Peer-reviewed article

Analysis of Causal Factors to Acute Malnutrition Among Children Under the Age of Five in West Nile, Uganda.

Watanabe K, Hori S, Mshilla C · 23 Mar 2026

Abstract

Addressing child malnutrition requires a comprehensive understanding of its determinants. However, empirical evidence examining the relationships between these determinants and child malnutrition outcomes remains limited in Uganda. This study examined the underlying causes of acute malnutrition among children under 5 years of age in refugee settlements and surrounding host communities in West Nile, Uganda. Quantitative data were collected through a cross-sectional survey using a two-stage cluster sampling method including 767 mothers and 1167 children under the age of 5 years. The data collected included household food security, dietary intake, access to health and nutritional services, and anthropometric measurements. Confirmatory factor analysis was used to assess the fit of the hypothetical model, and structural equation modeling (SEM) examined the relationships between latent variables and weight-for-height Z-scores. The prevalence of Global Acute Malnutrition was estimated to be 8.8%, and a low proportion of children (7.2%) and their mothers (15.0%) met the minimum dietary diversity requirements. SEM revealed that household food security (p = 0.006) and maternal body mass index (p < 0.001) had significant positive effects on children's nutritional status, whereas the direct effects of the other factors were not statistically significant. The analysis also revealed that access to health and nutrition services had significant positive effects on dietary intake (p = 0.002) and disease incidence (p < 0.001). Additionally, dietary intake had a significant protective effect against disease (p < 0.001), and, in turn, household food security positively and significantly influenced dietary intake (p = 0.042). These findings suggest that future interventions aimed at reducing undernutrition in children, particularly in the context of protracted emergencies, should integrate food security, maternal health, and food delivery services.