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Malnutrition among children under the age of five in the Democratic Republic of Congo (DRC) : does geographic location matter?
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Kandala, Ngianga-Bakwin, Madungu, Tumwaka P., Emina Be-Ofuriyua, Jacques, Nzita Kikhela, D. and Cappuccio, Francesco (2011) Malnutrition among children under the age of five in the Democratic Republic of Congo (DRC) : does geographic location matter? BMC Public Health, Vol.11 . Article:261. doi:10.1186/1471-2458-11-261 ISSN 1471-2458.
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Official URL: http://dx.doi.org/10.1186/1471-2458-11-261
Abstract
Background: Although 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.
Methods: We 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.
Results: Although 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.
Conclusion: 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 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.
Data sourced from Thomson Reuters' Web of Knowledge
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