Mapping spatial hotspots and location specific associated factor of diarrhea-wasting multimorbidity among children aged 6–24 months in East Africa: a geographically weighted regression analysis

Concurrent diarrhea and wasting (DW) among children aged 6–24 months represents a critical public health threat in East Africa, exacerbating infection susceptibility, stunting, cognitive impairment, and mortality. Despite national Demographic and Health Surveys documenting high burdens, spatial clustering and geographic determinants of DW remain underexplored, limiting targeted interventions. Geographically Weighted Regression (GWR) analyzed recent DHS data from 11 East African countries (n = 1,402 clusters), with Ordinary Least Squares (OLS) providing global benchmarks. DWM prevalence averaged 3% (range: 1–6%) with significant spatial clustering (Moran’s I = 0.145, Z = 38.07, p < 0.001); hotspots spanned Ethiopia, Uganda, Rwanda, Burundi, Tanzania, Malawi, Mozambique, and Madagascar. OLS explained 23.3% of spatial variation (adj. R² = 0.233) but violated key assumptions, while GWR substantially improved fit (adj. R² = 0.37, AICc: 14820 vs. 16001), revealing spatially varying relationships: male sex increased risk in Kenya/Tanzania/Rwanda (coeff: +0.048 max); maternal illiteracy elevated DW in Uganda/Zambia (coeff: +0.098 max); unimproved water sources posed greatest threat in Ethiopia/Zimbabwe. This study reveals prevalence, spatial patterns, and key factors of DW across the region, identifying precise intervention zones across eight hotspot nations. Policymakers should prioritize Ethiopia/Zambia water chlorination, Uganda/Rwanda maternal literacy campaigns via community health workers, and Kenya/Tanzania gender-sensitive caregiver training for optimal DW reduction.