Dietary and non-dietary factors of undernutrition using Composite Index of Anthropometric Failure in children aged 6–23 months in Democratic Republic of the Congo: the 2023 National Nutrition Survey

Introduction Undernutrition remains a significant public health challenge in the Democratic Republic of Congo (DRC). This study aims to identify dietary and non-dietary factors associated with undernutrition among children aged 6–23 months using the Composite Index of Anthropometric Failure. Methodology The secondary analysis was conducted using data from the 2023 National Nutrition Survey, a nationally representative cross-sectional study. The final analytical sample consisted of 5396 children, stratified into two age bands 6–11 months (n=1792) and 12–23 months (n=3604). Bivariate analysis (p<0.2), Multivariable logistic and stepwise regression models (p<0.05) were used to identify factors associated with undernutrition. Results The overall prevalence of undernutrition was 47.4%, rising significantly from 37.4% in infants aged 6–11 months to 52.6% in children aged 12–23 months. Stepwise logistic regression identified distinct risk profiles: for the 6–11 month group, male sex (adjusted OR (aOR)=1.7; 95% CI 1.3 to 2.1) and larger households with >2 children (aOR=1.3; 95% CI 1.1 to 1.6) increased the undernutrition, while acceptable minimum meal frequency (MMF) was the primary protective factor (aOR=0.12; 95% CI 0.08 to 0.19). Among the 12–23 month, high dietary diversity (aOR=0.5; 95% CI 0.4 to 0.7), acceptable MMF (aOR=0.6; 95% CI 0.5 to 0.8) and maternal education significantly reduced undernutrition. Conversely, rural residency, recent diarrhoea (aOR=1.4; 95% CI 1.2 to 1.7) and poor hand hygiene remained major factors associated with undernutrition. Conclusion Traditional indices significantly underestimate the true nutritional burden in the DRC. These findings underscore the need for a National Nutrition Programme to implement multisectoral interventions that prioritise maternal literacy and the integration of Water, Sanitation and Hygiene protocols to address the diverse drivers of undernutrition.