The Malnutrition–Infection Syndemic in Katsina State, Nigeria: Unravelling the Drivers and Catalysing Multi-Sectoral Public Health Action

Abstract

Background: Northern Nigeria, particularly Katsina State, bears a disproportionate burden of child malnutrition and infectious diseases. These conditions interact synergistically within a syndemic framework, exacerbated by social and environmental inequities, leading to worse outcomes than if they occurred independently. Objective: This narrative review aimed to critically synthesize evidence on the biological and contextual drivers of the malnutrition-infection syndemic in Katsina State and to propose a multi-sectoral framework for public health action. Methods:  This narrative review conducted Scopus-indexed literature (2018-2025) and key policy documents, with a focus on contextual relevance to the Sahelian and Nigerian context. Findings: The syndemic in Katsina is driven by a complex, self-reinforcing interplay of a biological vicious cycle, where malnutrition weakens immunity and infection depletes nutritional status, fueled by underlying drivers including severe food insecurity, gender inequity, poor Water, Sanitation, and Hygiene (WASH) access, climate shocks, and a fragile health system. Current interventions, often siloed and vertical, have proven insufficient to break this cycle. Conclusion: A paradigm shift from vertical programming to a syndemic-aware, multi-sectoral approach is urgently needed. Katsina Multi-Sectoral Action Framework (K-MSAF) was proposed, which centered on three pillars: Foundational Governance and Financing; Integrated Service Delivery; and Cross-Sectoral Programmatic Convergence. This framework provides a roadmap for policymakers to catalyze effective action to mitigate the syndemic in Katsina State.