title: Stunting among children under 3 years of age in Côte d'Ivoire: spatial and temporal variations between 1994 and 2011.
abstract: OBJECTIVE
  To investigate spatial heterogeneity of stunting prevalence among children in Côte d'Ivoire and examine changes in stunting between 1994 and 2011, to assess the impact of the 2002-2011 civil war that led to temporary partitioning of the country.
  
  
  METHODS
  Data from 1994, 1998 and 2011 Côte d'Ivoire Demographic and Health Surveys (DHS) were analysed using a geostatistical approach taking into account spatial autocorrelation. Stunting data were interpolated using ordinary kriging; spatial clusters with high and low stunting prevalence were identified using Kulldorff spatial scan statistics. Multilevel multivariable logistic regression was then carried out, with year of survey as the main independent variable and an interaction term for time by geographic zone (Abidjan, South, North).
  
  
  METHODS
  Côte d'Ivoire, West Africa.
  
  
  METHODS
  Children aged 0-35 months included in three DHS (n 6709).
  
  
  RESULTS
  Overall stunting prevalence was 30·7, 28·7 and 27·8 % in 1994, 1998 and 2011, respectively (P=0·32). Clusters with high prevalence were found in 1994 (in the West region, P<0·001) and 1998 (in the West and North-West regions, P<0·01 and P=0·01, respectively), but not in 2011. Abidjan was included in a cluster with low prevalence in all surveys (P<0·05). Risk of stunting did not change between 1994 and 2011 at national level (adjusted OR; 95 % CI: 1·39; 0·72, 2·64), but decreased in the South (0·74; 0·58, 0·94) and increased from 1998 to 2011 in Abidjan (1·96; 1·06, 3·64).
  
  
  CONCLUSIONS
  In Côte d'Ivoire, significant changes in stunting prevalence were observed at the sub-national level between 1994 and 2011.
authors.affiliation: 1École Normale Supérieure,Département des Sciences Naturelles,Bujumbura,Burundi.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Barankanira
authors.affiliation: 3IMAG,UMR 5149/Centre Hospitalier Régional Universitaire de Montpellier/Université de Montpellier,Montpellier,France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.affiliation: 2IRD UMI 233,INSERM U 1175,Université de Montpellier,Unité TransVIHMI,BP 64501,34394 Montpellier Cedex 5,France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Msellati
authors.affiliation: 2IRD UMI 233,INSERM U 1175,Université de Montpellier,Unité TransVIHMI,BP 64501,34394 Montpellier Cedex 5,France.
authors.forename: Christian
authors.initials: C
authors.lastname: Laurent
authors.affiliation: 2IRD UMI 233,INSERM U 1175,Université de Montpellier,Unité TransVIHMI,BP 64501,34394 Montpellier Cedex 5,France.
authors.forename: Kirsten A
authors.identifier: http://orcid.org/0000-0002-5909-7332
authors.initials: KA
authors.lastname: Bork
mesh_terms: D015992:Body Mass Index; D002675:Child, Preschool; D016000:Cluster Analysis; D007560:Cote d'Ivoire / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D009035:Mothers; D015995:Prevalence; D012959:Socioeconomic Factors; D062211:Spatio-Temporal Analysis
keywords: Africa; Children; Clustering; Spatial; Trends; Undernutrition