Nigussie Adam Birhan, Denekew Bitew Belay
Under nutrition is the main cause of child death in developing countries. The Composite Index of Anthropometric Failure (CIAF) combines all three forms of anthropometric failures to assess the nutrition status of children. Thus, the objective of this was to identify factors associated with CIAF of under-five children in Lesotho. A secondary analysis of the Lesotho Demographic and Health Survey 2023-24 was conducted, using the data for 1089 children under the age of 5 years. The CIAF was used to classify children based on stunting, wasting, and underweight. Descriptive summary statistics were computed. A binary logistic regression model was employed to identify predictors of CIAF for under-five children. Adjusted odds ratio with 95% confidence interval was estimated. The prevalence of CIAF in Lesotho was 34.68% (95% CI: 31.76-37.73). Female child 0.54 (AOR = 0.54; 95% CI: 0.375, 0.776), age group 24-59 months 2.42 (AOR = 2.42; 95% CI: 1.149, 5.109), rich households 0.29 (AOR = 0.29; 95% CI: 0.151, 0.554), multiple births 12.02 (AOR = 12.02; 95% CI: 1.199, 120.426), rural residence (AOR = 0.56: 95% CI: 0.335, 0.946), living children 3 to 4 were 2.54 (AOR = 2.54; 95% CI: 1.522, 4.226), and larger size at birth were 0.38 (AOR = 0.38; 95% CI: 0.211, 0.683) were found to be significantly associated with CIAF. The prevalence of CIAF among children under five in Lesotho was high. Child's age, child's sex, child's type of birth, wealth tercile, residence, number of living children, and child's birth size were found to be significantly associated with CIAF. We suggest that the government adapt CIAF as a metric for assessing children's nutritional status in order to estimate the overall prevalence of malnutrition and strengthening adequate nutrition intervention programs in rural areas. Furthermore, highlighting the factors influencing child CIAF will help inform future policies and programs designed to approach this major problem in Lesotho.