Beyond Conflict Presence: Cumulative Armed Insecurity and Childhood Stunting in Nigeria

Background: Stunting remains a major public health challenge in Nigeria, affecting 40% of children according to the Nigeria Demographic and Health Survey (NDHS, 2024) amid persistent insecurity orchestrated by Boko Haram/ISWAP insurgency, farmer-herder conflicts, and banditry. However, much of the existing studies treat conflict exposure as a binary condition, overlooking important differences in event frequency and fatality intensity and their potentially distinct implications for child growth and development. Aims: We aimed to assess whether cumulative conflict exposure, captured by event frequency and fatality intensity, better explains childhood stunting in Nigeria than measures of conflict presence alone. Methods: This cross-sectional analysis used the 2024 NDHS dataset (children under 59 months = 9,410), ACLED events (2009-2025 = 73,147), and UCDP GED (1990-2025 = 8,255) as data sources. Conflict events were geocoded to NDHS clusters using 5 km, 10 km, and 50 km buffers. The frequency and intensity of conflict exposure were estimated separately and jointly using weighted cluster-robust logistic regression. Model performance for cumulative exposure versus binary presence/absence exposure was assessed using AIC, BIC, and McFadden's pseudo-R². Results: Weighted prevalence of stunting was 39.1%, with the highest rate observed in the North-West at 52.4% and the lowest in the South-South at 17.9% (p < .001). Conflict experience also differed significantly across geopolitical zones based on both ACLED and UCDP GED indicators (p < .001). The adjusted result showed a significant negative correlation between higher frequency of ACLED events and stunting (AOR = 0.85, 95% CI: 0.76–0.97, p = .012). Overall, the findings indicate that the relationship between armed insecurity and stunting varies by the frequency, intensity, and cumulative nature of conflict exposure. Conclusions: Insecurity involving conflict was correlated with childhood stunting, although this was context-specific, depending on how conflict was captured and what data were utilised. Frequency was a better indicator than fatality, and cumulative metrics were not superior to non-cumulative indicators of conflict. Based on this study’s results, we recommend that nutrition interventions focus on regions experiencing the highest levels of insecurity and childhood stunting.