Unravelling the dual burden in regional context: how child malnutrition and socioeconomic gradients shape early childhood development

While the relationship between socioeconomic status and Early Childhood Development (ECD) is well-documented, less is known about how developmental outcomes and child malnutrition cluster and interact across geographically proximate areas. This study applies spatial analysis to examine regional disparities in ECD in Pakistan and to assess the extent of spatial dependency in these outcomes. Using cross-sectional data from multiple indicator cluster survey (120,151 children across 144 districts) covering 2017- 2018, Moran's I statistics revealed significant positive spatial autocorrelation, consistent with Tobler's First Law of Geography. Districts with high (or low) ECD outcomes tended to be surrounded by similar districts. A distinct core periphery pattern emerged, with Punjab and Gilgit-Baltistan forming high-high clusters and Sindh, Khyber Pakhtunkhwa and Balochistan forming low-low clus- ters. Ordinary Least Squares (OLS) and Spatial Error Models (SEM) confirmed that stunting, underweight and overweight negative- ly affect ECD, while female literacy, access to mass media and child engagement in playing activities influence development posi- tively. Wasting showed no significant relationship. Results reveal that unobserved regional factors contribute to child development across districts, indicating that developmental deficits often cluster geographically. These findings extend spatial dependency theory to the ECD context in South Asia, underscoring the need for geographically coordinated interventions that address both local deter- minants and regionally shared underlying influences on child development.