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Meta-analysis reveals significant disparities in childhood anthropometric failure across global regionsChildhood Undernutrition Rates Show Progress in Low and Middle Income Countries

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Key Takeaway
Anthropometric failure remains high in lower-income settings, disproportionately affecting children in rural areas.

This extensive meta-analysis analyzed data from over 2.6 million children under the age of five across 18 countries, primarily in South Asia and Africa. The study utilized several indices to measure anthropometric failure, including CIAF, CISAF, and eCIAF. Findings indicate a high pooled prevalence of CIAF at 49.07%, with a notable downward trend observed between 2005 and 2024.

Significant socioeconomic disparities were identified regarding nutritional outcomes. Children residing in rural areas showed higher rates of anthropometric failure compared to those in urban settings. Furthermore, children from the poorest households and those whose mothers had no formal education faced significantly higher risks of malnutrition.

While the prevalence of these conditions is declining globally, it remains a critical concern in low-income regions. The data underscores that maternal education and household wealth are primary drivers of nutritional inequality. These findings suggest that targeted interventions focusing on rural infrastructure and educational support for mothers may improve outcomes.

A large-scale review of data from 18 countries, primarily in South Asia and Africa, looked at the prevalence of malnutrition in children under five years old. The study analyzed over 2.6 million records to track how many children suffered from various forms of physical growth failure.

The findings show that while the overall rate of childhood undernutrition has dropped significantly since 2005, it remains high in many regions. Specifically, about 49 percent of children were found to have a composite index of anthropometric failure. The data also showed that children in rural areas and those living in the poorest households face higher risks.

Additionally, children whose mothers had no formal education were more likely to experience undernutrition. Because this study is based on observational data, it shows links between location, wealth, and nutrition rather than direct causes. These results highlight that while progress is being made, specific groups still need more support.

What this means for you:
Undernutrition rates are falling, but children in rural areas and poorer homes remain at higher risk.

Study Details

Study typeMeta analysis
Sample sizen = 54
EvidenceLevel 1
Follow-up60.0 mo
PublishedJul 2026
View Original Abstract ↓
BACKGROUND: The Composite Index of Anthropometric Failure (CIAF) and its extensions-the Composite Index of Severe Anthropometric Failure (CISAF) and extended CIAF (eCIAF)-capture overlapping forms of child undernutrition but remain under-reported at global and regional levels. We aimed to estimate the prevalence of CIAF, CISAF and eCIAF among children under 5 years and assess inequalities by sex, residence, household wealth and maternal education. METHODS: We systematically searched major databases, including Embase, MEDLINE (PubMed), Scopus, CINAHL, ProQuest, Global Index Medicus and the Cochrane Library, without language or geographic restrictions. Random-effects meta-analyses estimated pooled prevalence. Heterogeneity was assessed using Cochran's Q and I² statistics. Subgroup analyses, meta-regression, sensitivity analyses and publication bias assessments were conducted. Inequalities were quantified using prevalence ratios (PRs), prevalence differences, the Concentration Index and the Slope Index of Inequality (SII). RESULTS: We included 107 studies from 18 countries, predominantly low- and middle-income countries in South Asia and Africa (notably India, n=54), comprising over 2.6 million under-5 children for CIAF, 590 744 for eCIAF and 29 905 for CISAF. The pooled prevalence of CIAF was 49.07% (95% CI 46.00% to 52.14%), declining from 59.8% in 2005 to 45.9% in 2024. The pooled prevalence of CISAF and eCIAF was 12.77% and 40.41%, respectively. CIAF prevalence did not differ significantly by sex (pooled PR: 1.04, 95% CI 0.99 to 1.09) but was higher in rural than in urban settings (pooled PR: 1.18, 95% CI 1.10 to 1.27). Substantial socioeconomic inequalities were observed, with higher prevalence among children from the poorest households (pooled PR: 1.71, 95% CI 1.42 to 2.05) and among those whose mothers had no formal education (pooled PR: 1.55, 95% CI 1.26 to 1.90). Absolute inequalities were further confirmed by SII estimates for wealth (-31.28%) and maternal education (-26.60%). CONCLUSIONS: CIAF prevalence remains alarmingly high in low-income settings, disproportionately affecting children in rural areas, poorer households and those born to mothers with limited education.
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