The Risk Factors Associated with the Prevalence of Multimorbidity of Anaemia, Malaria, and Malnutrition among Children Aged 6-59 Months in Nigeria.

In the last ten years, multimorbidity in children under the age of five years has become an emerging health issue in developing countries. The study of multimorbidity of anaemia, malaria, and malnutrition (MAMM) among children in Nigeria has not received significant attention. This study aims to investigate what risk factors are associated with the prevalence of multimorbidity among children aged 6 to 59 months in Nigeria. This study used two nationally representative cross-sectional surveys, the 2018 Nigeria Demographic and Health Survey and the 2018 National Human Development Report. A series of multilevel mixed-effect ordered logistic regression models were used to investigate the associations between child/parent/household variables (at level 1), community-related variables (at level 2) and area-related variables (at level 3), and the multimorbidity outcome (no disease, one disease only, two or more diseases). The results show that 48.3% (4917/10,184) of the sample of children aged 6-59 months display two or more of the disease outcomes. Being a female child, the maternal parent having completed higher education, the mother being anaemic, the household wealth quintile being in the richest category, the proportion of community wealth status being high, the region being in the south, and place of residence being rural were among the significant predictors of MAMM (p < 0.05). The prevalence of MAMM found in this study is unacceptably high. If suitable actions are not urgently taken, Nigeria's ability to actualise SDG-3 will be in grave danger. Therefore, suitable policies are necessary to pave the way for the creation/development of integrated care models to ameliorate this problem.

The Intersection of a Child's Demographics and Household Socioeconomic Status in the Multimorbidity of Malaria, Anaemia, and Malnutrition among Children Aged 6-59 Months in Nigeria.

Multimorbidity of malaria, anemia, and malnutrition (MAMM) is a condition in which an individual has two or more of these health conditions, and is becoming an emergent public health concern in sub-Saharan African countries. The independent associations of a child's demographic variables and household socioeconomic (HSE) disparities with a child's health outcomes have been established in the literature. However, the effects of the intersection of these factors on MAMM, while accounting for other covariates, have not been studied. Therefore, this study aimed to determine how children's sex, age, and household socioeconomic status interact to explain the variations in MAMM among children aged 6-59 months in Nigeria. Data from the 2018 Nigeria Demographic and Health Survey and the 2018 National Human Development Report (NHDR) were used. This study included weighted samples of 10,184 children aged 6-59 months in Nigeria. A three-level multilevel mixed effect ordinal logistic regression model was used, such that individual characteristics at level 1 were nested in communities at level 2 and nested in states at level 3. Subsequently, predictive probability charts and average adjusted probability tables were used to interpret the intersectional effects. Five models were created in this scenario. Model 1 is the interaction between the child's sex and household wealth status; model 2 is the interaction between the child's sex and age; model 3 is the interaction between the child's age and household wealth status; model 4 has the three two-way interactions of the child's sex, age, and household wealth status; and model 5 includes model 4 and the three-way interactions between a child's sex, age, and household wealth quintiles; while accounting for other covariates in each of the models. The prevalence of children with a 'none of the three diseases' outcome was 17.3% (1767/10,184), while 34.4% (3499/10,184) had 'only one of the diseases', and 48.3% (4918/10,184) had 'two or more' MAMMs. However, in the multivariate analyses, model 3 was the best fit compared with other models, so the two-way interaction effects of a child's age and household wealth status are significant predictors in the model. Children aged 36-47 months living in the poorest households had a probability of 0.11, 0.18, and 0.32 of existing with MAMM above the probability of children of the same age who live in the middle class, more prosperous, and richest households, respectively, while all other covariates were held constant. Thus, the variation in the prevalence of MAMM in children of different ages differs depending on the household wealth quintile. In other words, in older children, the variations in MAMM become more evident between the richer and the poorer household quintiles. Therefore, it is recommended that policies that are geared toward economic redistribution will help bridge the disparities observed in the prevalence of multiple diseases among children aged 6-59 months in Nigeria.

Socio-economic, demographic, and contextual predictors of malnutrition among children aged 6-59 months in Nigeria.

Malnutrition has remained a global public health issue, particularly in low- and middle-income countries (LMICs). Researchers have committed to studying malnutrition (especially in children under the age of five) to address the nine malnutrition targets, set by the WHO to be achieved by 2025. This study seeks to evaluate the prevalence, the individual and contextual predictors of malnutrition among children aged 6-59 months across Nigeria and its states. Two separates, independently collected, nationally representative cross-sectional surveys, the National Human Development Report (NHDR 2018) and the 2018 Nigeria Demographic and Health Survey (2018 NDHS) were linked for this study. Spatial map was used to describe the prevalence of malnutrition, a 3-level multivariate multilevel logistic regression models were fitted where children/individuals (at level 1) were nested in communities/clusters (at level 2) and nested in states (at level 3). A weighted sample of 7,770 children 6-59 months were considered in this study. The results showed that an estimated 43.6% of children aged 6-59 months are poorly nourished in Nigeria. The proportions of poorly nourished children were generally highest in the Northern Nigeria. Child's gender, age, birth size, preceding birth order, anaemia status, maternal education, work status, body weight, household wealth status, number of bedrooms were among individual/household predictors of malnutrition. On the community level, being from community with high wealth index, distance to nearest health facilities is no big problem. Regional variations and gender inequality index were the state level predictors of malnutrition among children in Nigeria. This study has shown that two-third of children aged 6-59 months in Nigeria were poorly nourished, an indication of a growing concern of double burden of malnutrition in Nigeria.

Risk Factors Associated with Multimorbidity among Children Aged Under-Five Years in Sub-Saharan African Countries: A Scoping Review.

BACKGROUND/PURPOSE: Globally, the prevalence of multimorbidity (defined as the cooccurrence of two or more diseases in an individual without reference to an index disease) is greater than 33%. Consequently, childhood multimorbidity, a growing public health concern in Low- and Middle-Income-Countries (LMICs), frequently has an impact on children's health. Therefore, the aim of this scoping review was to locate and describe studies that investigate the association between socioeconomic, demographic, and environmental factors and the prevalence of multimorbidity among children aged under five years in Sub-Saharan Africa (SSA). METHODS/DESIGN: We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Scopus, and Web of Science for papers written in English, and published between January 1990 and March 2022. The search included papers that focused on children aged under five years with multimorbidity from Sub-Saharan Africa and used classical regression methods in their analysis. RESULTS: A total of 261 articles were identified. Out of the 66 articles selected for full-text reading, 60 were removed for various reasons. Therefore, data from a sample of six articles were finally extracted and reported in this study. The sample size for the 6 studies included ranged from 2343 to 193,065 children under five years of age. There were six distinct disease conditions (Pneumonia, diarrhoea, malaria, being overweight, stunting, and anaemia) analysed in the included studies. One of the studies had three concurrent diseases, while the other five studies had two current diseases as their multimorbidity outcome of interest. The prevalence of multimorbidity in these six studies ranged from 1.2% to 24.8%. CONCLUSIONS: The relatively few studies found in this research area is an indication of an evidence deficit/knowledge gap yearning to be filled to help policymakers in coming up with integrated multimorbidity care for children in SSA.

Individual, household and area predictors of anaemia among children aged 6-59 months in Nigeria.

Objectives: This study aims to determine the prevalence of anaemia among children aged 6-59 months in all states of Nigeria, including the Federal Capital Territory (FCT), and to quantify the predicted probabilities by individual, household and area factors. Study design: This study is a secondary analysis of data sets from two national representative cross-sectional surveys in Nigeria: the Nigeria Demographic and Health Survey (2018 NDHS) and the National Human Development Index (2018 NHDR). The state human development index (HDI) and the state multidimensional poverty index (MPI) from the 2018 NHDR were incorporated into the 2018 NDHS. Methods: The study included a weighted sample of 10,222 children aged 6-59 months. Both univariate and bivariate analyses were computed to determine the prevalence and factors associated with anaemia status, respectively. Multiple binary logistic regression analyses with adjusted predicted probabilities (APPs) were performed to quantify the predictors' probabilities. Results: The prevalence of anaemia among children aged 6-59 months in Nigeria was 68.1% (6962/10,222). Zamfara state had the highest prevalence (84.0% [266/317]), while Kaduna state recorded the lowest (50.0% [283/572]). The APPs of being anaemic decreased from 82.9% (95% confidence interval [CI]: 80.0-85.8) for children aged 6-18 months to 60.6% (95% CI: 56.8-64.4) for children aged 43-59 months, when other predictors were held constant. The APP for a child of an anaemic mother is 10.2% points higher than the APP for a child whose mother is not anaemic. In addition, the APPs for children decreased as the age group of their mothers increased. A child from a state that is mildly deprived in the MPI has a lower APP (67.2% [95% CI: 62.2-72.2]) compared with a child from highly deprived MPI state (79.0% [95% CI: 73.4-84.5]). Conclusions: Health strategies, including supplementation programmes, should be carried out at both ante-natal and post-natal clinics to reduce the prevalence of anaemia, especially in vulnerable population groups.

Individual and Contextual Factors Associated with Malaria among Children 6-59 Months in Nigeria: A Multilevel Mixed Effect Logistic Model Approach.

BACKGROUND/PURPOSE: Over the last two decades, malaria has remained a major public health concern worldwide, especially in developing countries leading to high morbidity and mortality among children. Nigeria is the world most burdened malaria endemic nation, contributing more than a quarter of global malaria cases. This study determined the prevalence of malaria among children at 6-59 months in Nigeria, and the effects of individual and contextual factors. METHODS: This study utilized data from 2018 Nigeria Demographic and Health Survey (NDHS) involving a weighted sample size of 10,185 children who were tested for malaria using rapid diagnostic test (RDT). Given the hierarchical structure of the data set, such that children at Level-1 were nested in communities at Level-2, and nested in states and Federal Capital Territory (FCT) at Level-3, multilevel mixed effect logistic regression models were used for the analysis. RESULTS: The proportion of children 6-59 months of age in Nigeria that had malaria fever positive as assessed by RDTs was 35.5% (3418/10,185), (CI: 33.9-37.1). Kebbi State had 77.7%, (CI: 70.2-83.5), which was the highest proportion of 6-59 months who were malaria positive, next in line was Katsina State with 55.5%, (CI: 47.7-63.1). The Federal Capital Territory (FCT), Abuja had the proportion of 29.6%, (CI: 21.6-39.0), malaria positive children of 6-59 months of age. Children between the age of 48 and 59 months were 2.68 times more likely to have malaria fever than children of ages 6-11 months (AOR = 2.68, 95% CI: 2.03-3.54). In addition, children from the rural area (AOR = 2.12, 95% CI: 1.75-2.57), were more likely to suffer from malaria infection compared to children from urban area. CONCLUSION: The study identified some individual and contextual predictors of malaria among children in Nigeria. These factors identified in this study are potential areas that need to be considered for policy designs and implementations toward control and total elimination of malaria-related morbidity and mortality among children in Nigeria.

A Scoping Review of Selected Studies on Predictor Variables Associated with the Malaria Status among Children under Five Years in Sub-Saharan Africa.

BACKGROUND/PURPOSE: In recent times, Sub-Saharan Africa (SSA) had been rated by the World Health Organization (WHO) as the most malaria-endemic region in the world. Evidence synthesis of the factors associated with malaria among children aged under-five in SSA is urgently needed. This would help to inform decisions that policymakers and executors in the region need to make for the effective distribution of scarce palliative resources to curb the spread of the illness. This scoping review is aimed at identifying studies that have used multivariate classical regression analysis to determine the predictors associated with malaria among children under five years old in SSA. METHODS/DESIGN: The search terms followed population, intervention, comparator, outcome, timing, setting (PICOTS), and were used in searching through the following databases: PubMed, MEDLINE, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, and Measure DHS. The databases were searched for published articles from January 1990 to December 2020. RESULTS: Among the 1154 studies identified, only thirteen (13) studies met the study's inclusion criteria. Narrative syntheses were performed on the selected papers to synchronize the various predictors identified. Factors ranging from child-related (age, birth order and use of a bed net), parental/household-related (maternal age and education status, household wealth index) and community-related variables (community wealth status, free bed net distribution) were some of the identified significant predictors. CONCLUSIONS: It is timely to have a synthesis of predictors that influence the malaria status of children under-five in SSA. The outcome of the review will increase the knowledge of the epidemiology of morbidity that will form the basis for designing efficient and cost-effective distribution of palliatives and control of malaria in SSA.

A Scoping Review of the Risk Factors Associated with Anaemia among Children Under Five Years in Sub-Saharan African Countries.

Background/Purpose: Globally, anaemia is a severe public health condition affecting over 24% of the world's population. Children under five years old and pregnant women are the most vulnerable to this disease. This scoping review aimed to evaluate studies that used classical statistical regression methods on nationally representative health survey data to identify the individual socioeconomic, demographic and contextual risk factors associated with developing anaemia among children under five years of age in sub-Saharan Africa (SSA). Methods/Design: The reporting pattern followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The following databases were searched: MEDLINE, EMBASE (OVID platform), Web of Science, PUBMED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Cochrane library, African Journal of online (AJOL), Google Scholar and Measure DHS. Results: The review identified 20 relevant studies and the risk factors for anaemia were classified as child-related, parental/household-related and community- or area-related factors. The risk factors for anaemia identified included age, birth order, sex, comorbidities (such as fever, diarrhoea and acute respiratory infection), malnutrition or stunting, maternal education, maternal age, mother's anaemia status, household wealth and place of residence. Conclusion: The outcome of this review is of significant value for health policy and planners to enable them to make informed decision that will correct any imbalances in anaemia across socioeconomic, demographic and contextual characteristics, with the view of making efficient distributions of health interventions.

Risk Factors Associated with Malnutrition among Children Under-Five Years in Sub-Saharan African Countries: A Scoping Review.

Background/Purpose: Malnutrition is a significant global public health burden with greater concern among children under five years in Sub-Saharan Africa (SSA). To effectively address the problem of malnutrition, especially in resource-scarce communities, knowing the prevalence, causes and risk factors associated with it are essential steps. This scoping review aimed to identify the existing literature that uses classical regression analysis on nationally representative health survey data sets to find the individual socioeconomic, demographic and contextual risk factors associated with malnutrition among children under five years of age in Sub-Sahara Africa (SSA). Methods: The electronic databases searched include EMBASE (OVID platform), PubMed (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science (WoS) and Cochrane Library. Only papers written in the English language, and for which the publication date was between 1 January 1990 and 31 July 2020, were included. Results: A total of 229 papers were identified, of which 26 were studies that have been included in the review. The risk factors for malnutrition identified were classified as child-related, parental/household-related and community or area-related. Conclusions: Study-interest bias toward stunting over other anthropometric indicators of malnutrition could be addressed with a holistic research approach to equally address the various dimension of the anthropometric indicators of malnutrition in a population.

Impact of dietary patterns, individual and workplace characteristics on blood pressure status among civil servants in Bida and Wushishi communities of Niger State, Nigeria.

The global burden estimate of hypertension is alarming and results in several million deaths annually. A high incidence of sudden deaths from cardiovascular diseases in the civil workforce in Nigeria is often reported. However, the associations between Dietary Patterns (DPs), individual, and workplace characteristics of hypertension among this workforce have not been fully explored. This study aimed to identify DP in the Bida and Wushishi Communities of Niger State and establish its relationship with hypertension along with other individual and workplace characteristics. Factor analysis was used to establish DP, Chi-square test to identify their relationships with hypertension, and logistic regression to determine the predictor risk factors. The prevalence of hypertension was 43.7%; mean weight, height, and body fat were: 72.8±15 kg, 166±8.9 mm and 30.4%, respectively. Three DPs: "Efficient Diet," "Local diet," and "Energy Boost Diet" were identified. The factor loading scores for these factors were divided into quintiles Q1-Q5; none of them had a significant effect on hypertension status. Conversely, increase in age, the Ministry, Department, and Agency (MDA) of employment, frequency of eating in restaurants, and obesity were identified as significant risk factors. After adjusting for confounders (age, body mass index, MDA, and eating habits), a high score (Q5) in "efficient diet pattern" was significantly related to a lower likelihood of hypertension than a low score (Q1). The prevalence of hypertension among the participants was relatively very high. An increase in age and working in educational sector were risk factors associated with hypertension. Therefore, it is recommended that civil servants engage in frequent exercise and undergo regular medical checkups, especially as they get older. These findings highlight the need for large-scale assessment of the impact of variables considered in this study on hypertension, among the civil workforce across Niger state and Nigeria.

Decision Making Autonomy and Maternal Healthcare Utilization among Nigerian Women.

BACKGROUND AND OBJECTIVES: Low assess to ante-natal care (ANC) services continue to pose a major public health challenge leading to high maternal mortality rates in developing countries. Non-utilization of ANC services among about a quarter of Nigerian women of reproductive age remains a major concern in the actualization of Sustainable Development Goals. Considering the complexity of healthcare utilization in Nigeria, the relationship between a particular health care utilization pattern and women autonomy has not been fully examined. This study examines the patterns of women autonomy and their relationships with ANC utilization in Nigeria. METHODS: This was a cross-sectional analysis of the 2013 nationally representative data from the Nigerian Demographic and Health Survey (NDHS). Factor analysis/score were used to construct women autonomy index, while chi-square and logistic regression were used to establish the relationships between the response and exposure variables. RESULTS: There is a strong relationship between women decision making autonomy status and ANC services among Nigeria women. The odds of utilizing ANC services among women with more decision making autonomy were significantly 3.79 higher than among women with low decision-making autonomy. The use of ANC increases as age, education and wealth status of respondents increase. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: These results indicate that women autonomy is undoubtedly a major determinant of ANC utilization in Nigeria.

Religion, Ethnicity and Contraceptive Use among Reproductive age Women in Nigeria.

BACKGROUND: Religion and Ethnicity are the two most important factors that shape the behavioral pattern especially health seeking behaviors of the people of Nigeria. This study seeks to examine the mediatory effects of the linkage between ethnicity and religion with selected socio-demographic variables on the current use of contraception (CUC) among women of reproductive age in Nigeria. METHODS: Nationally representative sample of 39,948 women of reproductive age (15-49 years) in the 2013 Nigerian Demographic and Health Survey (NDHS) was used. Chi-square was used to analyze the bivariate relationship between exposure variables and CUC. Multivariate logistic regression analysis was used to determine the odds ratio with the 95% confidence interval. RESULTS: The prevalence of CUC was generally low for women of reproductive age in Nigeria, highest among the Yoruba women and lowest among the Hausa/Fulani/Kanuri/Seriberi (HFKS) women; highest among other Christian women and lowest for Muslim women and highest for Yoruba/other religion and lowest for women of Hausa/Fulani/Kanuri/Seriberi/Islam. The odds ratios showed that disparity across ethno-religious boundaries is significant. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Globally, and especially in sub-Saharan African countries, maternal mortality resulting from the abortion of unintended pregnancies pose a major challenge in health delivery system. In Nigeria, a cultural and religious heterogeneous society, current use of contraceptives by women of reproductive age is found not to be a matter of independent effects of ethnicity, religiosity and other socio-demographic variables but also dependent on the effects of interactions between the ethnicity and religion.