MULTILEVEL ANALYSIS OF WOMEN'S DECISION MAKING POWER AND NUTRITIONAL STATUS OF UNDER FIVE CHILDREN IN NIGERIA

Abstract

Nutrition is a critical part of health and development. In Nigeria, malnutrition is widespread and persisted at alarming rate and continues to be a primary cause of ill health and mortality of under-five children. Women's empowerment is considered crucial for improving nutritional outcomes. This study is aimed at examining the relationship between mother's empowerment status and the nutritional status of under five children controlling for community characteristics in Nigeria. This was a cross - sectional population based study that used a sample of 24,505 under five children from the 2013 Nigerian Demographic and Health Survey Dataset. Information on women's empowerment was assessed through the three aspects of decision making, namely on own health care, major household purchases, and visits to family or relatives. Children's nutritional status was assessed through the WHO standard of measurement for stunting, wasting, and underweight. The distribution of respondent by key variables was assessed and summarized using percentages. The chi square test of association was used to test for statistical significance of the variables, while Multi level logistic regression was utilized to examine the effect of individual and community level factors on nutritional status. Overall, 36.4% of the under five children were stunted, 16.9% wasted, and 27.3% underweight. Involvement of women in decision making concerning large household purchases was found to be significantly associated with wasting and underweight. Wasted children were less likely to belong to women who were involved in decision making concerning large household purchases (OR = 0.82, 95% Cl = (0.72 - 0.93), P < 0.05). Also, underweight children were less likely to belong to \\'Omen who were involved in decision making concerning large household purchases (OR = 0.85, 95% Cl = (0.78 - 0.95), P < 0.05). Malnourished (stunted, wasted, and underweight) children were less likely to belong to women with tertiary (higher) education. Stunted and Underweight children were less likely lo belong to women from at least middle quintile of wealth. Wasted and Underweight children were about 2 times more likely to belong to women residing in the urban areas compared to women residing in the rural areas (OR= 1.22, 95% CI= (1.05 - 1.41), P < 0.05; OR = 1.16. 95% Cl = (1.02 - 1.32), P < 0.05). Intra - community correlation for stunting, wasting, and underweight was significant. The intra - community correlation for stunting was 4.87%, for wasting was 9.76%. and it was 7.68% for underweight. There are inter - community variation in the nutritional status of under - five children. Women's involvement in decision making concerning large household purchases was significantly associated child nutritional status. Maternal education, place of residence, and household wealth quintile were significantly associated with child nutritional status.