Spatial variations and determinants of malnutrition among under-five children in Nigeria: A population-based cross-sectional study

Abstract

Childhood undernutrition is a major public health challenge in sub-Saharan Africa, particularly Nigeria. Determinants of child malnutrition may have substantial spatial heterogeneity. Failure to account for these small area spatial variations may cause child malnutrition intervention programs and policies to exclude some sub-populations and reduce the effectiveness of such interventions. This study uses the Composite Index of Anthropometric Failure (CIAF) and a geo-additive regression model to investigate Nigeria’s prevalence and risk factors of childhood undernutrition. The geo-additive model permits a flexible, joint estimation of linear, non-linear, and spatial effects of some risk factors on the nutritional status of under-five children in Nigeria. We draw on data from the most recent Nigeria Demographic and Health Survey (2018). While the socioeconomic and environmental determinants generally support literature findings, distinct spatial patterns were observed. In particular, we found CIAF hotspots in the northwestern and northeastern districts. Some child-related factors (Male gender: OR = 1.315; 95% Credible Interval (CrI): 1.205, 1.437) and having diarrhoea: OR = 1.256; 95% CrI: 1.098, 1.431) were associated with higher odds of CIAF. Regarding household and maternal characteristics, media exposure was associated with lower odds of CIAF (OR = 0.858; 95% CrI: 0.777, 0.946). Obese maternal BMI was associated with lower odds of CIAF (OR = 0.691; 95% CrI: 0.621, 0.772), whereas, mothers classified as thin were associated with higher odds of CIAF (OR = 1.216; 95% CrI: 1.055, 1.411). Anthropometric failure is highly prevalent in Nigeria and spatially distributed. Therefore, localised interventions that aim to improve the nutritional status of under-five children should be considered to avoid the under-coverage of the regions that deserve more attention.

Determinants of coexistence of undernutrition and anemia among under-five children in Rwanda; evidence from 2019/20 demographic health survey: Application of bivariate binary logistic regression model

“…household, mother anemia level, and child anemia level [7,8,12,20,[32][33][34][35]. The above-listed independent variables that are correlated to anemia and undernutrition indicators are presented in Table 3.…”

Modeling the Risk Factors of Undernutrition among Children below Five Years of Age in Uganda Using Generalized Structural Equation Models

“…Undernutrition in Uganda, and in most parts of the world, has been analyzed without any attention paid to the nature of the variables that influence the problem. Little attention has been paid to the structural or causal mechanisms, pathways, or the structural system of causation [15][16][17][18][19], and this partly explains why undernutrition among children below 5 years of age, at 31.9 percent, is still unacceptably high and unpleasant. The structural mechanism of operation needs to be given much attention because undernutrition is multifaceted and complex in nature, and the factors influencing it operate at different levels in a hierarchical manner.…”