Social Determinants of Stunting in Nigeria: A Structural Equation Modelling Analysis of Direct and Mediated Pathways Using National Survey Data

Stunting affects approximately 37% of Nigerian children under five and reflects deeply embedded social and structural disadvantages that operate through multiple causal pathways. Although prevalence data are well-described, the relative contributions and interdependencies of structural, intermediate, and proximal determinants of stunting have not been formally modelled at national scale. This study employs structural equation modelling (SEM) using nationally representative data from the 2021 Nigeria Demographic and Health Survey, encompassing 27,843 children aged 0 to 59 months. A theoretically-informed hypothesised model was constructed based on the UNICEF conceptual framework for malnutrition, specifying direct paths from socioeconomic status, maternal education, and household food security to stunting, as well as mediated paths through dietary diversity, healthcare utilisation, and infection burden. SEM was implemented in Mplus version 8.7 using maximum likelihood estimation with robust standard errors. Model fit was acceptable (CFI 0.94, RMSEA 0.048). Maternal education had the largest total effect on stunting (standardised path coefficient negative 0.34), operating both directly and through dietary diversity, antenatal care attendance, and birth spacing. Household poverty had a large indirect effect through food insecurity and dietary quality (standardised indirect path negative 0.28). WASH access exerted a significant mediated effect through infection burden reduction. Geopolitical zone moderated all structural pathways, with north-western Nigeria demonstrating the strongest poverty-stunting association. This study provides the first comprehensive structural equation model of stunting determinants in Nigeria, making a major original contribution to paediatric nutritional epidemiology methodology. Keywords: stunting, structural equation modelling, social determinants, Nigeria, NDHS.