Trends in Prevalence and Predictors of Undernutrition in Tunisian Children Aged 0–23 Months: Evidence from Multiple Indicator Cluster Surveys (2011–2023)

Background: In recent years, undernutrition has remained a significant public health issue in Tu-nisia, increasing the risk of illness and mortality in young children. Therefore, this study aims to analyse the prevalence and factors contributing to undernutrition among Tunisian children aged 0-23 months; Methods: The study included 3265 children aged 0-23 months from the 2011-2023 Tunisia Multiple Indicator Cluster Surveys (MICS). Trends and logistic regression analyses were used to determine the prevalence and predictors of undernutrition; Results: The prevalence of stunting, wasting, and underweight in infants and children aged 0-23 months has increased by 3.3%, 0.5%, and 2.1%, respectively. Stunting and underweight were more common among infants aged 0-5 months (11.8% for stunting, 8.9% for underweight, p < 0.01), and first-time mothers (8.3% for stunting, 4.1% for underweight, p < 0.01). In 2023, compared to 2011, the odds of stunt-ing, wasting, and being underweight have increased by 22%, 16%, and 70% respectively. Infants aged 0-5 months had higher odds of undernutrition in all three indices. Children of obese or overweight mothers, and those who started breastfeeding late, were more likely to be stunted. Boys had significantly higher odds of wasting and underweight. Small birth weight, and dura-tion of breastfeeding > 12months had significantly higher odds of being underweight; Conclu-sions: This study shows that infants aged 0-5 months, first-time mothers, boys, and children from poor households in Tunisia are at a higher odd of undernutrition. To address the growing issue of undernutrition in Tunisian children, enhancing maternal and child health and nutrition ser-vices, improve parental education, and implement community-based programs that provide breastfeeding and nutritional education to infants born to new mothers and mothers with high/low BMI is recommended.