I'm looking at a published study that estimated the prevalence of a particular characteristic nationwide. The country is a large, sparsely populated country. The population is concentrated in three regions that have considerably different populations and are separated by large expanses that are uninhabited. The researchers used a multistage cluster sampling technique, and the first stage was to sample one of the three regions. To me this is intuitively unacceptable but I'm having difficulty describing the reasons. I would like to hear your opinion on this.