Multilevel analysis of individual and contextual determinants of stunting among infants (birth – 12 months) in Nigeria

There is currently little information on the burden of stunting and its contextual determinants among infants in Nigeria. Therefore, this study aimed to investigate the burden, and identify the individual and contextual determinants of stunting among infants in Nigeria. In this study, we used the Nigeria demographic and health survey (NDHS) 2018 collected via cross-sectional design during the period between August and December 2018. Cluster sampling technique was used to select 6247 infants from the six geo-political zones in Nigeria. The dependent variable was infant stunting and the independent variables were drawn at individual, household and community levels. Descriptive and bivariate analyses were done, after which multilevel analysis was done to adjust for child (Model 1), household (Model 2), community (Model 3) and all variables (Model 4). The prevalence of stunting among the infants was 66.7%. Age 6 to 12 months (AOR:12.7, 95% CI:10.3–15.6), small size at birth (AOR:1.7, 95% CI:1.3–2.2), multiple births (AOR:2.5, 95% CI:1.6–3.9), early breastfeeding initiation (AOR:1.3, 95% CI:1.1–1.5), stunting in mother (AOR:2.5, 95% CI:1.3–4.9) household size > 6 (AOR:1.4, 95% CI:1.0–1.9), and region (North-east vs North-central AOR:2.1, 95% CI:1.6–2.8) had significant positive associations with infant stunting. While female sex (AOR:0.6, 95% CI:0.5–0.7), starting breastfeeding the first day (AOR:0.3, 95% CI:0.2–0.3), preceding birth interval > 2 years (AOR:0.6, 95% CI = 0.5–0.7), succeeding birth interval > 2 years (AOR:0.1, 95% CI:0.0–0.2) older mother’s age at delivery of the child (25–29 vs < 20 years: AOR:0.7, 95% CI:0.5–0.9) higher mother’s education (AOR:0.6, 95% CI:0.4–0.9) higher father’s education (AOR:0.7, 95% CI:0.5–1.0) and mother’s BMI (normal vs underweight: AOR:0.7, 95% CI:0.5–0.9) had significant inverse associations with infant stunting. Multi-level modelling showed that the full model had the best fit (lowest Akaike information criteria: 4627.53), and the variations across communities were statistically significant (< 0.05) for all the models. The burden of infant stunting in Nigeria is high. Selected factors at individual and community levels were significantly associated with infant stunting in Nigeria. More attention needs to be put on infant stunting in Nigeria, and community-level interventions should be explored in addressing the challenge in Nigeria.