Published in PLOS One on 2025-10-03, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Amare Muche, Aznamariam Ayres, Tilahun Dessie Alene, Robel Asaminew Mekonnen, Elsabeth Addisu, Gebeyehu Tsega, Yawkal Tsega
Source: PLOS One • DOI 10.1371/journal.pone.0333785
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
The burden of malnutrition among children under-5 in Sub-Saharan Africa (SSA) remains a significant public health concern. Traditional indices such as stunting, wasting, and underweight often failing to capture the overlapping and multifaceted nature of malnutrition. The Extended Composite Index of Anthropometric Failure (ECIAF) offers a comprehensive measure by integrating stunting, wasting, underweight and obese/overweight addressing the overlap and co-occurrence of different forms of malnutrition conditions, thus providing a more accurate depiction of nutritional deficiencies. Aligning with the Sustainable Development Goals, the ECIAF serves as a robust tool for health policymakers and public health practitioners to identify high-risk populations, allocate resources effectively, and improve health outcomes for young children in this region. This study aimed to determine the pooled prevalence of the Extended Composite Index of Anthropometric Failure and to identify its associated factors among children under-5 in SSA countries.
This study is a secondary data analysis of nationally representative community-based cross-sectional Demographic and Health Surveys (DHS) conducted in Sub-Saharan African countries, including a weighted sample of 176,141 children under-5 years. The recent demographic and health survey of 26 Sub-Saharan African countries were involved in this analysis. A multilevel binary logistic regression model was fitted to identify factors associated with ECIAF in children under-5 years old. The AOR with its 95% CI was estimated, and a level of significance of 0.05 was used to determine the significant factors of ECIAF.
The pooled prevalence of ECIAF among children under-5 was 36% (95% CI: 33%, 40%) in Sub-Saharan Africa. Key factors associated with increased odds of ECIAF included: increasing child age (6–23 months [AOR = 1.56; 95% CI: 1.46, 1.66] & 24–59 months [AOR = 2.03; 95% CI: 1.88–2.19]), multiple births [AOR = 2.38; 95% CI: 2.05–2.76], reducing birth size (average [AOR = 1.20; 95% CI: 1.14, 1.26] & small [AOR = 1.80; 95% CI: 1.68–1.93]), having comorbidity [AOR = 1.12; 95% CI: 1.07, 1.16], reducing level of mother’s educational status (primary [AOR = 1.20; 95% CI: 1.12, 1.28] & no formal education [AOR = 1.36; 95% CI: 1.27, 1.45]), increasing number of children under-5 in the household (2 children [AOR = 1.17; 95% CI: 1.10, 1.23] & 3–5 children [AOR = 1.14; 95% CI: 1.06, 1.22]), reducing household wealth status (rich [AOR = 1.28; 95% CI: 1.17, 1.41], middle [AOR = 1.31; 95% CI: 1.19, 1.44], poor [AOR = 1.42; 95% CI: 1.28, 1.56] & poorest [AOR = 1.45; 95% CI: 1.31, 1.61]), living in rural area [AOR = 1.15; 95% CI: 1.09, 1.22]. Protective factors included female sex [AOR = 0.69; 95% CI: 0.66–0.72], birth interval >24 months [AOR = 0.86; 95% CI: 0.81, 0.91] health facility delivery [AOR = 0.79; 95% CI: 0.74–0.83], and antenatal care attendance [AOR = 0.83; 95% CI: 0.77–0.90].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Amare Muche, Aznamariam Ayres, Tilahun Dessie Alene, Robel Asaminew Mekonnen, Elsabeth Addisu, Gebeyehu Tsega, Yawkal Tsega. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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