Malnutrition, an important public health problem is a term used to describe a deficient or excess intake of nutrients in relationship to requirements. It could either be over-nutrition or under-nutrition. Over-nutrition is rare in the developing countries-Nigeria inclusive, but under-nutrition is the prevalent type of malnutrition (Adetokunbo); hence malnutrition is synonymous to under-nutrition in the developing countries. Protein-Energy malnutrition is the most prevalent form in these countries with the highest incidence in the under-five children (Barnes P.M). It is the most significant risk factor for the burden of diseases causing approximately 300,000 deaths per year directly and indirectly accountable for more than half of the deaths occurring in children (1) (2) from Ethiopian project). It has been estimated that more than one-quarter of all under-five children in the developing countries are underweight and this accounts for about 143 million children that are underweight in the developing world. (1) Lekan. Nearly three-quarters of these 143 million underweight children live in just ten countries. (1) Lekan. In addition, more than one-quarter of the under-five children are underweight in Sub-Saharan Africa. (1) Lekan. Worldwide, under-nutrition is said to be the underlying leading cause of about half of all deaths occurring in children. (2) Lekan. In 2008, the Nigeria Demographic and Health Survey (NHDS) conducted indicated that 41% of Nigeria children are stunted (short for their age and sex), 23% are underweight (small for their age and sex) and 14% are wasted (thin for their heights) (NHDS). Of Nigeria's 140.4 million people, an estimated 23.5% are infants and preschool children aged 0-59 months (Demographic year book); 67.8% of these children are living in the rural areas (NHDS). A recent household expenditure survey states that over 50% of the households in the country live below poverty line. Poverty is a main cause of malnutrition in Nigeria, especially in the rural settlement areas. It is a major concern of government of Nigeria which has been working hard to eliminate it by intervening where there is deficiency. Under-nutrition according to a recent comparative risk assessment is estimated to be the largest contributor to the global burden of disease in children. (2) (3) Lekan. Furthermore, in most of the developing countries, malnutrition is mutually reinforced by infections; both continuing to assume an ever present and alarming threat. It has recently been estimated that problems involving interaction of malnutrition and infection still affect three-quarters of the world's inhabitants (mostly the under-fives because of their fledgling immune system) and account for majority of deaths seen in them. Malnutrition causes an increased susceptibility to infections; also infections lead to increased requirement for nutrients by hyper catabolism and increased losses of body constituents. Often, there is additionally a decreased dietary intake, and together, these can result in precipitation of acute deficiency states in the under-fives who are marginally compensated before the infections. A vicious cycle can be started, which if not promptly and properly treated, can result in death. To break this cycle is immunisation.
From studies carried out in the past, it is clearly evident that childhood malnutrition is linked to a number of environmental and socioeconomic factors like sanitation, poverty/wealth index, place of residence (rural/urban) (16 bot), household headship (14 bot), maternal and paternal educational levels (9, 14 bot), access to health care services (19 bot), toilet (8 bot) and geographic region. Some demographic factors such as mother's age at birth, child's sex and age (8, 10, 17, 18 bot), breastfeeding (11 bot) and duration (12 bot), birth interval and child's birth weight have been associated with malnutrition (5-8) Lekan. Furthermore, some studies have shown disproportional burden of malnutrition on children from deprived households (4, 5) Lekan. Other studies linked malnutrition to sickness (respiratory infections) (18 bot) and diseases caused by parasites (32 bot).
Methods and Materials
This study will be based on 28,647 children aged 0-59 month(s) included in Nigeria Demographic and Health Survey (NDHS) in 2008. The NDHS collected demographic, socio-economic, and health data from nationally-representative sample of 34,596 women aged 15-49 years in 36,800 households included in the survey. The country was stratified into 36 states and the Federal Capital Territory (FCT) of Abuja within the six geopolitical regions. Each domain is made up of enumeration areas (EAs) established by a general population and housing census in 2006. The sampling frame was a list of all EAs (clusters). Within each domain, a two-stage sample was selected. The first stage involved selecting 888 clusters (primary sampling units) with a probability proportional to the size, the size being the number of households in the cluster. The second stage involved the systematic sampling of households from the selected clusters.
Nigeria is a country located in West Africa around the Gulf of Guinea. It covers a total area of about 923,768 kilometre squared. In the world, Nigeria is the thirty-second largest country in terms of land mass after Tanzania which is the thirty-first largest. It is the most populous country in Africa continent. The population and housing census conducted in 2006 puts her population at 140,431,790. The rural area has about 67.8% of the population while the urban area has about 32.2%. The population density of Nigeria is about 145 people per kilometre squared. There are more than 250 ethnic groups in Nigeria with varying languages, customs and cultures thereby creating a nation with rich ethnic diversity. The largest ethnic groups are the Yoruba, Hausa/Fulani and Igbo which account for 68% of the total population. About 27% of the population comprise of Ijaw, Kanuri, Tiv, Nupe, Edo and the Ebiras while the remaining 5% is made up of the other minority groups. The Nigeria Demographic and Health Survey carried out in 2008 puts under five children's population at 17.1% of the country's population which make every unit change in their health to have toll effect on each household's economy and by extension on Nigeria's economy and productivity