疟疾多发病,贫血,营养不良(MAMM)是指个体有两种或两种以上的健康状况,并正在成为撒哈拉以南非洲国家的新兴公共卫生问题。文献中已经建立了儿童人口统计学变量和家庭社会经济(HSE)差异与儿童健康结果的独立关联。然而,这些因素的交叉对MAMM的影响,在考虑其他协变量时,没有被研究过。因此,这项研究旨在确定儿童的性别,年龄,和家庭社会经济地位相互作用,解释了尼日利亚6-59个月儿童MAMM的变化。使用了2018年尼日利亚人口与健康调查和2018年国家人类发展报告(NHDR)的数据。这项研究包括尼日利亚10,184名6-59个月儿童的加权样本。采用三级多级混合效应序数logistic回归模型,这样,第1级的个体特征嵌套在第2级的社区中,嵌套在第3级的州中。随后,预测概率图和平均调整概率表被用来解释交叉效应。在此场景中创建了五个模型。模型1是儿童性别与家庭财富状况之间的相互作用;模型2是儿童性别与年龄之间的相互作用;模型3是儿童年龄与家庭财富状况之间的相互作用;模型4具有儿童性别的三个双向相互作用,年龄,和家庭财富状况;模型5包括模型4和儿童性别之间的三方互动,年龄,和家庭财富五分位数;同时考虑每个模型中的其他协变量。三种疾病均无结局的儿童的患病率为17.3%(1767/10,184),而34.4%(3499/10,184)患有“只有一种疾病”,48.3%(4918/10,184)有两个或两个以上的MAMM。然而,在多变量分析中,与其他模型相比,模型3是最佳拟合,因此,儿童年龄和家庭财富状况的双向交互效应是模型中的显著预测因子。生活在最贫困家庭中的36-47个月的儿童存在MAMM的概率为0.11、0.18和0.32,高于生活在中产阶级的同龄儿童的概率,更加繁荣,最富有的家庭,分别,而所有其他协变量保持不变。因此,不同年龄儿童MAMM患病率的差异取决于家庭财富的五分之一。换句话说,在年龄较大的儿童中,在富人和穷人家庭五分位数之间,MAMM的差异变得更加明显。因此,建议针对经济再分配的政策将有助于弥合尼日利亚6-59个月儿童中多种疾病患病率的差异.
Multimorbidity of malaria, anemia, and malnutrition (MAMM) is a condition in which an individual has two or more of these health conditions, and is becoming an emergent public health concern in sub-Saharan African countries. The independent associations of a child\'s demographic variables and household socioeconomic (HSE) disparities with a child\'s health outcomes have been established in the literature. However, the effects of the intersection of these factors on MAMM, while accounting for other covariates, have not been studied. Therefore, this study aimed to determine how children\'s sex, age, and household socioeconomic status interact to explain the variations in MAMM among children aged 6-59 months in Nigeria. Data from the 2018 Nigeria Demographic and Health Survey and the 2018 National Human Development Report (NHDR) were used. This study included weighted samples of 10,184 children aged 6-59 months in Nigeria. A three-level multilevel mixed effect ordinal logistic regression model was used, such that individual characteristics at level 1 were nested in communities at level 2 and nested in states at level 3. Subsequently, predictive probability charts and average adjusted probability tables were used to interpret the intersectional effects. Five models were created in this scenario. Model 1 is the interaction between the child\'s sex and household wealth status; model 2 is the interaction between the child\'s sex and age; model 3 is the interaction between the child\'s age and household wealth status; model 4 has the three two-way interactions of the child\'s sex, age, and household wealth status; and model 5 includes model 4 and the three-way interactions between a child\'s sex, age, and household wealth quintiles; while accounting for other covariates in each of the models. The prevalence of children with a \'none of the three diseases\' outcome was 17.3% (1767/10,184), while 34.4% (3499/10,184) had \'only one of the diseases\', and 48.3% (4918/10,184) had \'two or more\' MAMMs. However, in the multivariate analyses, model 3 was the best fit compared with other models, so the two-way interaction effects of a child\'s age and household wealth status are significant predictors in the model. Children aged 36-47 months living in the poorest households had a probability of 0.11, 0.18, and 0.32 of existing with MAMM above the probability of children of the same age who live in the middle class, more prosperous, and richest households, respectively, while all other covariates were held constant. Thus, the variation in the prevalence of MAMM in children of different ages differs depending on the household wealth quintile. In other words, in older children, the variations in MAMM become more evident between the richer and the poorer household quintiles. Therefore, it is recommended that policies that are geared toward economic redistribution will help bridge the disparities observed in the prevalence of multiple diseases among children aged 6-59 months in Nigeria.