Prevalence and determinants of malnutrition among Iraqi under-five children, 2025

Abstract

Background: Childhood malnutrition remains a critical public health challenge in Iraq, with limited comprehensive data on prevalence and determinants across the country. This study aimed to assess the nationwide prevalence and determinants of malnutrition among children under five years attending primary healthcare centers in Iraq.Methods: A cross-sectional descriptive study was conducted between December 2024 and April 2025 across Primary Healthcare Centers (PHCs) nationwide, excluding the Kurdistan Region. A multistage stratified random sampling selected PHCs and recruited 5,121 eligible children. Data collection included standardized questionnaires covering demographics, health, feeding practices, maternal knowledge, and anthropometric measurements following WHO protocols. Statistical analyses used SPSS for descriptive, bivariate, and multivariate assessments.Results: Among 5,121 children analyzed, 45.6% had normal nutritional status, while 18.8% were stunted, 9.3% underweight, 4.8% wasted, and 12.5% overweight, demonstrating a dual burden of malnutrition. Key predictors included low birth weight (adjusted OR: 1.758, 95% CI: 1.497-2.066), peripheral residence (adjusted OR: 1.443, 95% CI: 1.233-1.688), incomplete vaccination (adjusted OR: 1.393, 95% CI: 1.203-1.614), and low maternal education (adjusted OR: 1.264, 95% CI: 1.076-1.481). Regional disparities were significant, with Wasit (27.1%), Muthanna (26.8%), and Salah Al-Din (25.7%) showing highest stunting rates.Conclusion: This study reveals Iraq's complex malnutrition landscape with significant regional and socioeconomic disparities. Urgent, governorate-specific interventions are needed to strengthen maternal and child health services, improve feeding practices, and implement multi-sectoral policies.