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Do childhood growth indicators in developing countries cluster? Implications for intervention strategies
Bridget Fenn1, Saul S Morris, Chris Frost
1Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK. bridget.fenn@lshtm.ac.uk
Public Health Nutrition
|October 16, 2004
Summary
Geographic targeting of nutrition programs is often ineffective because childhood malnutrition, including stunting and wasting, shows low spatial clustering. This lack of clustering means interventions may miss many malnourished children, reducing cost-effectiveness.
Area of Science:
- Public Health
- Nutritional Epidemiology
- Spatial Analysis
Background:
- Geographic targeting is a common strategy for nutrition programs.
- Its effectiveness relies on the spatial clustering of malnutrition.
- Limited evidence exists on the spatial distribution of childhood malnutrition indicators.
Purpose of the Study:
- To investigate the spatial clustering of childhood stunting and wasting.
- To assess the implications of this clustering for the effectiveness of geographic targeting in nutrition programs.
Main Methods:
- Analysis of Demographic and Health Survey (DHS) data from 46 developing countries (1992-2001).
- Calculation of intra-cluster correlation coefficients (ICCs) to measure clustering.
- Modeling the coverage of geographic targeting strategies based on malnutrition prevalence and ICCs.
Main Results:
- Low spatial clustering of stunting (median ICC=0.054) and wasting (median ICC=0.032) was observed across most countries.
- 78-91% of countries exhibited low clustering (ICC <0.1).
- Geographic targeting showed better coverage for wasting than stunting, but many countries would achieve less than 20% coverage for stunting.
Conclusions:
- Childhood nutritional status is primarily determined at household or individual levels, not geographically.
- Geographically targeted nutrition programs risk significant under-coverage and leakage, compromising cost-effectiveness.
- The low spatial clustering challenges the appropriateness of current geographically targeted nutrition interventions.