INTRODUCTION: Malaria and undernutrition have independently contributed to mortality and morbidity among the under-five population of Nigeria. However, there remains complexity in the association between stunting, underweight, wasting, and malaria.

AIM: To evaluate the association between stunting, underweight, wasting, and malaria among under-five children of Nigeria, while assessing the effects of sociodemographic factors.

METHODS: Cross-sectional data from the most recent Demographic and Health Surveys for Nigeria 2018 was used, which included 13,058 children ages 0-59 months. Stunting (WHO height-for-age z-score below -2.0 SD), underweight (WHO weight-for-age z-score below -2.0 SD), wasting (WHO weight-for-height z-score below -2.0 SD), and the malaria blood smear test results were obtained. Sociodemographic factors, such as child’s age, sex, place of residence, educational level of the mother, and wealth quintile, were also obtained and examined. Logistic regression modeling was used to determine the associations between undernutrition status and sociodemographic factors, malaria and sociodemographic factors, and undernutrition status and malaria.

RESULTS: The prevalence of stunting was 37.0%, with 22.2% underweight, 7.0% wasting, and 22.6% tested positive for malaria. Stunting was frequent among 24-35 months old, 12-23 months old were mostly underweight and wasted, and 48-59 months old frequently suffered from malaria. Stunting, underweight, wasting, and malaria frequently occurred among males, residents of rural areas, poorest wealth quintile, and children of uneducated mothers. The odds of having malaria was 81% higher among under-five stunted children (AOR=1.81, 95% CI=1.55,2.12; p-value=<0.0001) and 23% higher among under-five underweight children (AOR=1.23, 95% CI=1.02,1.49; p-value=0.0339). However, wasting (AOR=0.91, 95% CI=0.69,1.19; p-value=0.4832) was not significantly associated with malaria.

DISCUSSION: There exists an association between stunting, underweight and malaria. However, there was no association between wasting and malaria. Sociodemographic factors can influence the effects between the variables, and therefore, policymakers also need to consider these factors when implementing strategies to decrease undernutrition and malaria.