Spatial distribution and factors associated with co-occurrence of anemia and undernutrition among children aged 6–59 months in East Africa

BACKGROUND: Anemia and undernutrition are major public health concerns affecting child growth, development, and survival, particularly in low-resource settings like East Africa. These conditions often occur together and exacerbate the health and developmental challenges of young children. Despite their high prevalence, no research has explored their co-occurrence and the spatial variations across East African countries. Hence, this study aimed to analyze the spatial distribution and identify predictors of the co-existence of anemia and under-nutrition among children aged 6-59 months in East Africa, utilizing recent Demographic and Health Survey data. Understanding the burden and factors affecting their co-occurrence is crucial for mapping geographic hotspot areas and identifying location-specific factors, which guide policymakers in developing targeted interventions. METHODS AND MATERIALS: This study analyzed the latest Demographic and Health Survey data from East African countries, focusing on children aged 6-59 months. It included those with complete outcome and geospatial data while excluding those with missing or inaccurate survey coverage. The primary outcome was the co-occurrence of anemia and undernutrition, which was defined as the presence of anemia together with at least one form of undernutrition, including stunting, wasting, or underweight. The data was managed and analyzed using STATA version 17, ArcGIS version 10.7.1, SaTScan v10.1, and MGWR version 2.2 software. Hotspot analysis was performed to identify high or low prevalence, and ordinary kriging was utilized for interpolation. Furthermore, the Bernoulli-based model was used to identify the most likely clusters of co-occurrences of these conditions by SaTScan analysis. Finally, the geographical weighted regression with the multiscale geographical weighted regression extension analysis was fitted to identify the spatially varying determinants. RESULTS: The overall prevalence of co-occurrence of anemia and undernutrition was 26.08% (95% CI: 25.70-26.46%). The spatial analysis revealed that the distribution was non-random (p-value