Prevalence of and Factors Associated with Childhood Malnutrition in Lesotho, 2018–2024

Abstract

Background: Childhood malnutrition is a significant public health concern in many developing countries, including Lesotho. While undernutrition has continued to plague low- and middle- income countries, recent years have seen a rise in overnutrition. Overnutrition is identified as overconsumption of calories and proteins. Undernutrition is linked to under-five mortality and hinders efforts to improve child health outcomes in many countries. This study aimed to estimate the prevalence of childhood malnutrition in Lesotho and to identify the factors associated with it. Methods: This was a secondary data analysis of the 2023-24 Lesotho Demographic and Health Survey. Based on the height-for-age, weight-for-age, and weight-for-height anthropometric indices (Z scores), child nutritional status was classified as stunting (low height-for-age), underweight (low weight-for-age), wasting (low weight-for-height), well-nourished, and overnutrition (overweight). Data analysis was done using STATA 17. The prevalence across the nutritional statuses was estimated using Chi-square tests for categorical variables and the Kruskal-Wallis test for continuous variables. A multinomial logistic regression was used to identify factors associated with malnutrition. Results: Of the 980 children, 32.3% were undernourished, 59.9% were well-nourished, and 7.8% were overnourished. The median age for undernutrition was two years (IQR:1-3), and one year for overnutrition (IQR:0-1). The prevalence of undernutrition was higher among children whose mothers had no formal education or only primary education (41.0%), those from households with unimproved toilet facilities (38.5%), those from lower-wealth tertile households (43.9%), and children from the Thaba-Tseka district (45.6%). Undernutrition was significantly associated with several factors, with some differences between the two models. Sex, birth size, birth order, and wealth index were significant in both the univariable and multivariable models. However, the univariable model showed significant associations with maternal education, type of toilet facility, type of residence, and certain districts (Mohale’s Hoek, Quthing, and Thaba Tseka), while the multivariable model showed significant associations with age, diarrhoea, and maternal age. On the other hand, the odds of overnutrition decreased 0.53 times, for every year increase in age [OR: 0.53 (95% CI: 0.37,0.76)]. iv Conclusion: Over one-third of children experienced undernutrition, while approximately 8.0% were classified as overnourished. Factors associated with undernutrition included the child’s sex, age, birth size, birth order, and wealth index. Therefore, gender-sensitive strategies are needed to address nutritional disparities among male and female children. Support through routine food supplementation programs during postnatal visits can combat undernutrition. Additionally, maternal health education initiatives should promote proper feeding practices and early childhood care.