Multilevel factors associated with anaemia in Nigerian under-five children: findings from 2024 nigeria demographic and health survey

Anaemia affects over half of Nigerian children under five years, contributing to impaired cognitive development and increased mortality. This study aimed to identify the individual, household, and community-level factors associated with childhood anaemia in Nigeria. We analyzed data from 9,356 children aged 6–59 months from the 2024 Nigeria Demographic and Health Survey (NDHS). Anaemia was defined as haemoglobin < 11.0 g/dl, adjusted for altitude. A three-level mixed-effects logistic regression model was fitted to account for the hierarchical data structure (children nested within households nested within communities/clusters). Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were reported. The prevalence of childhood anaemia was 58.1%. In the final multilevel model, individual-level factors associated with anaemia included: age 12–23 months (aOR = 1.45, 95%CI: 1.21–1.74) and 24–35 months (aOR = 1.58, 95%CI: 1.31–1.90) compared to 6–11 months; history of fever in the last 2 weeks (aOR = 1.52, 95%CI: 1.32–1.75); and severe stunting (aOR = 1.38, 95%CI: 1.12–1.70). Household-level factors included unimproved water source (aOR = 1.23, 95%CI: 1.06–1.43) and poorest wealth quintile (aOR = 2.14, 95%CI: 1.67–2.74). community-level factors included: rural residence (aOR = 1.31, 95%CI: 1.10–1.56) and Northwest zone (aOR = 2.35, 95%CI: 1.75–3.15). Childhood anaemia is prevalent in Nigeria and is driven by a complex interplay of individual, household, and community factors. Interventions should target young children, malaria prevention, nutrition, water sanitation, and socioeconomic empowerment, with special focus on rural areas in the affected zones.