Geospatial Modelling of Changes and Inequality in Nutrition Status among Children in Mali Further Analysis of the Mali Demographic and Health Surveys 2006-2018 DHS Further Analysis Reports No. 137 April 2020 This publication was produced for review by the United States Agency for International Development. It was prepared by Rukundo K. Benedict, Ben Mayala, Jean de Dieu Bizimana, Ibrahima Cissé, Idrissa Diabaté, and Kissia Sidibe. DHS Further Analysis Reports No. 137 Geospatial Modelling of Changes and Inequality in Nutrition Status among Children in Mali: Further Analysis of the Mali Demographic and Health Surveys 2006-2018 Rukundo K. Benedict1 Benjamin K. Mayala1 Jean de Dieu Bizimana2 Ibrahima Cisse3 Idrissa Diabaté4 Kissia Sidibe4 ICF Rockville, Maryland, USA April 2020 1 The DHS Program, ICF 2 The DHS Program, Vysnova 3 Direction Générale de la Santé – Département de la Nutrition 4 Institut National de la Statistique (INSTAT) Corresponding authors: Rukundo K. Benedict and Benjamin K. Mayala, The DHS Program, ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; phone: 301-572-0537; email: [email protected] Acknowledgments: The authors wish to thank Trinadh Dontamsetti for assisting with data preparation. Editor: Diane Stoy Document Production: Natalie Shattuck This report present findings from a further analysis of the 2018 Mali Demographic and Health Survey. The report is a publication of The DHS Program, which collects, analyses, and disseminates data on fertility, family planning, maternal and child health, nutrition, and HIV/AIDS. Funding was provided by the U.S. Agency for International Development (USAID) through the DHS Program (#720-0AA-18C-00083). The opinions expressed here are those of the authors and do not necessarily reflect the views of USAID and other cooperating agencies. Recommended citation: Benedict, Rukundo K., Benjamin K. Mayala, Jean de Dieu Bizimana, Ibrahima Cisse, Idrissa Diabaté, Kissia Sidibe. 2019. Geospatial Modelling of Changes and Inequality in Nutrition Status among Children in Mali: Further Analysis of the Mali Demographic and Health Surveys 2006-2018. DHS Further Analysis Reports No. 137. Rockville, Maryland, USA: ICF. CONTENTS TABLES ........................................................................................................................................................ v FIGURES .................................................................................................................................................... vii ABSTRACT ................................................................................................................................................. ix ACRONYMS AND ABBREVIATIONS ........................................................................................................ xi 1 INTRODUCTION .............................................................................................................................. 1 1.1 Programmatic Context ........................................................................................................ 2 2 DATA AND METHODS ................................................................................................................... 3 2.1 Variables included in the Spatial Models ............................................................................ 3 2.1.1 DHS covariates constructed for this analysis ........................................................ 3 2.1.2 Pre-existing geospatial covariates ......................................................................... 4 2.2 Geostatistical Model ............................................................................................................ 4 2.2.1 Overview of the modelling approach...................................................................... 4 2.2.2 Covariate modelling using stacked generalisation ................................................. 5 2.2.3 Model specification and development .................................................................... 6 2.2.4 Pixel-level model estimates ................................................................................... 8 2.2.5 Model estimates at administrative level 2 .............................................................. 8 2.2.6 Model validation ..................................................................................................... 9 3 RESULTS ...................................................................................................................................... 11 3.1 Model Estimates for Select Covariates ............................................................................. 11 3.2 Cercles-level Estimates of Stunting and Wasting among Children .................................. 12 3.2.1 Prevalence of stunting and wasting in 2018 ........................................................ 12 3.2.2 Prevalence of stunting and wasting in 2006 ........................................................ 14 3.3 Change in Prevalence of Stunting and Wasting between 2006 and2018 ........................ 15 3.3.1 Relative importance of determinants of stunting and wasting ............................. 16 4 DISCUSSION ................................................................................................................................. 19 5 CONCLUSION ............................................................................................................................... 21 REFERENCES ............................................................................................................................................ 23 APPENDIX .................................................................................................................................................. 29 iii TABLES Table 1 Definition of DHS indicators in the study ................................................................... 3 Table 2 Definition of geospatial variables in the study............................................................ 4 Appendix Table 1 Prevalence of stunting, 95% confidence intervals, and change in stunting prevalence by cercles .............................................................................................. 31 Appendix Table 2 Prevalence of wasting, 95% confidence intervals, and change in wasting prevalence by cercles .............................................................................................. 32 Appendix Table 3 Prediction metrics for each indicator aggregated at cercles-level ........................... 33 v FIGURES Figure 1 Geospatial modelling flowchart .................................................................................. 5 Figure 2 INLA mesh triangulation for Mali ................................................................................ 8 Figure 3 Cercles level estimates of select covariates ............................................................ 11 Figure 4 Prevalence of stunting (A) and the width of 95% credible interval (B) at the cercles level, 2018 ................................................................................................... 12 Figure 5 Prevalence of wasting (A) and the width of 95% credible interval (B) at the cercles level, 2018 ................................................................................................... 13 Figure 6 Prevalence of stunting (A) and the width of 95% credible interval (B) at the cercles level, 2006 ................................................................................................... 14 Figure 7 Prevalence of wasting (A) and the width of 95% credible interval (B) at the cercles level, 2006 ................................................................................................... 14 Figure 8 Cercles-level percent change in stunting prevalence between 2006 and 2018 ...... 15 Figure 9 Cercles-level percent change in wasting prevalence between 2006 and 2018 ....... 15 Figure 10 Percentage contribution of covariates to the stunting models in (A) 2006 and (B) 2018 ................................................................................................................... 16 Figure 11 Percentage contribution of covariates to the wasting models in (A) 2006 and (B) 2018 ................................................................................................................... 17 Appendix Figure 1 DHS covariates maps at the pixel level ................................................................... 29 Appendix Figure 2 Comparison of stunting predictions for (A) 2006 and (B) 2018, aggregated at cercles-level with 95% uncertainty intervals, plotted against data observations from the same area aggregated to the cercles-level ............................................... 33 Appendix Figure 3 Comparison of wasting predictions for (A) 2006 and (B) 2018, aggregated at cercles-level with 95% uncertainty intervals, plotted against data observations from the same area aggregated to the cercles-level ............................................... 33 vii ABSTRACT Background: Strengthening Mali’s multisectoral nutrition policies is key to achieving the Sustainable Development Goals for child malnutrition by 2030. Although the decline in stunting and wasting prevalence over the last decade is promising, we need to understand the reasons for the decline in order to create future policies and programmes. The aim of this study was to examine factors associated with stunting and wasting in Mali in 2006 and 2018 by using geospatial modelling