title: Stunting and severe stunting among children under-5 years in Nigeria: A multilevel analysis.
abstract: 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.
  
  
  
  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.
  
  
  
  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)].
  
  
  
  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.
authors.affiliation: School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia. B.Akombi@westernsydney.edu.au.
authors.forename: Blessing Jaka
authors.initials: BJ
authors.lastname: Akombi
authors.affiliation: School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia.
authors.forename: Kingsley Emwinyore
authors.initials: KE
authors.lastname: Agho
authors.affiliation: School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
authors.forename: John Joseph
authors.initials: JJ
authors.lastname: Hall
authors.affiliation: School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia.
authors.forename: Dafna
authors.initials: D
authors.lastname: Merom
authors.affiliation: Population Wellbeing and Environment Research Lab (PowerLab) School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia.|Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia.|Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Astell-Burt
authors.affiliation: School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
authors.forename: Andre M N
authors.initials: AM
authors.lastname: Renzaho
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology*; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009549:Nigeria / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Malnutrition; Multilevel analysis; Nigeria; Public Health; Severe stunting; Stunting