CHAPTER TWO

LITERATURE REVIEW

2.0 INTRODUCTION

This chapter presents a comprehensive review of the existing literature relevant to child
malnutrition in Nigeria, with a specific focus on geospatial patterns and socio-demographic
determinants. The literature is reviewed in two main segments: theoretical perspectives and
empirical findings. Key variables influencing child nutritional status are discussed to provide a
contextual foundation for the geospatial analysis. These variables include child and maternal
characteristics, health-related indicators, environmental factors, and socio-economic conditions.

2.1.1 Child Age (Months)

The age of the child, measured in months (0–59), is a continuous variable that significantly
influences nutritional outcomes. Younger children, particularly those in the weaning phase (6–24
months), are more vulnerable to malnutrition due to dietary transitions and immature immune
systems. Age-specific vulnerability helps in identifying critical periods for targeted nutritional
interventions. The progression of malnutrition often correlates with age, as inadequate
complementary feeding and infections become more prevalent as children grow older.

2.1.2 Mother’s Age

Maternal age, measured as a continuous variable, can impact child nutrition through various
channels including biological maturity, caregiving experience, and decision-making capacity.
Younger mothers may lack experience or autonomy in health-related practices, whereas older
mothers are often more knowledgeable and better positioned socio-economically. Maternal age is
thus a proxy for cumulative knowledge and maturity in child-rearing practices.
2.1.3 Diarrhea, Cough, and Fever

These are binary health indicators representing whether the child experienced diarrhea, cough, or
fever in the weeks preceding the survey. These illnesses compromise the body's ability to absorb
nutrients, thereby exacerbating or triggering malnutrition. Frequent illness also increases
metabolic demands, creating a cycle where illness and malnutrition reinforce each other.
Monitoring these symptoms is essential for understanding the immediate health environment
affecting children.

2.1.4 Vitamin A Received

This binary variable indicates whether a child received Vitamin A supplementation in the past
six months. Vitamin A is essential for immune function, vision, and overall growth. Its
supplementation is a critical preventive measure against malnutrition and child mortality.
Children who lack Vitamin A are more susceptible to infections and growth retardation,
highlighting the importance of coverage in public health strategies.

2.1.5 Size at Birth

Size at birth is an ordinal variable categorized as small, average, or large, based on maternal
recall. It serves as a proxy for birth weight—a strong early-life indicator of nutritional status.
Infants perceived as small are more likely to be undernourished during infancy and childhood.
Low birth size reflects poor intrauterine nutrition and maternal health, both of which predispose
children to long-term growth deficits.

2.1.6 Breastfeeding

Breastfeeding status is a binary variable indicating whether the child is currently being breastfed.
Breastfeeding, especially exclusive breastfeeding in the first six months, is critical for optimal
nutrition and immune protection. It supplies essential nutrients and antibodies while reducing
exposure to contaminated food and water sources. Breastfed children generally show better
growth and health outcomes compared to non-breastfed peers.
2.1.7 Working Status of Mother

This binary variable indicates whether the mother is employed. Maternal employment has
complex effects on child nutrition. While income from employment can enhance household food
security, work-related absence may reduce the time available for childcare. The net effect on
child malnutrition depends on factors such as job type, child care arrangements, and support
systems.

2.1.8 Toilet Facility Type

Toilet facility type, a categorical variable, distinguishes between improved and unimproved
sanitation. Sanitation plays a significant role in preventing waterborne diseases and infections
that contribute to malnutrition. Households with unimproved facilities expose children to
pathogens, increasing the risk of diarrhea and related complications. Improved sanitation is
essential for a healthy living environment and better nutritional outcomes.

2.1.9 Water Source Type

This variable categorizes the household’s drinking water source as improved or unimproved.
Clean water is vital for hygiene, food preparation, and prevention of waterborne diseases.
Households relying on unimproved water sources are more likely to experience frequent illness
among children, contributing directly to under nutrition through dehydration and poor nutrient
absorption.

2.1.10 Place of Residence

This binary classification identifies whether the child lives in an urban or rural area. Urban areas
generally offer better access to healthcare, education, sanitation, and nutrition programs. In
contrast, rural areas often lack such services, leading to higher prevalence of child malnutrition.
Place of residence thus captures geographical inequality in resources and infrastructure that
impact child health.

2.1.11 Wealth Index

The wealth index is a socio-economic indicator divided into quintiles: poorest, poorer, middle,
richer, and richest. It reflects household living standards based on asset ownership and housing
characteristics. Children from wealthier households typically have better access to food,
healthcare, and hygiene, reducing the risk of malnutrition. In contrast, poverty limits access to
nutritious food and medical care, increasing vulnerability.

2.1.12 Access to Media

Access to media is a composite binary indicator showing whether the mother regularly consumes
radio, television, or newspapers. Media exposure enhances awareness of child health, nutrition,
and hygiene practices. Mothers with media access are more likely to adopt beneficial behaviors,
including immunization, proper feeding, and hygiene, which contribute to improved child
nutritional status.

2.1.13 Educational Attainment

This categorical variable indicates the highest level of education attained by the mother: no
education, primary, secondary, or higher education. Higher educational attainment is strongly
associated with better health outcomes. Educated mothers are more likely to understand
nutritional needs, access healthcare, and engage in preventive practices. Education also improves
socio-economic standing, reducing the risk of malnutrition.

2.1.14 Region

Region represents Nigeria’s six geopolitical zones: North Central, North East, North West, South
East, South South, and South West. These regions differ significantly in terms of climate, socio-
economic development, cultural practices, and access to services. For instance, malnutrition rates
are often higher in the northern regions due to poverty, conflict, and lower female education.
Geospatial disparities in nutrition outcomes make regional classification a critical variable for
targeted policy interventions.

2.2 Empirical Review of Literature

Ahmed et al. (2023) conducted a study aimed at mapping local variations and identifying the
determinants of childhood stunting in Nigeria. Utilizing data from the 2018 Nigeria
Demographic and Health Survey (NDHS), the authors employed advanced spatial analysis
methods to visualize and quantify the spatial heterogeneity of childhood stunting across the
country. Their findings revealed significant geographical disparities in stunting prevalence, with
higher rates concentrated in the northern regions of Nigeria. The study identified key socio-
demographic and environmental determinants, including maternal education, household wealth,
and access to improved sanitation. By integrating spatial regression models with geographic
information systems (GIS), the authors highlighted regions requiring urgent policy intervention.
This research underscores the utility of geospatial tools in identifying localized public health
challenges and supports spatially targeted strategies to reduce child malnutrition.

Amusa, Yahya, and Bengesai (2023) examined the spatial variations and determinants of
malnutrition among children under five in Nigeria through a population-based cross-sectional
study. The study used data from the NDHS and applied spatial autocorrelation and regression
techniques to uncover clustering patterns of malnutrition indicators such as stunting, wasting,
and underweight. Their analysis identified significant spatial clustering of malnutrition,
particularly in the north-western and north-eastern zones of the country. Socioeconomic factors
such as maternal education, household wealth index, and access to health services were
consistently associated with higher odds of malnutrition. The use of spatial regression models
allowed the authors to capture the influence of place-specific factors, reinforcing the importance
of localized interventions in tackling malnutrition.

Fagbohungbe, Gayawan, and Orunmoluyi (2020) employed a spatial point process modeling
approach to predict childhood malnutrition in Nigeria using point-referenced survey data. The
study implemented a stochastic partial differential equation (SPDE) approach within a Bayesian
framework to model spatially continuous surfaces of malnutrition risk. Their findings indicated
substantial spatial variation in the risk of malnutrition, which could not be explained by
covariates alone, suggesting that unobserved spatial processes were influencing malnutrition
outcomes. This approach provided high-resolution risk maps that can inform the geographic
prioritization of health resources. The study demonstrates the potential of geostatistical methods
in revealing subtle spatial patterns of health outcomes that are often masked in traditional survey
analyses.

In another notable study, Gayawan et al. (2019) explored the spatial distribution of malnutrition
among children under five in Nigeria using a Bayesian quantile regression approach. Drawing on
data from the NDHS, the authors assessed the relationship between malnutrition and several
explanatory variables across different quantiles of the malnutrition distribution. The study found
significant spatial heterogeneity in the effects of variables such as maternal education, child’s
sex, and urban-rural residence. Notably, the spatial maps generated in the study provided visual
insights into regional disparities and highlighted states where targeted nutritional programs could
be most impactful. The study's advanced statistical approach provided a nuanced understanding
of the malnutrition landscape in Nigeria.

Sandler and Sun (n.d.) carried out a hierarchical and spatial analysis of the socio-environmental
determinants of childhood malnutrition in Nigeria. Combining data from environmental,
demographic, and economic sources, they employed multilevel spatial models to assess how
regional and community-level characteristics influenced malnutrition outcomes. Their study
identified environmental stressors—such as water scarcity and land degradation—alongside
social determinants like maternal education and poverty as key predictors of child malnutrition.
By integrating hierarchical modeling with spatial techniques, this research provided a multi-
dimensional view of the factors driving malnutrition, emphasizing the need for cross-sectoral
interventions that address both social and environmental vulnerabilities.

A systematic review by Shamsuddin et al. (2022) highlighted the application of spatial analysis
techniques in childhood malnutrition research. The review synthesized findings from multiple
studies across Africa and Asia, focusing on the methodological advancements in spatial
epidemiology. The authors found that techniques such as spatial autocorrelation, geographically
weighted regression (GWR), and Bayesian spatial modeling were commonly used to assess
malnutrition patterns. The review emphasized that geospatial analysis not only aids in visualizing
malnutrition distribution but also in understanding the contextual factors that contribute to
regional disparities. This review serves as an important reference point for future research
employing spatial methods in child nutrition studies.

Njatanga, Djourdebbéb, and Wadoub (n.d.) analyzed the interplay between climate variability,
armed conflict, and child malnutrition in Nigeria, Ethiopia, and Kenya using a spatial analytical
framework. Focusing on the Nigerian context, the study used conflict event data, climate indices,
and malnutrition metrics to identify spatial and temporal correlations. The results indicated that
regions affected by prolonged conflict and erratic rainfall patterns, especially in northern Nigeria,
exhibited higher levels of child malnutrition. The spatial overlay analysis provided compelling
evidence that conflict and climate-related stressors significantly compromise nutritional
outcomes. This study underscores the necessity of integrating environmental and conflict data in
nutrition surveillance systems.

In a related international context, Mandadi et al. (2023) conducted a geostatistical exploratory

analysis of child malnutrition in India. Although based in a different national setting, the study
offers methodological parallels and insights relevant to Nigeria. The authors used kriging
techniques and spatial regression models to analyze district-level data and found that access to
clean water, maternal literacy, and local economic conditions significantly influenced
malnutrition rates. This research reinforces the global applicability of geospatial methods in
nutritional epidemiology and serves as a methodological benchmark for similar analyses in
Nigeria.

Seboka et al. (n.d.) investigated spatial trends and projections of chronic malnutrition among
children under five in Ethiopia using geographically weighted regression (GWR). The study
analyzed spatial data over several years to detect both static and dynamic patterns in
malnutrition. Their findings indicated that the strength and direction of the relationships between
predictors (such as maternal education and household wealth) and malnutrition outcomes varied
across geographic locations. Though the study focused on Ethiopia, its findings are highly
relevant to Nigeria, particularly in terms of adopting longitudinal spatial analysis methods to
inform future nutrition policy planning.

Collectively, these studies highlight the growing use of spatial analysis in understanding the
complex patterns and determinants of child malnutrition in Nigeria and beyond. From advanced
geostatistical techniques to integrated socio-environmental models, these methods offer a more
granular understanding of malnutrition than conventional analyses. Importantly, they support the
development of geographically targeted policies and interventions that are essential for
addressing regional disparities in child health outcomes.
 CHAPTER THREE

RESEARCH METHODOLOGY

3.0 INTRODUCTION

This chapter presents the research methodology adopted in the study titled Geospatial Analysis
of Child Malnutrition in Nigeria. The study aims to assess the spatial distribution and socio-
demographic determinants of child malnutrition across Nigeria using data from the 2018
Demographic and Health Survey (DHS). The methodology outlines the source of data, the
variables considered, the geospatial and statistical techniques applied, and the model diagnostics
used to ensure the validity of the results. A combination of geospatial analysis and binary logistic
regression was used to explore regional disparities and the socio-economic factors influencing
child malnutrition.

3.1 DATA SOURCE

This study utilizes secondary data from the 2018 Nigeria Demographic and Health Survey
(NDHS). The DHS is a nationally representative household survey that collects a wide range of
health and population data, including maternal and child health indicators, household
characteristics. The dataset includes anthropometric measurements of children aged 0–59 months
and detailed information on mothers and household socio-economic conditions. The data used in
this study is secondary data obtained from DHS, which has already undergone ethical approval
processes.
3.2 STUDY VARIABLES

3.2.1 RESPONSE VARIABLES

Child Malnutrition: This variable indicates whether a child under the age of five is
malnourished based on the data obtained from the DHS 2018 dataset. The variable is suitable for
binary logistic regression models, which are effective in identifying key socio-demographic and
environmental determinants of malnutrition. Additionally, due to the spatial nature of the data,
these malnutrition indicators are also well-suited for geospatial analysis methods that explore
patterns, clustering, and regional disparities in child malnutrition across Nigeria.

3.2.2 PREDICTOR VARIABLES

The independent variables are socio-economic factors believed to influence child

malnutrition. These include:

1. Child Age (months)

 Continuous variable indicating the age of the child in months (0–59).
 Important for assessing age-specific vulnerability to malnutrition.
2. Mother’s Age
 Continuous variable representing the age of the child's mother.
 Maternal age can influence child health through experience, biological factors,
and care practices.
3. Diarrhea, Cough, and Fever
 Binary variables indicating whether the child had experienced diarrhea, cough, or
fever in few weeks preceding the survey.
 These are health-related variables that can negatively impact nutritional status.
4. Vitamin A Received
  Binary variable indicating whether the child received a Vitamin A supplement in
the last six months.

5. Size at Birth
 Ordinal variable (small, average, large) based on maternal recall of child size at
birth.
 Proxy for birth weight, which is a strong predictor of future malnutrition.
6. Breastfeeding
 Binary variable indicating whether the child is currently being breastfed.
 Breastfeeding is crucial for early child nutrition and immunity.
7. Working Status of Mother
 Binary variable indicating whether the mother is currently employed.
8. Toilet Facility Type
 Categorical variable indicating whether the household has an improved or
unimproved toilet facility.
 An important environmental factor influencing child health.
9. Water Source Type

 Categorical variable indicating improved or unimproved drinking water source.

10. Place of Residence

 Urban or rural classification.

 Reflects access to healthcare, infrastructure, and other services.

11. Wealth Index

 Quintile-based socio-economic classification (poorest to richest).

 Derived from household assets and amenities.

12. Access to Media

  Composite binary indicator reflecting whether the mother has regular access to radio,
television, or newspapers.

13. Educational Attainment:

- Categorical variable indicating the highest level of education completed by the

respondent:

- No education

- Primary education

- Secondary education

- Higher education

- Higher educational attainment is generally associated with better health knowledge,

access to healthcare, and socio-economic status, all of which can lower child mortality.

14. Region:

- Categorical variable indicating the geographical region of residence. Nigeria is divided

into six geopolitical zones:

- North Central

- North East

- North West

- South East

- South South

- South West
3.3 ANALYTICAL FRAMEWORK

This study uses a two-stage approach for data analysis: (1) geospatial techniques to map and
explore spatial distribution and clustering of malnutrition, and (2) statistical modeling using
binary logistic regression to determine the effects of socio-demographic variables.

3.4 METHOD OF DATA ANALYSIS

3.4.1 GEOSPATIAL ANALYSIS

Geospatial techniques were used to analyze and visualize the spatial distribution of child
malnutrition across Nigeria. The geospatial analysis included:

 Spatial Interpolation: Kriging and Inverse Distance Weighting (IDW) methods were
used to estimate malnutrition prevalence in unsampled areas based on survey data.
 Hotspot Analysis: Getis-Ord Gi statistic was applied to identify statistically significant
clusters of high and low malnutrition prevalence.
 Spatial Autocorrelation: Moran’s I statistic was used to measure the degree of
clustering in child malnutrition rates across different regions.

3.4.2 LOGISTIC REGRESSION ANALYSIS

To identify the key socio-demographic and environmental factors influencing child

malnutrition, a binary logistic regression model was employed. The dependent variable
was malnutrition status, categorized as malnourished (1) or not malnourished (0), based
on WHO-recommended Z-scores for stunting, wasting, and underweight.

The logistic regression model is given as:

Logit ( p )=log ( 1−pp )=β + β x + β x +⋯+ β x

0 1 1 2 2 n n (3.1)
 Where, р is the probability of the event occurring (dependent variable = 1), β 0 is the
intercept, and β 0 , β 1 ,⋯ , β n are the coefficients for the independent variables X 1 , X 2 ,…, X n
.

3.4.3 Spatial-Statistical Integration

To enhance the interpretation of malnutrition determinants, the results from the logistic
regression were integrated into the geospatial analysis. The predicted probabilities of
malnutrition were mapped to visualize how socio-economic and environmental factors
contribute to regional disparities in child malnutrition.

3.6 SPATIAL-STATISTICAL INTEGRATION

To improve policy relevance, the outputs of logistic regression were integrated into the
geospatial framework:

 Predicted probabilities from the logistic regression models were mapped across Nigeria.
 This visual representation illustrates how socio-economic factors influence malnutrition
patterns geographically.
 This integration supports region-specific recommendations for intervention.
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