Supplementary file 1_Structural equation analysis of rural communities in South Africa and Nigeria: social determinants of health, nutritional deficiencies, and perceived HIV symptoms.docx

IntroductionThis study examines the pathways through which social determinants of health influence nutritional deficiency and perceived HIV-related symptoms in rural communities across Southwest Nigeria and the Eastern Cape, South Africa. Specifically, it explores how income, healthcare access, and housing quality are associated with both nutritional status and perceptions of HIV-related symptom burden within these underserved populations.
MethodsUsing structural equation modelling (SEM), the study analysed survey data from 496 respondents to assess the direct and indirect effects of key social determinants on nutritional deficiency and perceived HIV symptoms. The model incorporated income, access to healthcare, and housing quality as predictor variables. Additionally, one-way ANOVA tests were conducted to explore subgroup differences based on education level and employment status for both nutritional deficiency and perceived HIV-related symptoms.
ResultsSEM findings indicate that income and healthcare access each exert significant negative direct effects on nutritional deficiency, highlighting the influence of poverty and limited healthcare utilisation on malnutrition in rural contexts. Housing quality showed a positive but non-significant direct relationship with nutritional status, and its indirect pathways through perceived HIV symptoms were minimal. Perceived HIV-related symptoms emerged as a significant mediator, intensifying the association between nutritional deficiency and social determinants, especially income. Complementary ANOVA results revealed no significant differences in nutritional deficiency across education levels, while employment status demonstrated a significant effect on perceived HIV-related symptom burden. No significant subgroup differences were detected for nutritional deficiency.
DiscussionThe findings underscore the intertwined roles of material deprivation, healthcare access, and health perceptions in shaping nutritional vulnerability and perceived HIV symptom burden in rural African communities. The significant mediating effect of perceived HIV symptoms suggests that individuals’ symptom interpretations amplify the impact of social disadvantage on nutritional status. These results offer critical policy insights, emphasising the need for integrated interventions that address both structural deprivation and subjective health vulnerabilities. Such perception-sensitive, multisectoral strategies are essential for improving health outcomes in resource-constrained rural environments in Nigeria and South Africa.