Longitudinal Trajectories of Child Growth Faltering and Cognitive Development from Birth to Age Five in a Nigerian Cohort: Disentangling the Roles of Nutrition, Infection, and Social Stimulation

The pathways linking early childhood growth faltering to impaired cognitive development are multi-causal, yet longitudinal cohort data from Nigeria capable of disentangling the independent and interactive contributions of nutritional, infectious, and psychosocial stimulation pathways are absent. This study establishes a birth-to-five cohort of 540 children in Kano State, North West Nigeria, recruiting mother-infant dyads at delivery from Murtala Mohammed Specialist Hospital and following them at two-month intervals through 60 months of age. Primary exposures measured longitudinally include anthropometric status (weight-for-age, length-for-age, and head circumference z-scores), infectious disease episode burden, dietary diversity scores, and structured home stimulation measured using the Home Observation for Measurement of the Environment (HOME) inventory. Primary outcome is cognitive composite score measured by the Bayley-III at 24 and 60 months. Structural equation modelling and latent growth curve analysis will decompose direct and mediated pathways. Preliminary data from the 24-month assessment of 480 children reveal that linear growth faltering trajectory class membership at 12 months significantly predicts Bayley-III cognitive composite at 24 months (beta 0.38, p less than 0.001) independently of concurrent infection burden. Home stimulation moderated the growth-cognition relationship, with high stimulation attenuating the negative effect of stunting on cognition (interaction term p less than 0.05). This cohort study generates unprecedented longitudinal evidence linking physical growth, infection, and stimulation to cognitive outcomes in a northern Nigerian paediatric population. Keywords: growth faltering, cognitive development, longitudinal cohort, Kano State, North West Nigeria.