Background Malnutrition among children under five remains a major public health challenge in sub-Saharan Africa, with those born to young mothers being particularly vulnerable. Evidence on the role of water, sanitation, and hygiene (WASH) in this subgroup is limited in Ghana. We estimated the association between WASH and childhood malnutrition, and characterized its spatial and socioeconomic distribution, in young mother–child pairs in Ghana. Methods We analyzed 620 child–mother pairs (mothers aged 15–24 years) from the 2022 Ghana Demographic and Health Survey. Outcomes were stunting, wasting, and underweight, defined using WHO growth standards (< −2 SD). Survey-weighted multilevel logistic regression examined WASH–nutrition associations. Spatial patterns were assessed using Global Moran’s I, and LISA and Getis-Ord G*. Socioeconomic inequality was measured via concentration indices, the Theil T index, Lorenz curves, and difference/relative indices. Population attributable fractions (PAF) and risks (PAR) were estimated for binary WASH exposures. Results Stunting prevalence was 18.8% (95% CI 15.5–22.6), wasting 8.7% (6.2–11.9), and underweight 15.6% (12.4–19.4). Volta Region recorded the highest observed weighted prevalence for all three outcomes (stunting 32.0%, wasting 16.8%, underweight 39.4%), but these estimates were based on a small subsample (unweighted n = 20). Global spatial autocorrelation was not statistically significant for any outcome (all p ≥ 0.296). LISA identified Oti as a possible hotspot for underweight ( p = 0.039), and Central and Bono as cold spots for stunting ( p = 0.047) and wasting ( p = 0.018). Improved water access showed the largest protective population-level association (PAF: stunting −36 to −41%; underweight −37%), interpreted as a population-level attributable-burden estimate under a cross-sectional design. Concentration indices were negative for all outcomes, indicating disproportionate burden among poorer and less-educated households, reaching statistical significance for underweight. WASH covariates were not significantly associated with any outcome in fully adjusted models. Multilevel models showed high apparent discrimination (AUC 0.859–0.868). Conclusion Malnutrition among children of young mothers in Ghana is unevenly distributed and concentrated among socioeconomically disadvantaged populations. Equitable WASH services, alongside targeted nutrition programming, may help reduce nutritional inequalities in support of SDG 2 and SDG 6.
Deda Ogum, Yula Salifu, Abdul Razak Abubakari et al.
ABSTRACT Infant undernutrition is linked to cognitive deficits and reduced future economic productivity. This makes mitigating its effects on neurodevelopment an important health priority. The gut microbiome is hypothesised to influence host physiology, including brain function, through the production of microbial metabolites such as the short-chain fatty acids (SCFAs). However, direct epidemiological evidence linking SCFAs to infants’ cognitive development remains scarce in low-resourced settings. This study aimed to assess the association between SCFA concentrations and infants’ (6 to 23 months) cognitive development at a tertiary hospital in Northern Ghana. This age- and sex-matched case-control study included 132 infants admitted with severe acute malnutrition and 132 healthy counterparts. Cognitive development was assessed using the Ages and Stages Questionnaire-3. Infant faecal SCFAs (acetate, propionate, butyrate) were quantified via Gas Chromatography-Mass Spectrometry. Associations between SCFAs and atypical cognitive development were analysed using conditional logistic regression, adjusting for covariates. The prevalence of atypical cognitive development was 18.2%. The mean age of infants was 14.92 ± 5.13 months. In the adjusted models, each unit increase in acetate (AOR = 0.88, 95% CI: 0.82-0.95), propionate (AOR = 0.75, 95% CI: 0.63-0.87), and butyrate (AOR = 0.72, 95% CI: 0.60-0.87) was associated with 12%, 25% and 28% significantly reduced likelihood of atypical cognitive development, respectively (p < 0.001 for all). This study provides evidence that SCFAs may influence cognitive development among infants. Effective strategies are urgently needed to specifically enhance SCFA production among undernourished infants. Such strategies may include continued breastfeeding, diversified dietary intake, or targeted prebiotic supplementation.
Hammond Yaw Addae, Charles Apprey, Alexander Kwarteng
Background: Routine childhood immunisation is central to child survival in Nigeria, yet coverage and completion vary across settings and over time. Facility-level evidence is needed to assess programme performance during disruption and recovery. Objectives: This study reviewed routine childhood immunisation coverage and dropout rates at the University of Port Harcourt Teaching Hospital (UPTH), a tertiary hospital in South-South Nigeria, from 2022 to 2025, identified vaccines with consistently high uptake, and assessed schedule completion between Penta1-Penta3 and BCG-measles. Methods: A retrospective descriptive analysis was conducted using routine immunisation registers from the Family Health Clinic, UPTH. All children aged 0-23 months vaccinated between January 2022 and December 2025 were included. Administrative coverage rates were calculated for each antigen, and monthly dropout rates were estimated for Penta1-Penta3 and BCG-measles. Results: A total of 37,685 immunisation visit records were reviewed. Male children accounted for 17,570 (46.6%) visit records, while female children accounted for 20,115 (53.4%). Administrative coverage estimates were generally high but varied over time, with a decline in 2023, an increase in 2024, and a subsequent reduction in 2025. Vaccines administered at birth and at 6 weeks of age, including BCG, OPV0, HBV0, Penta1, and PCV1, consistently had the highest uptake. In contrast, vaccines administered later in infancy, including rotavirus vaccine, inactivated polio vaccine (IPV), measles vaccine, yellow fever vaccine, and meningococcal A conjugate vaccine (MenA), showed greater variability. Penta1–Penta3 dropout rates were slightly above the recommended threshold in 2022, improved in 2023, and increased in 2024, while BCG–measles dropout rates remained high and fluctuated throughout the study period. Conclusion: Facility administrative immunisation coverage estimates at UPTH remained generally high, although completion across the schedule was inconsistent, particularly for rotavirus, inactivated polio, measles, yellow fever, and meningococcal A conjugate vaccines. Strengthening follow-up systems and defaulter-tracking may improve completion rates.
This study examines emergent gender issues in the analysis of newspaper coverage of maternal and child healthcare (MCH) in Nigeria over a one-year period. MCH is a major challenge in Nigeria as the country is among the highest contributors to maternal and child mortalities globally. Even though this pattern has wider implication to society at large, it may be regarded as being more relevant to women. Premised on gender bias and journalistic norms hypotheses, the study combines content analysis and in-depth interviews (IDI) to determine the dominant gender leading in the newspaper coverage of such a womencentred issue, and underlying reasons for the dominance. The study thus examines the dominant gender of journalists, and other voices projected in the newspaper reports on the issues. It also compares views of male and female health journalists for possible differences of opinion regarding media coverage of MCH. The study finds male dominance amongst journalists and voices quoted in the coverage of MCH issues and related stories, though there was minimal influence of gender in the overall coverage of issues. The study thus deviates from the media gender studies attributing underrepresentation of women in the media to gender bias; noting that gender imbalance is often rooted in journalistic norms pervading media operations.
Effective complementary feeding is essential for infant growth, development, and prevention of malnutrition. This study assessed the attitude and practice of effective weaning techniques and identified factors influencing these practices among breastfeeding mothers attending the antenatal clinic at General Hospital Koko, Koko/Besse Local Government Area, Kebbi State, Nigeria. A descriptive cross-sectional design was adopted. The target population comprised 90 eligible breastfeeding mothers with children aged 6–24 months, from which a sample of 73 respondents was obtained using Taro Yamane’s formula. A self-structured 25-item questionnaire covering demographic characteristics, attitude, practice, and influencing factors was used for data collection. The instrument was subjected to face and content validity and test-retest reliability, yielding a reliability coefficient of 0.81. Data were analyzed using descriptive statistics with SPSS version 25. All 73 questionnaires were retrieved. Respondents demonstrated a generally positive attitude toward effective weaning techniques, with a grand mean of 3.0. They also reported positive weaning practices, with a grand mean of 3.0, particularly in hygienic preparation of foods, hand hygiene, introduction of complementary foods at six months, and avoidance of harmful foods. Financial status was the most strongly identified influencing factor (mean = 3.3), followed by lack of knowledge and health workers’ advice (mean = 3.0 each). The study concludes that although mothers demonstrated favourable attitudes and reported appropriate practices, economic constraints, knowledge gaps, family influence, and other contextual factors may affect effective weaning. Strengthening nutrition education and counselling through antenatal and community-based services is recommended.
Almustapha Lawal Ahmad, Danjuma Aishatu, Sani Gaddafi Wasagu et al.
Abstract Background There are two distinct failure points in childhood immunization: children who receive no immunization (“zero-dose”); and children who start but do not complete the immunization series (“dropout”). Two failure points to address are possible: ‘zero-dose’, where children receive no first doses; and ‘dropout’, where children begin but do not complete the immunization series. These are plausibly different failure points that require different interventions. Nigeria has the largest number of children with zero doses in absolute numbers in the world. The newly released Nigeria Demographic and Health Survey (NDHS) 2023–24 is used to describe failure cases and to compare the performance of machine learning techniques with standard regression in predicting them. Methods We analyzed 4,937 children aged 12-23 months (the age range covered by the WHO/UNICEF children’s recode) in the NDHS. Survey-weighted logistic regression was used to model ZDS and dropout (Penta1 received vs. Penta3 not received) and to compare them with the WHO/UNICEF national coverage estimates (WUENIC). With the same held-out test data, each of three additional algorithms - elastic net, random forest, and XGBoost - was compared to logistic regression, and sampling weights were added to each. Geographic clustering, after adjusting for individual-level effects, was quantified using a mixed-effects model with a state-level random intercept. Results Zero-dose prevalence was 37.3% (implied Penta1 coverage 62.7%), compared with the WUENIC national estimate of 71% Penta1 coverage; incomplete series coverage was at 9.1% (14.5% of Penta1 recipients), and full vaccination coverage was at 53.6%, which is lower than the administratively weighted global coverage estimates (67% Penta3). The associations of zero-dose status were strong and independent for maternal education, facility delivery, attending ANC, and household wealth, whereas these factors were surprisingly weak, albeit statistically significant for Maternal education and Facility delivery, and not significant for the other factors in the dropout group. After full adjustment, religious affiliation (among Muslims) remained an independent predictor of zero dose, even though clustering by state was adjusted for. Survey-weighted logistic regression performed best for both outcomes (zero-dose AUC=0.825; dropout AUC=0.613), whereas XGBoost performed worst for both. Only 4.7% of the residual variation in dropout could be accounted for by state of residence, but 11.2% could be accounted for by zero-dose status. Conclusions Zero-dose status as well as dropout are characterized by very different predictor profiles and are, therefore, separate policy problems and should not be treated as a single “coverage gap”. There was no improvement in prediction performance in terms of algorithmic complexity compared to a correctly specified logistic regression for either outcome.
Eloghosa Aisosa Nosa-Ihaza, Michael Chiebuka Ogidi, Stephen Okello Odeke et al.
Anthropometric indices have become practical tools for evaluating the nutritional status of populations. Understanding the nutritional status of children has far-reaching implications for promoting the health of future generations. The necessity for routine blood pressure screening in children was debated in the past, the main argument against it being that essential hypertension is an adult disease and there was no evidence that screening apparently healthy children for hypertension is rewarding. Its value as a screening tool for hypertension in adults has long been documented. This study has been designed to assess the relationship between nutritional status and blood pressure among apparently healthy primary school pupils aged 6–12 years in Zaria Local Government Area, Kaduna State. The study was conducted on 219 pupils randomly selected from public and private schools using a table of random numbers. Blood pressure was measured after 5 minutes of rest in the sitting position with an aneroid sphygmomanometer and a cuff suitable to the pupil’s arm circumference according to WHO standard procedures. Nutritional and growth status were determined using z-score for BMI-for-age and height-for-age (HA). Pearson correlation was used to determine the correlation coefficients between anthropometric indices and blood pressure parameters. Study findings revealed a z-score of < -3 in 4.34% (n=5) of boys and 1.92% (n=2) of girls as severe wasting while severe stunting was recorded to be 2.61% (n=3) in boys and 1.92% (n=2) in girls. Significant differences (P ≤ 0.05) were not observed between severe thinness or stunting between boys and girls P ≤ 0.05 level of significant. Pearson correlation revealed a positive correlation between weight and Systolic BPs, Diastolic BPs and mean arterial pressures of the subjects ( r =0.77, 0.61, and 0.74 respectively). The study found out that severe malnutrition exists among the pupils, as significant percentages of the school children were thin and stunted. Blood pressure increased with age and was higher among pupils from private schools than among those from public schools.
Ubangida Suleiman, Olumuyiwa Adeyemi Owolabi, Abbas Olagunju et al.
Background: Stunting remains a major public health challenge in Nigeria, affecting 40% of children according to the Nigeria Demographic and Health Survey (NDHS, 2024) amid persistent insecurity orchestrated by Boko Haram/ISWAP insurgency, farmer-herder conflicts, and banditry. However, much of the existing studies treat conflict exposure as a binary condition, overlooking important differences in event frequency and fatality intensity and their potentially distinct implications for child growth and development. Aims: We aimed to assess whether cumulative conflict exposure, captured by event frequency and fatality intensity, better explains childhood stunting in Nigeria than measures of conflict presence alone. Methods: This cross-sectional analysis used the 2024 NDHS dataset (children under 59 months = 9,410), ACLED events (2009-2025 = 73,147), and UCDP GED (1990-2025 = 8,255) as data sources. Conflict events were geocoded to NDHS clusters using 5 km, 10 km, and 50 km buffers. The frequency and intensity of conflict exposure were estimated separately and jointly using weighted cluster-robust logistic regression. Model performance for cumulative exposure versus binary presence/absence exposure was assessed using AIC, BIC, and McFadden's pseudo-R². Results: Weighted prevalence of stunting was 39.1%, with the highest rate observed in the North-West at 52.4% and the lowest in the South-South at 17.9% (p < .001). Conflict experience also differed significantly across geopolitical zones based on both ACLED and UCDP GED indicators (p < .001). The adjusted result showed a significant negative correlation between higher frequency of ACLED events and stunting (AOR = 0.85, 95% CI: 0.76–0.97, p = .012). Overall, the findings indicate that the relationship between armed insecurity and stunting varies by the frequency, intensity, and cumulative nature of conflict exposure. Conclusions: Insecurity involving conflict was correlated with childhood stunting, although this was context-specific, depending on how conflict was captured and what data were utilised. Frequency was a better indicator than fatality, and cumulative metrics were not superior to non-cumulative indicators of conflict. Based on this study’s results, we recommend that nutrition interventions focus on regions experiencing the highest levels of insecurity and childhood stunting.
This study addresses this evidence gap by investigating maternal determinants of child nutritional status in a predominantly rural district where no prior published study had examined these relationships. A community-based analytical cross-sectional study was conducted among 340 mother-child pairs. Systematic random sampling was employed at Child Welfare Clinics across five sub-districts of Mion District. Associations between maternal factors and nutritional outcomes were assessed via bivariate chi-square and Fisher's exact tests at p < 0.05. Prevalence of stunting (22.4%), wasting (15.8%), and underweight (18.3%) significantly exceeded national averages of 18.4%, 5.3%, and 10.4% respectively. Notably, wasting exceeded the WHO emergency threshold of 15%, indicating a critical public health situation. Significant associations were identified between household income and wasting (p = 0.03), maternal religious affiliation and underweight (p = 0.006), and maternal educational level and stunting (p < 0.001). Stunting prevalence unexpectedly increased with maternal education, likely attributable to small sample sizes in higher education tiers and uncontrolled confounding. Maternal age, marital status, and occupation were not significantly associated with any nutritional outcome. Undernutrition in Mion District has reached WHO-defined emergency levels, necessitating an immediate scale-up of Community-based Management of Acute Malnutrition (CMAM) services. Interventions must be culturally tailored, engaging religious and community leaders to address nutritional disparities linked to religious affiliation, while integrating social protection programmes, including targeted cash transfers, to mitigate the impact of low household income on acute malnutrition.
Maternal malnutrition remains a key driver of adverse birth outcomes in sub-Saharan Africa, yet contextual evidence on multi-level determinants in north-eastern Nigeria is scarce. This study explored how socio-cultural, environmental, and health-system factors shape maternal nutrition and child health in Balanga Local Government Area (LGA), Gombe State. An exploratory qualitative design underpinned by interpretive phenomenology was employed. Two focus-group discussions (n = 20), five in-depth interviews, and twelve key-informant interviews were conducted among pregnant women, health workers and governance actors. Data were analysed thematically using NVivo 14 and triangulated across sources. Carbohydrate dominance (97% consumed tuwo daily) was reinforced by cultural prohibitions: 70% avoided eggs due to “theft destiny” beliefs. The 2019 Balanga Dam collapse reduced irrigated area from 11 000 ha to ess-than 2 000 ha, raised dried-fish prices by 180% and cut dietary diversity from 28% to 18%. Antenatal care attendance averaged 2.9 visits; 64% of facilities lacked haemoglobinometry. Participants attributed low birth-weight, stunting and delayed vaccination to “weak blood” from maternal undernutrition. Maternal malnutrition in Balanga LGA is produced by intersecting cultural taboos, agronomic shock and health-system challenges. An integrated package of point-of-care diagnostics, conditional e-vouchers and irrigation rehabilitation could avert maternal and child death caused by low birth weight and maternal malnutrition. The findings can be adapted by other Sub-Saharan African countries experiencing similar environmental instability and gendered food allocation.
Rosemary Dickson-Nze, Paul Balogun, Laughter Amamchukwu et al.
