title: Environmental predictors of stunting among children under-five in Somalia: cross-sectional studies from 2007 to 2010.
abstract: Stunting among children under five years old is associated with long-term effects on cognitive development, school achievement, economic productivity in adulthood and maternal reproductive outcomes. Accurate estimation of stunting and tools to forecast risk are key to planning interventions. We estimated the prevalence and distribution of stunting among children under five years in Somalia from 2007 to 2010 and explored the role of environmental covariates in its forecasting.
  
  
  
  Data from household nutritional surveys in Somalia from 2007 to 2010 with a total of 1,066 clusters covering 73,778 children were included. We developed a Bayesian hierarchical space-time model to forecast stunting by using the relationship between observed stunting and environmental covariates in the preceding years. We then applied the model coefficients to environmental covariates in subsequent years. To determine the accuracy of the forecasting, we compared this model with a model that used data from all the years with the corresponding environmental covariates.
  
  
  
  Rainfall (OR = 0.994, 95 % Credible interval (CrI): 0.993, 0.995) and vegetation cover (OR = 0.719, 95 % CrI: 0.603, 0.858) were significant in forecasting stunting. The difference in estimates of stunting using the two approaches was less than 3 % in all the regions for all forecast years.
  
  
  
  Stunting in Somalia is spatially and temporally heterogeneous. Rainfall and vegetation are major drivers of these variations. The use of environmental covariates for forecasting of stunting is a potentially useful and affordable tool for planning interventions to reduce the high burden of malnutrition in Somalia.
authors.affiliation: INFORM Project, Spatial Health Metrics Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya. DKinyoki@kemri-wellcome.org.
authors.forename: Damaris K
authors.initials: DK
authors.lastname: Kinyoki
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (coast), Kilifi, Kenya.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX3 7LJ, UK.
authors.forename: James A
authors.initials: JA
authors.lastname: Berkley
authors.affiliation: Nutrition Section, United Nations Children's Fund (UNICEF), Kenya Country Office, UN Complex Gigiri, Nairobi, Kenya.
authors.forename: Grainne M
authors.initials: GM
authors.lastname: Moloney
authors.affiliation: Food Security and Nutrition Analysis Unit (FSNAU) - Somalia, Food and Agriculture Organization of the United Nations, Ngecha Road Campus, Nairobi, Kenya.
authors.forename: Elijah O
authors.initials: EO
authors.lastname: Odundo
authors.affiliation: Warwick Medical School, Health Sciences Research Institute, University of Warwick, Warwick Evidence, Gibbet Hill, CV4 7AL, Coventry, UK.|Department of Mathematics and Information sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.|Department of Population Health, Luxembourg Institute of Health (LIH), 1A-B, rue Thomas Edison, L-1445, Strassen, Luxembourg.
authors.forename: Ngianga-Bakwin
authors.initials: NB
authors.lastname: Kandala
authors.affiliation: INFORM Project, Spatial Health Metrics Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX3 7LJ, UK.
authors.forename: Abdisalan M
authors.initials: AM
authors.lastname: Noor
mesh_terms: D001499:Bayes Theorem; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004777:Environment; D005191:Family Characteristics; D005260:Female; D005544:Forecasting / Q000379:methods; D006130:Growth Disorders / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D009749:Nutrition Surveys; D015995:Prevalence; D011891:Rain; D012307:Risk Factors; D012998:Somalia / Q000453:epidemiology; D062211:Spatio-Temporal Analysis
keywords: Forecasting; Malnutrition; Somalia; Stunting