Beyond the Nutrition Transition: Severe Underweight Prevalence and Paternal Employment as Key Determinants of Malnutrition among Children with Intellectual Disability in Northwestern Nigeria

Abstract

Background: Children and adolescents with intellectual disability face significant malnutrition risks stemming from feeding challenges, inadequate caregiving, and profound socioeconomic disadvantage. While much has been written about the emerging obesity epidemic, the persistent underweight crisis in resource-constrained regions like Northwest Nigeria remains largely undocumented.
Methods: We examined 87 participants aged 6-18 years with confirmed intellectual disability (IQ < 70 via Raven's Progressive Matrices) at Abdulrashid Adisa Raji Special School in Sokoto State. We collected detailed anthropometric data, calculated BMI using WHO standards, and gathered comprehensive socio-demographic information including parental education, employment status, family structure, and socioeconomic classification. Our analysis employed chi-square tests, Fisher's exact test, and logistic regression modeling.
Results: More than half our participants 58.6% were severely underweight, while only one-third maintained normal BMI. Overweight and obesity were surprisingly rare, affecting just 5.7% and 3.4% respectively. Female participants showed significantly higher mean BMI than males (20.13 ± 4.41 vs 18.84 ± 3.01 kg/m²; p = 0.021). The most striking finding emerged from our multivariate analysis: paternal unemployment increased the likelihood of underweight by more than twenty-fold (adjusted OR = 21.64; 95% CI: 1.22-384.37; p = 0.036).
Conclusions: This study reveals a hidden malnutrition crisis where nearly six out of ten children with intellectual disability in Sokoto struggle with severe underweight. The overwhelming influence of paternal employment status exposes the vulnerabilities inherent in northern Nigeria's patriarchal economic system, where families depend almost entirely on fathers' earnings for basic nutrition. These findings demand immediate action through targeted school nutrition programs, conditional cash assistance, and employment support initiatives.