Peer-reviewed article
A mixed-methods study of the drivers of stunting reduction among children under five in Nigeria, 2008-2018.
Adebola E Orimadegun, Ayodele S Jegede, Michelle F Gaffey, Isaac Olufadewa, Erica Confreda et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined why stunting (poor child growth) declined in some Nigerian states between 2008 and 2018, even though the national rate of improvement was slow. Researchers used household surveys, interviews, and policy reviews to identify the main drivers of progress in states with the best results. The findings show that improvements in parental education, household wealth, and sanitation were more important than health sector interventions alone, though malaria prevention also played a significant role.
Key points
- Parental education explained 43% of predicted improvement in child height-for-age z-score in exemplar states
- Household wealth and sanitation together contributed 11% of predicted HAZ improvement
- Malaria prevention was associated with 29% of predicted HAZ change
- Non-health sector factors (education, wealth, sanitation) explained nearly 60% of predicted improvements
- Insecurity, poverty, lower education, and insufficient health workforce were identified as barriers to progress in other areas
Limitations
The study identifies associations between factors and stunting reduction but cannot definitively prove causation. The analysis explains only 66% of the observed improvement, leaving one-third of the progress unexplained.
Abstract
BACKGROUND: Although stunting reduction at the national level in Nigeria has been modest in recent decades, especially considering the country's rapid economic growth, there is much subnational variation. OBJECTIVES: The objective of this study was to identify the factors associated with declining stunting prevalence in those states in Nigeria where the most progress was made between 2008 and 2018. METHODS: This mixed-methods study included quantitative analysis of household survey data using regression-based Oaxaca-Blinder decomposition analysis to identify factors associated with a change in mean height-for-age z-score (HAZ) over time; deductive thematic analysis of qualitative data collected through key informant interviews and focus group discussions; and policy and program review. RESULTS: Improvement in child linear growth over the past decade is evident in exemplar states in both the north and south of Nigeria, driven largely by the same factors. Our modeling predicted 66% of the observed +0.25 increase in mean HAZ over time in exemplar states, with nearly 60% of the predicted increase associated with improvements in non-health sector factors: parental education (43%), household wealth (8%), and household sanitation (3%). Malaria prevention was associated with an additional 29% of the predicted HAZ change. Qualitative participants highlighted insecurity, poverty, and lower education levels in some parts of the country as barriers to improving child health and nutritional status, along with insufficient human resources for health despite an increase in the number of healthcare facilities in the country. Participants identified a range of policies and programs across multiple sectors as having likely contributed to the decline in stunting prevalence. CONCLUSIONS: A multisectoral approach to stunting reduction in Nigeria appears to have been key, with progress having been driven by both the health sector and, especially, non-health sector action.