Child Nutritional Outcomes: Issues of Spatial Clustering and Neighbourhood Effects in Sub-Saharan Africa

Abstract

This thesis addresses three objectives: (1) assess spatial dependence of stunting in children (2) examine the effects of neighbouring mothers’ education on child health, and (3) investigate differences in the neighbourhood effects of the correlates of stunting. Data from the last round of the Demographic and Health Surveys of Ghana and 29 other Sub-Saharan African countries are used. The Moran’s I statistic and the Local Indicator of Spatial Association statistic are computed to assess the extent of spatial dependence of stunting rates. Spatial Lag and Spatial Error models are used to ascertain the cause of spatial dependence and the effect of neighbourhood mothers’ education on stunting. Structural Equation Modelling is used to ascertain the effect of socioeconomically advantaged neighbourhoods on stunting and wasting in Ghana. Multilevel logistic regressions are employed to examine the neighbourhood effects of the correlates of stunting. The results of the spatial analysis show that 17 districts with high rates of stunting are clustered in the north-eastern part of Ghana. The study found that the effect of stunting in adjacent neighbourhood districts is 19 per cent as large as it is in the focal district in Ghana. The Structural Equation Model shows that children living in advantaged neighbourhoods have better health outcomes. Achieving a target of at least 75 per cent of mothers obtaining secondary education and higher could bridge the rural-urban gap in stunting in Sub-Saharan Africa. Improved water reduces a child’s probability of being stunted by 1 per cent in a rural area and 4 per cent in urban. Initiatives to address stunting should be broadened to cover districts with the likelihood of contributing to poor child health outcomes in adjoining settlements.