Stunting and severe stunting among children under-5 years in Nigeria: A multilevel analysis

Blessing Jaka Akombi; Kingsley Emwinyore Agho; John Joseph Hall; Dafna Merom; Thomas Astell-Burt; Andre M N Renzaho

doi:10.1186/s12887-016-0770-z

Stunting and severe stunting among children under-5 years in Nigeria: A multilevel analysis

BMC Pediatr. 2017 Jan 13;17(1):15. doi: 10.1186/s12887-016-0770-z.

Authors

Blessing Jaka Akombi¹, Kingsley Emwinyore Agho², John Joseph Hall³, Dafna Merom², Thomas Astell-Burt^{4

5

6}, Andre M N Renzaho⁷

Affiliations

¹ School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia. B.Akombi@westernsydney.edu.au.
² School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia.
³ School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
⁴ Population Wellbeing and Environment Research Lab (PowerLab) School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia.
⁵ Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia.
⁶ Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia.
⁷ School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.

Abstract

Background: Stunting has been identified as one of the major proximal risk factors for poor physical and mental development of children under-5 years. Stunting predominantly occurs in the first 1000 days of life (0-23 months) and continues to the age of five. This study examines factors associated with stunting and severe stunting among children under-5 years in Nigeria.

Methods: The sample included 24,529 children aged 0-59 months from the 2013 Nigeria Demographic and Health Survey (NDHS). Height-for-age z-scores (HFAz), generated using the 2006 World Health Organisation (WHO) growth reference, were used to define stunting (HFAz < -2SD) and severe stunting (HFAz < -3SD). Multilevel logistic regression analyses that adjusted for cluster and survey weights were used to determine potential risk factors associated with stunting and severe stunting among children under-5 years in Nigeria.

Results: The prevalence of stunting and severe stunting were 29% [95% Confidence interval (Cl): 27.4, 30.8] and 16.4% [95%Cl: 15.1, 17.8], respectively for children aged 0-23 months, and 36.7% [95%Cl: 35.1, 38.3] and 21% [95%Cl: 19.7, 22.4], respectively for children aged 0-59 months. Multivariate analysis revealed that the most consistent significant risk factors for stunting and severe stunting among children aged 0-23 months and 0-59 months are: sex of child (male), mother's perceived birth size (small and average), household wealth index (poor and poorest households), duration of breastfeeding (more than 12 months), geopolitical zone (North East, North West, North Central) and children who were reported to having had diarrhoea in the 2 weeks prior to the survey [Adjusted odds ratio (AOR) for stunted children 0-23 months = 1.22 (95%Cl: 0.99, 1.49)];[AOR for stunted children 0-59 months = 1.31 (95%Cl: 1.16, 1.49)], [AOR for severely stunted children 0-23 months = 1.31 (95%Cl: 1.03, 1.67)]; [AOR for severely stunted children 0-59 months = 1.58 (95%Cl: 1.38, 1.82)].

Conclusions: In order to meet the post-2015 sustainable development goals, policy interventions to reduce stunting in Nigeria should focus on poverty alleviation as well as improving women's nutrition, child feeding practices and household sanitation.

Keywords: Malnutrition; Multilevel analysis; Nigeria; Public Health; Severe stunting; Stunting.

MeSH terms

Child, Preschool
Cross-Sectional Studies
Female
Growth Disorders / epidemiology
Growth Disorders / etiology*
Health Surveys
Humans
Infant
Infant, Newborn
Logistic Models
Male
Multivariate Analysis
Nigeria / epidemiology
Prevalence
Risk Factors
Severity of Illness Index