title: Investigating the spatial variations of high prevalences of severe malnutrition among children in Papua New Guinea: results from geoadditive models.
abstract: BACKGROUND
  Papua New Guinea (PNG) is one of the nutritionally vulnerable countries with a high rate of children death without showing a sign of improvement in last two decades. Current study investigated the prevalences of stunting and wasting among a cohort of children in PNG and described the spatial features of these outcomes at the province and district-levels.
  
  
  OBJECTIVE
  To determine the prevalences of stunting and wasting among a cohort of children in PNG and to describe the spatial features of these outcomes at the province and district-levels. We also described the spatial features of these outcomes at province and district-levels.
  
  
  METHODS
  The health and nutritional status of 683 children aged less than five years was assessed using a cross-sectional multi-stage household survey conducted in the Eastern Highlands and Madang Provinces of PNG during the period of 2003-2004. Growth z-scores such as height-for-age and weight-for-age were generated using World Health Organization classifications.
  
  
  RESULTS
  The prevalences of stunting (height-for-age z-score less than -2.0) were 59% and 49% in the Eastern Highlands and Madang respectively (P = 0.019). The prevalences of wasting (weight-for-height z-score less than -2.0) were 14% and 22% in Eastern Highlands and Madang respectively, (P = 0.039); overall, only 21% of the children had completed all their scheduled vaccines and 95% of the caregivers had less than primary school education. Our statistical maps showed considerable spatial variations (province- and district-levels) with regard to the stunting, wasting and other key factors within a relatively small geographical region.
  
  
  CONCLUSIONS
  Current study determined one of the highest prevalence of stunting among children in PNG. The impact of geographical locations on the risk factors must be recognized as it affects epidemiology and intervention coverage.
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia. hwand@kirby.unsw.edu.au
authors.forename: Handan
authors.initials: H
authors.lastname: Wand
authors.forename: Namarola
authors.initials: N
authors.lastname: Lote
authors.forename: Irene
authors.initials: I
authors.lastname: Semos
authors.forename: Peter
authors.initials: P
authors.lastname: Siba
mesh_terms: D001827:Body Height; D001835:Body Weight; D017028:Caregivers / Q000523:psychology; D015362:Child Nutrition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004522:Educational Status; D006130:Growth Disorders / Q000175:diagnosis / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D007223:Infant; D044342:Malnutrition / Q000175:diagnosis / Q000453:epidemiology*; D009752:Nutritional Status; D010219:Papua New Guinea / Q000453:epidemiology; D015995:Prevalence; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014611:Vaccination; D019282:Wasting Syndrome / Q000175:diagnosis / Q000453:epidemiology*