Double Burden of Childhood Malnutrition in Nigeria: Findings from Six National Surveys, 1990–2024

Background

Nigeria faces a childhood nutritional paradox in which under- and overnutrition coexist, representing a population-level double burden of malnutrition (DBM). However, most evidence relies on single-year prevalence estimates. This study assessed the population-level DBM by examining prevalence, determinants, and temporal trends among Nigerian children aged 6–59 months.

Methods

We analyzed pooled individual-level data from six nationally representative Nigerian Demographic and Health Surveys rounds spanning 1990-2024. Children were classified using weight-for-height z-scores for wasting, normal nutritional status, and overweight/obesity. Weighted prevalence estimates and 95% confidence intervals (CIs) were estimated. Associations with child-, maternal-, and household-level factors were examined by multivariable multinomial mixed-effects logistic regression. Annual trends in DBM were fitted using temporal models.

Results

Among 69,353 children, 50·3% were boys (mean age 31·1 months, SE 0.09). Wasting (11·27% [95% CI: 10·79-11·74]) was associated with male sex, smaller at birth, maternal underweight, larger households, and urban residence; and inversely associated with older age, breastfeeding, larger birth size, children from educated, working, or overweight/obese mothers, and higher-income households. Overweight/obesity (4·44% [4·18-4·70]) was associated with male sex, larger birth size, caesarean delivery, and maternal overweight/obese mothers, but inversely associated among older children, small at birth, children of underweight, working, or older mothers, and those from larger, higher-income, or urban households. The temporal modelling showed stable DBM prevalence in 1990-2003 (range, 15·8-19·8%), which increased in 2004-2010 (19·4-26·1%), and declined from 2011 to 2024 (5·2-25·7%).

Conclusions

The data support the need for individual, contextual, and multisectoral interventions to mitigate the DBM in Nigerian children aged 6–59 months.

Key messages

• Nigeria faces a double burden of malnutrition, with wasting remaining high while overweight/obesity is emerging among children under five.

• The child nutrition agenda should address socially determined maternal and household factors.