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. © The Author [2008]. Published by Oxford University Press. All rights reserved.