Socio-demographic and household determinants of stunting in children under five years: a pooled analysis of data from Ethiopia, Malawi, Nigeria, and Zambia.

backgroundStunting, a form of chronic malnutrition, remains a major public health concern in sub-Saharan Africa. Ethiopia, Malawi, Nigeria, and Zambia are among the countries with the highest stunting rates globally. Few multi-country studies have examined household and socio-demographic determinants of stunting in sub-Saharan Africa, creating a gap in understanding cross-country patterns. This study aimed to investigate the socio-demographic and household determinants of stunting in children under the age of five across four countries in sub-Saharan Africa.

methodsCross-sectional analysis was conducted in Stata 16 using pooled data from the Ethiopia, Malawi, Nigeria, and Zambia Demographic and Health Surveys (2015-2018), comprising 38,227 children under five. Stunting was assessed using height-for-age z-scores, with children below - 2 standard deviations classified as stunted. Normalised weights, applied via the svyset command, were used to account for complex survey design. Binary logistic regression models were used to assess associations between the variables. Covariates included age and sex of the child, mother's education, orphanhood type, children under five in the household, co-residence typology, sex of household head, source of water for drinking, type of toilet facility, household wealth, place of residence, and country. Data were harmonised using DHS standard recode variables and pooled after applying normalised weights to ensure comparability across countries.

resultsThe overall prevalence of stunting was 36.7% (38.3% in Ethiopia, 37.1% in Malawi, 36.8% in Nigeria, and 34.6% in Zambia). Stunting was associated with child age (higher odds among those aged 18-23 months, AOR = 1.61, 95% CI = 1.44-1.79), maternal education (no education: AOR = 3.20, 95% CI: 2.60-3.94), poor household wealth status (AOR = 1.65, 95% CI: 1.50-1.81). Having access to flush toilets (AOR = 0.80, 95% CI: 0.69-0.93) was a protective factor in child stunting, whereas those who lived in households with pit latrine toilets had higher odds of stunting (AOR = 1.21, 95% CI: 1.11-1.32). Unexpectedly, children not living with any parent had lower odds (AOR = 0.76, 95% CI: 0.66-0.86) of stunting.

conclusionsChild stunting in Ethiopia, Malawi, Nigeria, and Zambia is shaped by maternal education, household wealth, living arrangements, and access to safe water and sanitation. By integrating co-residence typology and household composition, this study highlights the importance of household structure and underscores the need for targeted and context-specific interventions to reduce child stunting in sub-Saharan Africa.