The Dual Burden of Anaemia and Stunting in Children under Five in Nigeria: Shared Determinants and Public Health Implication
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Abstract
Anaemia and stunting frequently coexist among children under five and share socioeconomic, maternal, environmental, and health-related determinants, yet they are often investigated separately. This study examined their shared determinants and spatial distribution in Nigeria using nationally representative Nigeria Demographic and Health Survey data from 9,562 children under five. Anaemia was defined as haemoglobin concentration below 11 g/dL, while stunting was defined as a height-for-age z score below −2 according to the World Health Organization child growth standards. A Bayesian shared component model jointly analyzed spatial variation across Nigeria’s 36 states, decomposing it into shared and condition-specific components while accounting for individual, household, and environmental covariates. Greater household wealth and maternal education at primary, secondary, or higher levels were associated with lower odds of anaemia, stunting, and their co-occurrence. Improved water sources, sanitation facilities, and maternal antenatal care were also associated with lower risk, whereas rural residence and inadequate household amenities were associated with greater vulnerability. Spatial analysis identified a high shared burden in several northern states, including Sokoto, Kebbi, Zamfara, Katsina, Kano, Jigawa, Yobe, and Borno, while most southern states exhibited comparatively lower joint risk. These findings demonstrate overlapping socioeconomic and geographic patterns in childhood anaemia and stunting and support addressing both conditions through coordinated interventions. The study contributes spatial evidence for integrated, geographically targeted policies that strengthen maternal education, improve household socioeconomic conditions, expand access to quality healthcare, and enhance water, sanitation, and hygiene infrastructure.
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