Factors Associated With Childhood Undernutrition in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Undernutrition increases the risk of morbidity and mortality, making it essential to identify and address its key determinants. This systematic review and meta-analysis examines the impact of selected child-related, household and hygiene, and sanitation factors on the nutritional status of infants and young children aged 0-59 months in Sub-Saharan Africa. We conducted a comprehensive search of online databases using defined Medical Subject Headings and keyword search terms. Nutritional status was assessed using the WHO child growth Standards Z-scores for stunting, underweight and wasting. A meta-analysis was performed to estimate pooled associations, and heterogeneity was assessed using the Cochrane Q and I² statistic. Sensitivity analyses were conducted, and publication bias was evaluated. Out of 1, 992 articles identified, 49 studies met the inclusion criteria. Our findings indicated that diarrhoea was associated with 77% increased risk of overall undernutrition (odds ratio (OR) = 1.77; confidence interval [Cl] = 1.52, 2.06), and 92% increased risk of wasting (OR = 1.92; 95% Cl = 1.48, 2.48). Low birthweight was linked to a two-fold increased risk of stunting (OR = 2.35; 95% Cl = 1.84, 3.00), while low maternal education was associated with a higher risk of underweight (OR = 1.55; 95% Cl = 1.17, 2.04). These findings highlight the need for targeted interventions to reduce childhood undernutrition in the region.