Spatial variation and determinants of underweight among under-five children in Ethiopia, Data from EDHS 2019: A multilevel and spatial analysis

• Underweight is a common problem among under-five children in Ethiopia. • Underweight has a significant spatial variation in Ethiopia. • The most affected areas of underweight were Tigray, Afar and Somali regions. • Nutritional interventions are needed based on geo-spatial variation of underweight. : Childhood underweight is a critical public health problem that needs urgent attention in developing countries, like Ethiopia. Despite its variation between localities, the determinant factors and its geospatial variation were not addressed enough across the various regions of the country. Therefore, the current study was conducted to investigate the spatial variation and determinant factors of underweight among under-five children in Ethiopia. : The total weighted samples of 5753 under-five children were included in this study. The data were taken from 2019 Ethiopian Demographic and Health Survey (EDHS 2019). Arc GIS software was used to analyze geospatial variations to identify the hot and cold spot areas of underweight in Ethiopia. A multilevel multivariable logistic regression model was used to identify the determinant factors of underweight. Excel, STATA-16, and ArcGIS, soft-wares were used for the data management and analysis. In the multivariable multilevel analysis, Adjusted Odds Ratio with 95% CI was used to declare significant determinants of underweight among under-five children. : Among 5753 under-five children, 21.3% of them were underweight in Ethiopia during the 2019 EDHS. The distribution showed that there was a geospatial variation of underweight among under-five children in Ethiopia; the Global Moran's index value was 0.36 with a p-value < 0.001. In multivariable multilevel analysis, the significant factors associated with underweight were the sex of the child (AOR = 1.25; 95% CI (1.09-1.44)), age of the child; the highest odds of being underweight was observed under the age group of 24 - 35 months (AOR = 3.52; 95% CI (2.60-4.74)), wealth index; the poorer wealth index status was higher odds of underweight (AOR = 2.25; 95%CI (1.58-3.24)) and the regions; the highest odds of underweight was observed in Tigray (AOR = 5.63; 95% CI (2.79-11.36)) and Afar (AOR = 4.71; 95% CI (2.33-9.51)). : Underweight has a significant spatial variation in Ethiopia, with spatial clustering in Northern and Eastern parts of the country. It is recommended for the regions like Tigray, Afar, Somali, and some areas in Gambella to provide as priority areas for reducing the burden of underweight in under-five children. Thus, nutritional intervention programs better to be strengthened, with special emphasis in families of poor wealth index in the hot-spot areas used to develop intervention strategies.