A GIS Based Spatio-Temporal Analysis of Socioeconomic and Environmental Determinants of Child Malnutrition in Pakistan

Child malnutrition remains a critical global health challenge, yet most existing studies rely on static risk estimates and overlook the spatial–temporal nature of environmental exposures and localized socioeconomic disparities. To address this gap, we integrated Earth observation-derived environmental indicators, geolocated conflict events, socioeconomic variables, and child health outcomes, and applied a Fixed Effects Two-Stage Least Squares Spatial Durbin Error Model (FE-2SLS-SDEM). We found distinct hotspots of joint vulnerability, where areas experiencing both high conflict intensity and recurrent droughts show significantly higher rates of childhood stunting. High conflict intensity, drought severity, diarrheal prevalence, and inadequate sanitation significantly increase stunting, while maternal and paternal education, improved sanitation, economic development (proxied by nighttime light intensity), and agricultural productivity reduce it. Among these determinants, female education demonstrated the most pronounced inverse relationship with childhood stunting. Additionally, exposure to both drought severity and high conflict intensity independently and in combination worsens childhood stunting not only within affected regions but also in nearby localities. Our results underscore the urgency of geographically targeted, multisectoral, and action-oriented policies aimed at strengthening community and health system capacities to mitigate the converging risks of climate change and conflict on child malnutrition.