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. DESIGN: Multilevel logistic regression analysis. SUBJECTS AND SETTING: A total of 4007 children resident in 96 rural villages in Nigeria. MAIN OUTCOME: Stunting: height-for-age that is less than the international reference value by >2 standard deviations (SDs). MAIN 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. CONCLUSION: 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.