Malnutrition among children under the age of five in the Democratic Republic of Congo (DRC): does geographic location matter?

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.

Gender Determined Roles and Under-Five Mortality among Agro-Pastoralist Communities in Handeni District, Tanzania

“…Women having more time with their underfive children will be able to promptly respond against diseases and other health problems. Studies by Kandala et al (2011) and Tambi et al (2017), which were conducted in DRC and Cameroon, observed that women involvement in subsistence farming limits care giving to under-five children. Unequal involvement in subsistence farming can expose under-five children to health problems which when persist longer may end in mortality.…”

“…Health of the under-five children varies from place to place which may be due to cultural differences (Kandala et al, 2011). Culture can be one of the most important factors influencing gender inequality, which burdens women with unequal division of gender roles that subsequently impact the health of under-five children.…”

“…It is clear that the sex category considered to be superior can make decision in different areas including decision on kind of treatment (at formal or informal health facilities), access to education, employment, household resources and assets ownership. A wider gap between male and female has implications to various household aspects including caring for family, which has implication for the health of under-five children (Kandala et al, 2011;Ringo et al, 2018).…”

A systems science perspective and transdisciplinary models for food and nutrition security

“…Progress in management of infectious diseases would directly or indirectly make a major contribution to reduction in malnutrition (2), and the links between nutrition and disease are complex enough to make modeling an important source of new insights. Modeling techniques such as ABM and SD are already widely used in epidemiology (56)(57)(58)(59)(60)(61)(62)(63)(102)(103)(104), where they offer advantages in capturing spatial and nonlinear dynamics, heterogeneity (56,105), and adaptive behavior. We have argued (above) that these same advantages make their application to agri-food systems compelling.…”

Imitation dynamics of vaccine decision-making behaviours based on the game theory

“…There exists ample theoretical work investigating infectious diseases and very valuable results on the control of epidemic spread have been obtained. In some of the studies [5,16,18,22,29,34] on childhood diseases, one eminent feature is that the transmission rates have salient differences since children have different immunities.…”