Investigating Multiple Overlaps in the Determinants of Risk Factors of Anaemia, Malaria, and Malnutrition, and their Multimorbidity, among Children aged 6 to 59 months in Nigeria

Background: In the last ten years multimorbidity in children under the age of five years has becoming an emerging health issue in developing countries. The absence of a proper understanding of the causes, risk factors, and prevention of these new health disorders (multimorbidity) in children is a significant cause for concern, if the sustainable development goal 3 of ensuring healthy lives and the promotion of well-being for all especially in the associated aim of ending preventable deaths of new-borns and children must be achieved by 2030. In the past, most studies conducted in Nigeria and some other least developed nations of the world focused on these multiple diseases by employing conventional analytical techniques to examine them separately as distinct disease entities. But the study of multimorbidity of anaemia, malaria, and malnutrition has not been done, especially in children. Aim: This study aims to investigate the multiple overlaps in the impact of individual and contextual variables on the prevalence of anaemia, malaria, malnutrition, and their multimorbidity among children aged 6 to 59 months in Nigeria. Methods: The 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 interaction effects between child's sex, age, and household wealth quintiles and the outcome while accounting for some covariates in the model were also investigated. Results: 48.3% (4,917/10,184) of the sample of children aged 6-59 months cohabit with two or more of the disease outcomes. Child's sex, age, maternal education, mother’s anaemia status. household wealth quintiles, the proportion of community wealth status, states with high human development index, region, and place of residence, were among the significant predictors of MAMM (p<0.05). There was a significant interaction effect between a child's age and wealth status when some other covariates were accounted for. Conclusions: The prevalence of MAMM observed in the sample is large, with almost half of the children living with two or more of the diseases at the time of the survey and several potentially modifiable risk factors have been identified. If suitable actions are not urgently taken, Nigeria’s ability to actualise the SDG 3 will be in grave danger. Therefore, possible actions to ameliorate this problem include developing and implementing a suitable policy that will pave the way for integrated care models to be developed

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. Conclusion: 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

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 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

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

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% confi dence 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