Spatial distribution and determinants of Vitamin A Supplementation Nonreceipt among children aged 6–35 months in Ethiopia: A Multiscale Geographically Weighted Regression Analysis

Altaseb Beyene Kassssaw^1*Amare Abera Tareke¹Gosa Mankelkl¹Tamrat Anbesaw²Alemu Gedefie³Habtu Debash³Dawit Dawit Tamirat⁴Gashaw Abebe¹

• ¹Department of Biomedical Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
• ²Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia., Dessie, Ethiopia
• ³Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara, Ethiopia
• ⁴Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia

Background: Vitamin A supplementation is a critical public health strategy to reduce childhood morbidity and mortality. Despite its importance, coverage in Ethiopia remains low, with marked regional disparities. This study aimed to examine the spatial distribution and determinants of not receiving Vitamin A supplements among children aged 6–35 months. Methods: Data from the 2019 Ethiopia Mini Demographic and Health Survey, collected between March and June 2019, were analyzed. A weighted sample of 2,540 children aged 6–35 months was included. Data management and analysis employed STATA 17, ArcGIS 10.7.1, SaTScan v10.1, and MGWR 2.2 software. Spatial autocorrelation analysis assessed whether non-supplementation cases were randomly distributed. Hotspot analysis identified areas of high and low prevalence, while ordinary kriging was used for interpolation. SaTScan’s Bernoulli-based model identified likely clusters of non-receipt. Geographically Weighted Regression (GWR) and Multiscale GWR models were applied to determine spatially varying factors associated with not receiving supplementation. Results: Spatial analysis revealed significant variation in Vitamin A supplementation coverage across Ethiopia. High-prevalence clusters were detected in Sidama, the Southern Nations, Nationalities, and Peoples’ Region, and parts of Oromia. Scan statistics identified 44 primary clusters in Sidama, Southwest Ethiopia, and Oromia (Relative Risk = 1.5, p < 0.001). Spatial regression indicated that non-receipt was associated with maternal lack of education, female-headed households, poorer socioeconomic status, being the first child, female sex, and age 6–23 months. Conclusion: There is considerable geographical variation in Vitamin A supplementation coverage among Ethiopian children aged 6–35 months. Sociodemographic factors, including maternal education, household wealth, child age, birth order, and sex, contribute to this disparity. Region-specific public health strategies are recommended to enhance Vitamin A supplementation coverage and reduce childhood morbidity and mortality in Ethiopia.