Ahmed, Abdulsalam, Khan, Hafiz T.A. ORCID: https://orcid.org/0000-0002-1817-3730, Asiamah, Nestor ORCID: https://orcid.org/0000-0002-1502-3884 and Japhet, Sharry Leah (2026) The impact of adverse childhood experiences on the development of multimorbidity in older adults in Nigeria. Plos One.

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Abstract

Background
Adverse Childhood Experiences (ACEs) are established life-course determinants of adult health, yet evidence linking ACEs to multimorbidity in sub-Saharan Africa remains limited. Nigeria is undergoing rapid demographic and epidemiological transitions characterized by population ageing and a rising burden of non-communicable diseases (NCDs). This study examined whether cumulative ACE exposure predicts multimorbidity among older adults in North-Central Nigeria.

Methods
A cross-sectional study was conducted among 734 adults aged ≥60 years in Niger State, Nigeria. ACE exposure before age 18 was assessed using the Adverse Childhood Experiences International Questionnaire (ACE-IQ) across 13 domains. Multimorbidity was defined as the presence of two or more chronic conditions (NICE criteria) from a list of 24 conditions and analyzed both as a count and dichotomized (≥3 vs. < 3 conditions). Descriptive statistics summarized participant characteristics. Chi-square tests examined bivariate associations. Hierarchical logistic regression models estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to determine independent predictors of multimorbidity.

Results
High cumulative ACE exposure was observed, with 68.4% reporting ≥4 ACEs. Multimorbidity was common: 38.4% reported three or more chronic conditions. ACE exposure was strongly associated with multimorbidity (χ² = 116.07, p < 0.001). In unadjusted analysis, participants reporting ≥4 ACEs had significantly higher odds of multimorbidity(OR = 67.14; 95% CI: 9.25–487.04). After adjusting for socio-demographic covariates, cumulative ACE exposure remained an independent predictor (OR = 15.58; 95% CI: 1.33–182.21). Advanced age (≥80 years) and living in three-generation households were also independently associated with multimorbidity.

Conclusions
Cumulative childhood adversity significantly predicts multimorbidity among older Nigerian adults, demonstrating a clear dose–response relationship. These findings underscore the importance of life-course approaches and trauma-informed strategies in public health policy. Early identification and prevention of childhood adversity may contribute to reducing the long-term burden of multimorbidity in low- and middle-income settings.

Item Type:	Article
Identifier:	https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358944
Subjects:	Medicine and health > Health promotion and public health
Date Deposited:	30 Sep 2026
Dates:	Date Publication status 8 September 2026 Accepted 25 September 2026 Published
School, department or research centre:	College of Nursing, Midwifery and Healthcare
URI:	https://repository.uwl.ac.uk/id/eprint/15461
Sustainable Development Goals:	Goal 3: Good Health and Well-Being

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