Child malnutrition remains one of the most concerning public health problems in low- and middle-income countries, particularly in sub-Saharan Africa. It mainly manifests as stunting, underweight, and wasting among children under five years of age. According to the United Nations Children’s Fund, millions of children worldwide continue to suffer from various forms of malnutrition, with significant consequences on morbidity, mortality, and cognitive development [1]. Long-term consequences also include reduced human capital and lower productivity in adulthood [2].

The determinants of child malnutrition are multiple and interconnected. They include socio-economic factors, feeding practices, household food security, access to healthcare services, and environmental conditions [3][4]. Among these factors, infant and young child feeding practices play a central role in children’s growth and development. Inadequate feeding characterized by low dietary diversity or insufficient meal frequency is strongly associated with an increased risk of malnutrition [5][6]. Several studies conducted in Africa have shown that minimum dietary diversity is an important protective factor against malnutrition among children under five years of age [7].

Furthermore, household food insecurity remains a major determinant of children’s nutritional status in rural areas. It is reflected by limited food availability, reduced food portions, or a decrease in the number of meals consumed per day. In contexts of rural poverty, these food-related constraints particularly affect young children whose nutritional needs are high [5][8]. Frequent childhood illnesses such as diarrheal and respiratory infections may also worsen malnutrition by reducing nutrient absorption and increasing the body’s energy requirements [9][10].

In the Democratic Republic of the Congo, child malnutrition remains a major public health problem, especially in rural areas where socio-economic conditions and access to health services remain limited [11][12]. Despite efforts undertaken in the field of nutrition, empirical data on household feeding practices and their relationship with child malnutrition remain limited in several regions of the country, particularly in Tshopo Province.

In this context, the present study aimed to analyze feeding practices and factors associated with malnutrition among children aged 6 to 59 months in the Isangi territory, Democratic Republic of the Congo.

This study aimed to analyze the factors associated with malnutrition among children aged 6 to 59 months in a rural setting characterized by specific socio-economic dynamics. The findings show that malnutrition remains an important public health problem in the study area. This situation is consistent with trends observed in several sub-Saharan African countries, where child malnutrition continues to be strongly influenced by socio-economic and dietary conditions [1][3][4].

One of the most important findings of this study concerns the role of dietary diversity in children’s nutritional status. Children with acceptable dietary diversity had a significantly lower risk of underweight and wasting. Dietary diversity is recognized as an important indicator of diet quality and adequacy of nutrient intake. Several studies have demonstrated that diversified diets improve the intake of essential micronutrients and contribute to reducing the risk of malnutrition among children [5]-[7]. Studies conducted in different African settings have also confirmed the association between low dietary diversity and child malnutrition [4][5][7].

The number of meals consumed per day also appeared to be an important determinant of children’s nutritional status. In this study, receiving at least two meals per day was associated with a significant reduction in the risk of underweight. This finding is consistent with international recommendations on infant and young child feeding, which emphasize the importance of adequate meal frequency to meet the high energy requirements during early childhood [13]. In food-insecure settings, insufficient meal frequency can rapidly lead to chronic energy deficiency, contributing to the development of malnutrition [14].

Children’s health status was also identified as a major determinant of malnutrition. Children who experienced recent illnesses had a significantly higher risk of wasting. The relationship between infection and malnutrition is well documented in the scientific literature. Infectious diseases, particularly diarrheal and respiratory infections, may reduce appetite, impair nutrient absorption, and increase metabolic demands, thereby worsening children’s nutritional status [10]. This phenomenon illustrates the vicious cycle between malnutrition and infection widely described in low- and middle-income countries [2].

Complete vaccination according to the immunization schedule showed a protective effect against wasting. Properly vaccinated children had a lower risk of acute malnutrition. Vaccination plays an essential role in preventing infectious diseases that may compromise children’s nutritional status. Previous studies have shown that improving vaccination coverage indirectly contributes to reducing malnutrition by limiting childhood morbidity [9].

Overall, these findings confirm that child malnutrition is a multifactorial phenomenon involving dietary and health factors. Interventions aimed at improving dietary diversity and strengthening infant and young child feeding practices could significantly contribute to reducing malnutrition in rural communities.

The findings of this study suggest several important implications for public policies and malnutrition control programs. First, nutrition interventions should strengthen the promotion of dietary diversity and appropriate infant and young child feeding practices at the community level. Second, strengthening vaccination coverage and the prevention of childhood illnesses remains essential to reducing acute malnutrition.

This study has several strengths. First, it combines nutritional and health variables to provide an integrated analysis of the determinants of child malnutrition in a rural setting. Second, the use of logistic regression analysis made it possible to identify factors independently associated with different forms of malnutrition among children.

However, some limitations should be considered. The cross-sectional nature of the study does not allow formal causal relationships to be established between the studied factors and children’s nutritional status. In addition, some feeding-related variables relied on household self-reporting, which may have introduced recall bias. Finally, because the findings are specific to the study area, caution should be exercised when generalizing the results to other contexts.

This study highlights the main determinants of malnutrition among children aged 6 to 59 months in the Isangi territory. The findings show that dietary diversity, meal frequency, recent morbidity and vaccination status significantly influence children’s nutritional status. Children benefiting from diversified diets and adequate meal frequency had a significantly lower risk of underweight and wasting. Conversely, recent episodes of illness considerably increased the risk of acute malnutrition.

These findings confirm the multifactorial nature of child malnutrition, resulting from complex interactions between dietary and health. In this context, strategies to combat malnutrition should adopt an integrated approach combining improvement of feeding practices and strengthening preventive health services in order to sustainably reduce children’s nutritional vulnerability.

This research did not receive any specific funding from public, commercial, or non-profit organizations.

The authors express their sincere gratitude to the local health authorities and community leaders of the Isangi territory for their collaboration and support during data collection. They also thank the field investigators and the households who agreed to participate in this study. Their contribution was essential to the completion of this work.

Conceptualization: Dieudonné Epeleka Mazembe and Joris Likwela Losimba. Methodology: Dieudonné Epeleka Mazembe and Joris Likwela Losimba. Data collection and Formal analysis: Dieudonné Epeleka Mazembe, Raphael Iseayembele Bosalo, and Satos Lobwa. Writing—original draft preparation: Dieudonné Epeleka Mazembe. Writing—review and editing: Dieudonné Epeleka Mazembe, Raphael Iseayembele Bosalo, Satos Lobwa, Alliance Tagoto Tepungipame, Basile Solomo Elumbu, and Joris Likwela Losimba. Supervision: Joris Likwela Losimba. All authors have read and approved the final version of the manuscript.