04, 1.45), occurrence of diarrhoea in the last two weeks (OR = 1.18, 95% CI: 1.02, 1.37), a lower proportion of mothers with overweight (BMI ≥ 25) (OR = 0.82, 95% CI: 0.71, 0.95), a higher proportion of mothers with no or only primary education (OR = 1.14, 95% CI: 0.99, 1.36). Also, a higher probability of living in a house with poor flooring material (OR = 1.22, 95% CI: 1.06, 1.41), reliance on a non-improved water source (OR = 1.13, 95% CI: 1.00, 1.27), and a low wealth index were identified as risk factors of stunting. Mapping of the spatial residuals effects showed that, in particular, the Northern and Western regions, followed by the Southern region of Rwanda, still exhibit a higher risk of stunting even after accounting for all the covariates in the spatial model. Conclusions: Further studies are needed to identify the still unknown spatially explicit factors associated with higher risk of stunting. Finally, given the spatial heterogeneity of stunting, interventions to reduce stunting should be geographically targeted.
AB - Background: Stunting remains a significant public health issue in Rwanda and its prevalence exhibits considerable geographical variation. We apply Bayesian geostatistical modelling to study the spatial pattern of stunting in children less than five years considering anthropometric, socioeconomic and demographic risk factors in Rwanda. In addition, we predict the spatial residuals effects to quantify the burden of stunting not accounted for by our geostatistical model. Methods: We used the data from the 2015 Rwanda Demographic and Health Survey. We fitted two spatial logistic models with similar structures, only differentiated by the inclusion or exclusion of spatially structured random effects. Results: The risk factors of stunting identified in the geostatistical model were being male (OR = 1.32, 95% CI: 1.16, 1.47), lower birthweight (kg) (OR = 0.96, 95% CI: 0.95, 0.97), non-exclusive breastfeeding (OR = 1.24, 95% CI: 1.04, 1.45), occurrence of diarrhoea in the last two weeks (OR = 1.18, 95% CI: 1.02, 1.37), a lower proportion of mothers with overweight (BMI ≥ 25) (OR = 0.82, 95% CI: 0.71, 0.95), a higher proportion of mothers with no or only primary education (OR = 1.14, 95% CI: 0.99, 1.36). Also, a higher probability of living in a house with poor flooring material (OR = 1.22, 95% CI: 1.06, 1.41), reliance on a non-improved water source (OR = 1.13, 95% CI: 1.00, 1.27), and a low wealth index were identified as risk factors of stunting. Mapping of the spatial residuals effects showed that, in particular, the Northern and Western regions, followed by the Southern region of Rwanda, still exhibit a higher risk of stunting even after accounting for all the covariates in the spatial model. Conclusions: Further studies are needed to identify the still unknown spatially explicit factors associated with higher risk of stunting. Finally, given the spatial heterogeneity of stunting, interventions to reduce stunting should be geographically targeted.
KW - Bayesian modelling
KW - Rwanda
KW - Spatial pattern
KW - Spatial residuals
KW - Stunting
KW - ITC-ISI-JOURNAL-ARTICLE
KW - ITC-GOLD
UR - https://ezproxy2.utwente.nl/login?url=https://library.itc.utwente.nl/login/2022/isi/osei_bay.pdf
U2 - 10.1186/s12889-022-12552-y
DO - 10.1186/s12889-022-12552-y
M3 - Article
C2 - 35073893
AN - SCOPUS:85123616099
VL - 22
SP - 1
EP - 14
JO - BMC public health
JF - BMC public health
SN - 1471-2458
IS - 1
M1 - 159
ER -