Dietary and non-dietary factors of undernutrition using Composite Index of Anthropometric Failure in children aged 6-23 months in Democratic Republic of the Congo: the 2023 National Nutrition Survey.

Abstract

Introduction: Undernutrition remains a significant public health challenge in the Democratic Republic of Congo (DRC). This study aims to identify dietary and non-dietary factors associated with undernutrition among children aged 6-23 months using the Composite Index of Anthropometric Failure.

Methodology: The secondary analysis was conducted using data from the 2023 National Nutrition Survey, a nationally representative cross-sectional study. The final analytical sample consisted of 5396 children, stratified into two age bands 6-11 months (n=1792) and 12-23 months (n=3604). Bivariate analysis (p<0.2), Multivariable logistic and stepwise regression models (p<0.05) were used to identify factors associated with undernutrition.

Results: The overall prevalence of undernutrition was 47.4%, rising significantly from 37.4% in infants aged 6-11 months to 52.6% in children aged 12-23 months. Stepwise logistic regression identified distinct risk profiles: for the 6-11 month group, male sex (adjusted OR (aOR)=1.7; 95% CI 1.3 to 2.1) and larger households with >2 children (aOR=1.3; 95% CI 1.1 to 1.6) increased the undernutrition, while acceptable minimum meal frequency (MMF) was the primary protective factor (aOR=0.12; 95% CI 0.08 to 0.19). Among the 12-23 month, high dietary diversity (aOR=0.5; 95% CI 0.4 to 0.7), acceptable MMF (aOR=0.6; 95% CI 0.5 to 0.8) and maternal education significantly reduced undernutrition. Conversely, rural residency, recent diarrhoea (aOR=1.4; 95% CI 1.2 to 1.7) and poor hand hygiene remained major factors associated with undernutrition.

Conclusion: Traditional indices significantly underestimate the true nutritional burden in the DRC. These findings underscore the need for a National Nutrition Programme to implement multisectoral interventions that prioritise maternal literacy and the integration of Water, Sanitation and Hygiene protocols to address the diverse drivers of undernutrition.