• Mohammed Seid Ali, Tewodros Getaneh Alemu, Masresha Asmare Techane, Chalachew Adugna Wubneh, Nega Tezera Assimamaw, Getaneh Mulualem Belay, Tadesse Tarik Tamir, Addis Bilal Muhye, Destaye Guadie Kassie, Amare Wondim, Bewuketu Terefe, Bethelihem Tigabu Tarekegn, Beletech Fentie, Almaz Tefera Gonete, Berhan Tekeba, Selam Fisiha Kassa, Bogale Kassahun Desta, Amare Demsie Ayele, Melkamu Tilahun Dessie, and Kendalem Asmare Atalell.
• Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. Electronic address: muheseid2592@gmail.com.
• Nutrition. 2022 Oct 1; 102: 111743.

ObjectivesChildhood underweight is a critical public health problem that needs urgent attention in developing countries like Ethiopia. Despite its variation between localities, the determinant factors and its geospatial variation have not been adequately addressed across the various regions of the country. Therefore, the aim of this study was to investigate the spatial variation and determinant factors of underweight among children under 5 y of age in Ethiopia.MethodsThe total weighted samples of 5753 children aged <5 y were included in this study. The data were taken from the 2019 Ethiopian Demographic and Health Survey (EDHS 2019). Arc GIS software was used to analyze geospatial variations to identify the hot- and cold spot areas of underweight in Ethiopia. A multilevel multivariable logistic regression model was used to identify the determinant factors of underweight. Excel, STATA-16, and ArcGIS software were used for the data management and analysis. In the multivariable multilevel analysis, adjusted odds ratio (aOR) with 95% confidence interval (CI) was used to declare significant determinants of underweight among children aged <5 y.ResultsAmong 5753 children aged <5 y in Ethiopia, 21.3% were underweight during the 2019 EDHS. The distribution showed that there was a geospatial variation of underweight among children aged <5 y in Ethiopia; the Global Moran's index value was 0.36 with P < 0.001. In multivariable multilevel analysis, the significant factors associated with underweight were the sex of the child (aOR, 1.25; 95% CI, 1.09-1.44); age of the child, with the highest odds of being underweight observed in the age group of 24 to 35 mo (aOR, 3.52; 95% CI, 2.60-4.74); wealth index, with poorer children having higher odds of being underweight (aOR, 2.25; 95% CI, 1.58-3.24); and the regions, with the highest odds of underweight was observed in Tigray (aOR, 5.63; 95% CI, 2.79-11.36) and Afar (aOR, 4.71; 95% CI, 2.33-9.51).ConclusionsUnderweight has significant spatial variation in Ethiopia, with spatial clustering in the northern and eastern parts of the country. It is recommended that in regions like Tigray, Afar, and Somali, as well as some areas in Gambella, priority steps be taken to reduce the burden of underweight in children aged <5 y. Thus, nutritional intervention programs should be strengthened and intervention strategies developed, with special emphasis on families with poor wealth index in the hotspot areas.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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