Understanding drivers of stunting reduction in Nigeria from 2003 to 2018: a regression analysis

Abstract

Nigeria is a high burden country for stunting. Stunting reduction has been slow and characterized by unequal progress across the 36 states and federal capital territory of the country. This study aimed to assess the changes in prevalence of stunting and growth determinants from 2003 to 2018, identify factors that predicted the change in stunting, and project future stunting prevalence if these predicted determinants improve. Trend and linear decomposition analyses of growth outcomes and determinants were conducted using 2003, 2008, 2013, and 2018 Nigeria Demographic and Health Survey data. Pooled data included 57,507 children 0 to 59 months old. Findings show that stunting and severe stunting significantly reduced from 43 to 37% and 23% to 17%, respectively (p < 0.001), between 2003 and 2018. Disturbingly, height-for-age z-scores at birth significantly decreased, indicating risks of potential future stunting increase. Improvements in nine stunting determinants (maternal body mass index, maternal height, ≥ 4 antenatal care visits, health facility delivery, reduced child illnesses, asset index, maternal education, paternal education, and preceding birth interval) predicted stunting reductions in children 0–59 months. Few of these nine determinants improved in subpopulations with limited stunting progress. Intra-sectoral and multisectoral coordination were potentially inadequate; 12% of children had received all of three selected health sector interventions along a continuum of care and 6% had received all of six selected multisector interventions. Forward looking projections suggest that increased efforts to improve the nine predictors of stunting change can reduce under-five stunting in Nigeria to ≤ 27% in the short term.

Knowledge, Attitude, Feeding Practices and Nutritional Status of Infants and Young Children in Eseka District, Cameroon

“…Appropriate breastfeeding practices are fundamental to children's survival, growth and development. Continued, frequent breastfeeding also protects child health and wellbeing by reducing the child's risk of morbidity and mortality in disadvantaged populations (Adeyemi et al, 2022). This could be due to the immunological, hygienic and nutritional advantages of breastfeeding.…”

Childhood Stunting and Wasting Following Independence in South Sudan

“…Since there were few other covariates present in both surveys that were potential predictors of nutritional status, these data were not deemed suitable for assessing how the impact of other predictors of nutritional status beyond these 3 demographic variables has changed over time. In round 22, we were additionally able to assess whether access to public health campaigns (measles, deworming, and vitamin A receipt) and child illness, which have been previously shown to be associated with child nutritional outcomes, 21,22 were relevant in this sample. However, we verified that exclusion of these other covariates did not much affect the coefficients on age, sex, and state.…”

Changes in Nigeria’s enabling environment for nutrition from 2008 to 2019 and challenges for reducing malnutrition

“…Changes in the nutrition enabling environment in Nigeria between 2008 and 2019 were assessed for the federal level and in two states. Representative state-level data for Nigeria became available in 2008; this time-point therefore allowed triangulation between empirical changes in nutrition determinants (Adeyemi et al, 2022) and perceived changes in the nutrition enabling environment. Nigeria operates a federal structure; states are semiautonomous and change across the country is driven by the efficiency and effectiveness of state-level processes (Akindele et al, 2002;Khemani, 2001).…”

“…Progress towards reducing undernutrition has been particularly limited in West Africa, including in Nigeria, which bears a sizeable proportion of global malnutrition (UNICEF et al, 2021). Recent improvements in undernutrition determinants in Nigeria have not been sufficient to produce considerable reductions in undernutrition (Adeyemi et al, 2022). Overall, the prevalence of wasting halved between 2008 and 2018, stunting declined by 9.4%, and maternal undernutrition did not improve (Table 1).…”

“…Even for determinants that improved, the levels in 2018/2019 were inadequate. For instance, in 2018, less than 50% of births occurred in a health facility and less than 25% of children had received all age-appropriate vaccinations, even though child vaccinations had increased by more than 100% between 2008 and 2018 (Adeyemi et al, 2022). These findings suggest that interventions to address nutrition have been insufficient, indicating a limited nutrition enabling environment in Nigeria.…”