1.1 Background of the study

Childhood undernutrition — commonly measured as stunting (low height-for-age) and wasting (low weight-for-height) — remains a leading cause of impaired child survival, development and long-term human capital loss in low- and middle-income countries (LMICs). Stunting is an indicator of chronic deprivation and cumulative exposure to poor nutrition and infections, while wasting reflects recent or acute energy deficits and infectious disease episodes; both carry elevated mortality and morbidity risks and reduce cognitive and economic potential across the life course (Tamir et al., 2024; Obasohan et al., 2024). In Nigeria the burden of undernutrition is large and spatially heterogeneous: national surveys and subnational analyses show that large parts of northern Nigeria — including Kano State — carry a disproportionate share of stunting and wasting, with important within-state and within-LGA variation (National Bureau of Statistics [NBS], 2018; Ahmed et al., 2023). Geospatial analyses using the 2018 DHS demonstrate pronounced local “hot spots” where stunting prevalence far exceeds national averages; these local patterns argue for LGA-level investigation rather than reliance on state or national aggregates when planning interventions (Ahmed et al., 2023). Recent reviews and national analyses identify a consistent set of predictors across African settings: low maternal education, household poverty and food insecurity, poor water-sanitation-hygiene (WASH) conditions, recent diarrhoeal or febrile illness, low birth size or intra-uterine growth restriction, suboptimal infant and young child feeding (IYCF) practices, and low use of preventive maternal–child health services (Tamir et al., 2024; Obasohan et al., 2024). Northern Nigeria faces compounding drivers — chronic poverty, shocks to food availability, rising food prices and insecurity related to conflict and climate — that amplify both acute and chronic forms of undernutrition (Akpoghelie et al., 2024). State-level reviews and advocacy briefings for Kano document very high stunting burdens and rising acute malnutrition in some urban and peri-urban communities; these conditions create urgent need for locally-granular prevalence and determinant data to guide targeted nutrition and health programming (CS-SUNN, 2023; Akpoghelie et al., 2024). Gwale LGA — a densely populated urban district in Kano metropolis with mixed socio-economic pockets and informal settlements — is therefore an appropriate and policy-relevant unit for a focussed epidemiologic assessment of stunting and wasting and their context-specific predictors.

1.2 Statement of the problem

Although high-level surveys (DHS/NNHS) provide state-level and regional estimates, they can mask sharp intra-urban and intra-LGA differences in burden and drivers of undernutrition (Ahmed et al., 2023). Program managers and local health authorities in Kano often plan with state averages that miss small areas where stunting or wasting is concentrated, or misidentify dominant drivers. For Gwale LGA health teams lack current, LGA-level data that quantify the prevalence of stunting and wasting among children 6–59 months and identify the mix of household (wealth, maternal education, household food security), child (recent illness, birth size, dietary diversity), and environmental (WASH, crowding) determinants most strongly associated with those outcomes. Without LGA-level evidence: interventions risk being generic (for example, blanket supplementary feeding everywhere) rather than targeted (for example, combining community management of acute malnutrition in high-prevalence wards with WASH and IYCF counselling where those are dominant drivers), resources may be inefficiently allocated, and opportunities for rapid impact missed (Ahmed et al., 2023; Obasohan et al., 2024). Moreover, recent economic shocks and food-price inflation in Nigeria have increased household food insecurity and may have worsened both wasting and early growth faltering, but the timing and local magnitude of these effects are uneven across urban communities (Akpoghelie et al., 2024). Gwale’s mix of formal households and informal settlements means that some neighbourhoods may be resilient while others are acutely vulnerable; only an LGA-level household survey with anthropometry and contextual data can expose these patterns and identify the actionable predictors (Obasohan et al., 2024; Tamir et al., 2024).

1.3 Aim and Objectives of the Study

Aim: To estimate the prevalence of stunting and wasting and to identify individual, household and environmental predictors of undernutrition among children aged 6–59 months in Gwale Local Government Area, Kano State.

Specific objectives:

1. To measure the point prevalence of stunting (HAZ < ?2) and wasting (WHZ < ?2) among children aged 6–59 months in Gwale LGA.
2. To describe age- and sex-specific patterns of stunting and wasting and assess co-occurrence (e.g., children with both deficits).
3. To measure household food-security, maternal education and maternal nutritional status, WASH indicators (safe water, improved sanitation), and recent child illness (diarrhoea, fever, ARI) in the same households.
4. To estimate associations (adjusted odds ratios) between stunting/wasting and hypothesised predictors: child factors (age, sex, birth size, recent illness), caregiver factors (education, BMI, ANC and delivery location), household factors (wealth index, food security, household crowding), and environmental factors (WASH, urban-ward).
5. To map within-LGA variation (ward level) in undernutrition prevalence and identify “hotspots” for targeted programming.
6. To provide practical, evidence-based recommendations for local planners (nutrition-specific and nutrition-sensitive interventions) and to prioritise wards for immediate vs. longer-term actions.

1.4 Research Questions

1. What are the current prevalences of stunting and wasting among children aged 6–59 months in Gwale LGA?
2. How do prevalence and severity of undernutrition vary by child age, sex and ward within Gwale?
3. Which child, maternal and household factors are independently associated with stunting and with wasting in Gwale after adjustment for confounders?
4. What is the role of recent infectious illness (diarrhoea, fever, ARI) and IYCF practices in explaining undernutrition in the LGA?
5. Which wards within Gwale show clustering of high undernutrition prevalence and therefore warrant prioritised interventions?

1.5 Scope of the study

Design: Cross-sectional, household-based anthropometric survey combined with a brief household questionnaire and a small qualitative component. The quantitative survey will collect anthropometry (length/height and weight measured to WHO standards), child health history (last two weeks diarrhoea/fever/ARI), IYCF indicators (breastfeeding, complementary feeding, dietary diversity), maternal characteristics (education, BMI, ANC history), household socio-economic variables (assets for wealth index), food-security screening (e.g., FIES or reduced Coping Strategies Index), and WASH indicators. GPS coordinates at cluster/ward level will permit mapping of within-LGA variation.

Population and inclusion criteria: Children aged 6–59 months residing in Gwale LGA for at least six months, and their primary caregivers (mother or guardian) consenting to interview and anthropometry. Exclusions: children with acute medical conditions requiring immediate referral will be stabilised and referred per ethical protocol.

Sampling and sample size (outline): A two-stage cluster sample (wards/clusters, then households) will provide LGA-representative estimates. Sample size should be calculated to estimate stunting prevalence with ±3–4 percentage point precision (e.g., for an expected stunting prevalence of ~35–45% in Kano, with design effect ~1.5–2.0) — a preliminary calculation indicates a sample of roughly 720–1,200 children depending on desired precision and design effect; final numbers to be confirmed during the methods write-up and after choice of cluster count.

Data analysis: Anthropometric indices will be computed using WHO Anthro standards; prevalence of HAZ < ?2 and WHZ < ?2 reported with 95% confidence intervals. Bivariate and multivariable logistic regression (or generalized linear mixed models with cluster random effects) will identify predictors; spatial mapping (choropleth maps by ward) will visualise hotspots. Qualitative interviews with caregivers and health staff will contextualise quantitative findings and explore local food-access, care-seeking and cultural feeding practices.

Ethical and referral considerations: Ethical approval will be obtained from the appropriate institutional review board and Kano State health authorities. Children identified with severe acute malnutrition or medical danger signs will be referred urgently to local primary health facilities or therapeutic feeding services following national protocols.

Policy relevance: By producing LGA-level prevalence, risk-factor estimates and ward maps, the study will equip Kano State and Gwale LGA planners to target community management of acute malnutrition, expand preventive services (IYCF counselling, maternal nutrition), and coordinate WASH and social-protection responses in the highest-burden wards — delivering more efficient use of constrained resources and faster reductions in child malnutrition (Ahmed et al., 2023; Obasohan et al., 2024; Akpoghelie et al., 2024).

References

Ahmed, K. Y., Ross, A. G., Hussien, S. M., Agho, K. E., Olusanya, B. O., Ogbo, F. A., … Tovor, A. (2023). Mapping local variations and the determinants of childhood stunting in Nigeria. International Journal of Environmental Research and Public Health, 20(4), 3250. https://doi.org/10.3390/ijerph20043250

Obasohan, P. E., Walters, S. J., Jacques, R., Khatab, K., Akingbade, O., & [other authors]. (2024). Socio-economic, demographic, and contextual predictors of malnutrition among children aged 6–59 months in Nigeria. BMC Nutrition, 10, Article 1. https://doi.org/10.1186/s40795-023-00813-x

National Bureau of Statistics (NBS). (2018). National Nutrition and Health Survey (NNHS) 2018: Report on the nutrition and health situation of Nigeria. National Bureau of Statistics.

Tamir, T. T., Gezhegn, S. A., Dagnew, D. T., Mekonenne, A. T., Aweke, G. T., et al. (2024). Prevalence of childhood stunting and determinants in low and lower-middle income African countries: Evidence from standard demographic and health survey. PLOS ONE, 19(4), e0302212. https://doi.org/10.1371/journal.pone.0302212

Akpoghelie, E. O., Chiadika, E. O., Edo, G. I., Al-Baitai, A. Y., Zainulabdeen, K., Keremah, S. C., … Ekpekpo, L. D. (2024). Malnutrition and food insecurity in northern Nigeria: an insight into the United Nations World Food Programme (WFP) in Nigeria. Discover Food, 4, Article 165. https://doi.org/10.1007/s44187-024-00249-7

CS-SUNN (Civil Society Scaling Up Nutrition Network). (2023). Kano State — Nutrition interventions: Situation and budget analysis (CS-SUNN state brief). CS-SUNN.