Geographic equity in multiple micronutrient deficiencies among women of reproductive age in Ethiopia: a spatial multiscale weighted regression analysis.

Women's micronutrient deficiency, also named hidden hunger, remains a serious public health concern of low- and middle-income countries. To reduce micronutrient deficiencies, Sustainable Development Goal was designed to provide universal access to essential health and nutrition services to women of reproductive age. Recent evidence indicates that multiple micronutrient deficiencies often co-occur. But little is known about their extent, geographic variation, and underlying determinants among non-pregnant women of reproductive age, a critical gap that limits targeted interventions. Therefore, mapping the most affected women is critical to tailor interventions targeting needy segments of the population. We analyzed individual record and coordinates data from the Ethiopian National Micronutrient Survey 2015 to examine the spatial distribution of multiple micronutrient deficiencies. Vitamin A, folate, vitamin B12, zinc, iron, and iodine were micronutrients considered in the analysis. Weighted sample of 1450 non-pregnant women aged 15-49 years was included. Global spatial autocorrelation and hotspot analysis were performed to display geographic equity in multiple micronutrient deficiencies. A multi-scale geographical weighted regression analysis was also performed to identify factors explaining geographic disparities in the distribution of multiple micronutrient deficiencies. Two-fifths (41.3%; 95% CI 37.9-44.8) of women were found to have multiple micronutrient deficiencies in Ethiopia. There were geographical variations in the distribution of multiple micronutrient deficiencies among women in Ethiopia (Global Moran's I value of 0.11 (p < 0.0087)). Higher proportions of multiple micronutrient deficiencies were observed in the Eastern parts of the country. Dire Dawa City Administration, Harari, and the Northern, Eastern, and Southwest parts of the Somali region had higher predicted multiple micronutrient deficiency levels. Hotspot areas with significantly higher rates of multiple micronutrient deficiencies were observed in southern Afar, Dire Dawa, Harari, Eastern Oromia, and Southern Somali regions. Multiple micronutrient deficiencies affect a substantial proportion of non-pregnant women of reproductive age in Ethiopia, highlighting a critical public health concern. The findings demonstrate significant regional variation and identify key predictors, including rural residence, breastfeeding status, and lack of multivitamin supplementation. These findings underscore public health efforts must integrate multiple micronutrient supplementation into maternal health services. In addition, designing targeted interventions that can reduce the high burden of hidden hunger and geographic inequity. Furthermore, addressing the micronutrient requirements of breastfeeding women and rural communities are critical step toward reducing multiple micronutrient deficiencies across Ethiopia.