The Fria prefecture, located in Lower Guinea within the Boké administrative region, covers an area of 1811 km² and has a population of around 82,000 inhabitants, with a population density of 45 inhabitants/km². It is traversed by the Konkouré River and lies 160 km north of Conakry. Historically, Fria is known for the presence of Africa’s first alumina plant, built in 1957 by Péchiney. Connected to Conakry by both a road and a railway, this industry was once a major economic driver. However, its closure has had profound socio-economic consequences, worsening food insecurity and the nutritional vulnerability of the local population. Administratively, the prefecture is divided into four sub-prefectures (Baguinet, Banguingny, Fria-Centre, and Tormelin) and several urban neighborhoods. The Fria prefecture was selected as the study area due to the impact of the industrial crisis on food security and child malnutrition. This situation justifies the need for an in-depth analysis of the nutritional and socio-economic factors influencing dietary practices and the hematological-parasitological profile of children under five in Fria Prefecture [10] . As shown in Figure 1 , the map of the Prefecture of Fria highlights the enumeration areas.

The study was conducted in collaboration with the Department of Statistics and Data Analysis at the Faculty of Science of Gamal Abdel Nasser University of Conakry, and the National Quality Control Office (ONCQ) of Matoto. This collaboration was essential to ensure a rigorous methodological approach and guarantee the quality of the data collected throughout the analysis [11] . As shown in Figure 2 , maps illustrate the location of Gamal Abdel Nasser University of Conakry and the Laboratory of the National Office of Quality Control in Matoto.

This is a cross-sectional descriptive study conducted over one month, from November 4 to December 4, 2024. It aims to collect data on sociodemographic, anthropometric, hemoglobin, hematological, parasitological variables, and dietary practices of children aged 6 to 59 months. L’étude transversale descriptive a utilisé un questionnaire validé et testé pour mesurer les pratiques alimentaires et les facteurs influençant le profil hémato-parasitologique des enfants. La validité du questionnaire a été assurée par une révision d’experts en nutrition et en santé publique, et sa fiabilité a été testée par un test-retest auprès d’un échantillon pilote, avec un coefficient de corrélation de 0.85. Ce questionnaire comprenait 20 items couvrant les pratiques alimentaires, les connaissances nutritionnelles et les caractéristiques socio-économiques.

All children aged 6 to 59 months residing in the Fria prefecture.

The sample includes children aged 6 to 59 months whose mothers or guardians have given their consent for participation in the study.

The sampling frame is based on the enumeration areas (EA) derived from the 2014 General Population and Housing Census (RGPH). Each EA is a geographical unit with defined boundaries, including a known number of households and people [12] .

Cluster selection, the primary unit of sampling, was carried out by proportional allocation to the population size of the strata to ensure representativeness.

Households were selected by systematic random sampling after a prior census of the primary sampling units.

All children aged 6 to 59 months present in the selected households were included in the sample, regardless of the number of children per household.

The sample size was determined using the Emergency Nutrition Assessment (ENA) software version 2016, considering a non-response rate of 3%. A maximum prevalence of 5% for Global Acute Malnutrition (GAM) in the Fria prefecture was taken into account, and the following formula was applied:

$N=\frac{z^2\times p\times \left(1-p\right)\times e}{D^2\times r}$

By applying these parameters, the sample size was calculated to be 428 children. According to WHO guidelines for this sample size, it is recommended to use between 20 and 30 enumeration areas (EAs). Given the critical importance of this study, we randomly chose to use the maximum of 30 EAs for the Fria prefecture, in accordance with these recommendations.

The results from Table 1 show that the majority of mothers are aged between 18 and 35 years (86.6%), which corresponds to the age range where women are generally in their childbearing years. The lower proportion of mothers aged ≥36 years (13.3%) may be due to a decrease in fertility rates with age. Our results are similar to those reported by Samuel KEÏTA in his doctoral thesis in medicine in Bamako, Mali, where 63.1% of the mothers of children included in his study were in the 20-40 age range [13] .

The results from Table 2 show that 30.2% of the mothers are illiterate, and only 20.4% have reached a higher education level, which may influence their understanding of nutrition and food hygiene recommendations. A low education level may limit the adoption of good dietary and health practices, thereby increasing the risk of malnutrition and infections. Our results are lower than those reported by Samuel KEÏTA in his doctoral thesis in Bamako, Mali, where 38.6% of the mothers of children included in his study had no education [13] .

The results from Table 3 show that 47.1% of the mothers live in urban areas, mainly in Fria, while 52.9% live in rural areas, particularly in the localities of Baguinet, Banguinyi, and Toromelin. This distribution is significant because it highlights disparities in access to health infrastructure, nutritional follow-up services, and varied diets. Indeed, rural areas often face major challenges such as distance from healthcare centers, limited availability of foods rich in essential nutrients, and sometimes insufficient awareness of good dietary practices. These factors contribute to increasing the risk of child malnutrition, necessitating targeted interventions to improve nutritional care for children in these regions.

The distribution of children by age and gender, as shown in Table 4 , revealed a G/F ratio of 0.9 in favor of boys. The percentage of boys is slightly higher in the 6 to 17-month (55.7%) and 42 to 53-month (66.7%) age groups, which may suggest biological or behavioral differences influencing the survival and nutritional status of boys. The proportion of children aged 6 to 17 months is the highest (35.1%), corresponding to a critical period for growth and development, requiring adequate nutrition to avoid malnutrition. Our results are consistent with those reported by Élie Mutombo in 2023 in the Democratic Republic of Congo, where 50.8% of the children included in his study were male compared to 49.2% female, with a boy/girl ratio of 1.03 in favor of boys [14] .

The distribution of acute malnutrition by age group is shown in Table 5 . Severe Acute Malnutrition (SAM) affects 3.3% of children, and Moderate Acute Malnutrition (MAM) affects 5.6%, for a total of 8.9% of children in a state of acute malnutrition. The 54 to 59-month age group is the most affected (SAM: 29.4%; MAM: 17.6%), indicating increased vulnerability as children grow older. This may be related to insufficient access to protein-rich and micronutrient-rich foods. Overall, 83.3% of children have normal nutritional status, indicating a moderate prevalence of acute malnutrition compared to WHO thresholds. Our results are lower than those reported by Élie Mutombo in 2023 in the Democratic Republic of Congo, where the overall prevalence of acute malnutrition was 19.8%, with 13.9% presenting severe forms and 5.9% with moderate acute malnutrition. Only 80.2% of children had normal nutritional status [14] .

The distribution of children by hemoglobin level is shown in Table 6 . This table shows that 41.1% of children have anemia with a hemoglobin level lower than 12 g/dL, while 58.9% have normal hemoglobin levels (≥12 g/dL), which is a major public health problem. The high prevalence of anemia may be due to deficiencies in iron, vitamin B12, and folic acid, as well as parasitic infections. Our results are higher than those reported by Djidita Hagré et al. in 2022 in two hospitals in the southern district of N’Djamena, Chad, where 34% of children had anemia defined by hemoglobin levels lower than 12 g/dL [15] .

As shown in Table 7 , among children with an abnormal hemoglobin level, 69.7% of anemic children are parasitized by Plasmodium (malaria), confirming the link between anemia and parasitic infections. Among them, 18.9% of children suffer from moderate anemia associated with hookworm infection, a condition that can cause chronic blood loss, and 11.4% of severe anemia cases are linked to schistosomiasis, another parasitic infection frequently associated with malnutrition and chronic infections. Our results differ from those of Soumana et al. (2011) in Niamey concerning the types of parasitic infections. Their study reported 86.4% protozoa and 13.6% helminths (nematodes). The identified protozoa were Giardia intestinalis (50%), Entamoeba histolytica (31.8%), and Trichomonas intestinalis (4.6%). Among the helminths, species transmitted via the fecal-oral route were predominant: Ascaris lumbricoides (4.5%), Enterobius vermicularis (4.5%), and Trichuris trichiura (1.5%). Ankylostoma duodenale (1.5%) was the only nematode transmitted through skin contact [16] .

As shown in Table 8 , the distribution of children based on hematocrit levels shows that 10.8% of anemic children have a severely decreased hematocrit (< 20%), indicating an advanced form of anemia. This critical level requires urgent medical intervention to prevent severe complications and ensure prompt action to restore the blood balance and general health of the children.

As shown in Table 9 , 64.9% of anemic children exhibit microcytosis (MCV < 80 fL), suggesting that most cases of anemia are due to deficiency, particularly iron deficiency. This microcytosis is a key indicator of iron deficiency, which is essential for red blood cell production and oxygen transport in the body. A targeted nutritional intervention is necessary to correct this deficiency and prevent long-term effects on the growth and development of children [17] .

As shown in Table 10 , among the children aged 6 to 24 months included in our study, only 20.7% were breastfed immediately after birth, while 47.4% were breastfed late, after several hours or within the day. The WHO recommends breastfeeding within the first hour of birth, as it strengthens immunity and helps prevent infections, both of which are crucial for infant health.

As shown in Table 11 , 78.4% of children consume primarily energy foods, while only 12.9% consume builder foods and 8.6% consume protective foods. This imbalanced food distribution is concerning as it exposes children to nutritional deficiencies, particularly in proteins and essential micronutrients. Insufficient intake of builder foods (rich in proteins) and protective foods (rich in vitamins and minerals) can lead to deficits in growth, development, and immunity, thereby increasing the risk of chronic malnutrition and associated diseases. It is crucial to diversify children’s diets to prevent these deficiencies and improve their overall nutritional status.

As shown in Table 12 , 78.4% of children primarily consume energy foods, while only 12.9% consume builder foods and 8.6% consume protective foods. This imbalanced food distribution is concerning, as it exposes children to nutritional deficiencies, particularly in proteins and essential micronutrients. Insufficient intake of builder foods (rich in proteins) and protective foods (rich in vitamins and minerals) can lead to deficits in growth, development, and immunity, thereby increasing the risk of chronic malnutrition and associated diseases. It is crucial to diversify children’s diets to prevent these deficiencies and improve their overall nutritional status.

As shown in Table 13 , among the 116 children, only 6 (5.2%) received a minimum acceptable diet, including three food groups and four meals a day. In contrast, 94.8% of children did not receive the recommended minimum diet. This dietary insufficiency partly explains the high prevalence of malnutrition and anemia observed in the studied population, highlighting the urgent need to improve access to a diverse and balanced diet to ensure children’s health and development. Our results are higher than those reported in the 2016 Guinea MICS survey, which indicated that only 0.6% of children aged 6 to 24 months in the Boké region received a diversified diet [18] .

As shown in Table 14 , among the children aged 6 to 24 months included in our study, 30.2% receive only two meals per day, which is insufficient according to the World Health Organization (WHO) recommendations. The WHO advises at least three to four daily meals for this age group to ensure adequate nutrient intake. Only 24.2% of children meet the minimum recommended frequency of four meals per day, while 35.3% consume three meals daily. A similar proportion (24.2%) benefits from a higher meal frequency, which positively contributes to their nutritional development. These findings highlight a concerning dietary insufficiency among a significant proportion of children, exposing those who do not meet the minimum meal frequency to an increased risk of nutritional deficiencies and growth retardation. Enhancing both the frequency and quality of meals is therefore essential to reduce the prevalence of childhood malnutrition and ensure adequate energy and micronutrient intake for optimal growth and development.

As shown in Table 15 , the results indicate that 67.2% of households rely on prolonged cooking methods, which, while effective in eliminating certain pathogens, may lead to the loss of essential nutrients. Among these households, 54.3% use boiled or potable water, a critical factor in reducing the risk of foodborne contamination. However, only 43.1% adhere to hygienic cooking practices, potentially compromising the microbiological safety of prepared foods. Furthermore, 35.3% of households implement food preservation techniques, such as refrigeration or proper storage, which play a crucial role in preventing bacterial proliferation and ensuring food safety. These findings highlight the need for targeted interventions to promote safe and nutritionally adequate food preparation and storage practices, thereby reducing the risk of foodborne illnesses and nutrient depletion.

As shown in Table 16 , over 60% of caregivers lack knowledge of basic nutritional principles, including the importance of essential micronutrients such as iron and iodine. This lack of awareness significantly contributes to the high prevalence of anemia and parasitic infections observed in the children studied. Specifically, 59.5% of caregivers are unaware of the importance of food diversification, which could lead to nutritional deficiencies in children if not addressed. Additionally, 62.9% of caregivers fail to recognize the signs of malnutrition, which may delay timely intervention for malnourished children. Finally, 70.7% of caregivers are unaware of the role that iron and iodine play in preventing anemia and micronutrient deficiencies, further exacerbating the risk of malnutrition. These findings emphasize the critical need for nutritional education programs targeting caregivers to raise awareness about the essential micronutrients necessary for children’s growth and development and to promote early identification and intervention for malnutrition.