A multilevel analysis of individual and community effect on chronic childhood malnutrition in rural Nigeria.
BACKGROUND
Protein energy malnutrition is the second most important cause of childhood morbidity and mortality in Nigeria after infections. The purpose of this article was to develop and test a model of childhood malnutrition that includes individual-level characteristics along with contextual characteristics defined at the community level.


METHODS
Multilevel logistic regression analysis.


METHODS
A total of 4007 children resident in 96 rural villages in Nigeria.


RESULTS
Stunting: height-for-age that is less than the international reference value by >2 standard deviations (SDs).


RESULTS
Independent of other factors, children born to underweight mothers were 1.32-times more likely to be stunted [adjusted odds ratio (aOR) 1.32; 95% confidence interval (CI) 1.07-1.64]. For each additional month of breastfeeding the odds of being stunted increased by 4% (aOR 1.04; 95% CI 1.03-1.06). Each SD increase in the household wealth index and maternal health-seeking behaviour index decreased the odds of being stunted by 16% (aOR 0.84; 95% CI 0.76-0.94) and 29% (aOR 0.71; 95% CI 0.60 -0.82), respectively.


CONCLUSIONS
The study has provided evidence that both individual and community characteristics are important predictors of childhood malnutrition in rural Nigeria; and that scholars trying to understand variation in childhood malnutrition should pay attention to the characteristics of both children and place of residence.
Uthman
Olalekan A
OA
Center for Evidence-Based Global Health, Save the Youth Initiative, Nigeria. uthlekan@cebglobalhealth.org
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D009035:Mothers / Q000193:education; D055361:Multilevel Analysis; D009549:Nigeria / Q000453:epidemiology; D016017:Odds Ratio; D011159:Population Surveillance; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D055815:Young Adult