Trends in the Nutritional Status of Children Under 5 in Africa (1990–2024): A Multidimensional Analysis by Country Income Level

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Their nutritional status is directly related to an individual's lifelong health and the quality of the population in a country or region. The nutritional status in African regions is a global disaster area and one of the core areas of global health monitoring by the World Health Organization (WHO). Objective This study aims to analyze the changing trends in the nutritional status of children under 5 years old in the African region from 1990 to 2024, based on the 2024 data from the World Health Organization's Global Health Observatory (GHO) database. Methods This study uses data from the Global Health Observatory database in 2024 to conduct a retrospective analysis, covering the nutritional status of children under 5 years old in 46 countries in the African region from 1990 to 2024, and adopts descriptive statistics for the nutritional status. Based on the 2025 income level grouping by the World Bank (WB), three countries with different income levels, namely Algeria, Senegal, and Niger, were selected. Stratification was performed according to dimensions such as gender, education level, and place of residence, and two-way analysis of variance was used to compare whether there were differences in nutritional status across different dimensions and different years. Results In African regions, indicators such as stunting, underweight, wasting, and severe wasting have decreased to varying degrees, while overweight has increased slightly. In Algeria, there are significant differences in child nutrition indicators among different ages, places of residence, genders, economic statuses, and maternal education levels. The overweight rate among children aged 0–1 is high, and the problem of undernutrition is more prominent in groups such as males and those in poverty. In Senegal, various child nutrition indicators are significantly affected by multiple factors. Indicators such as overweight among children aged 0–1 are relatively high, and undernutrition indicators are higher in rural areas, among males, in poverty-stricken groups, and in groups where mothers have low educational levels. In Niger, child nutrition indicators are significantly affected by multiple factors. Undernutrition indicators are higher in rural areas, among males, and in groups where mothers have low educational levels, while economic status has no significant impact on various indicators. Conclusion The nutritional status of children under 5 in Africa has improved significantly, but the improvement varies across different regions and income levels. The nutritional transition shows differentiation, and socioeconomic factors have different impacts on various nutritional indicators. Therefore, targeted intervention measures need to be formulated based on different dimensions in different countries. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors Africa children under 5 nutritional status socioeconomic factors different dimensions GHO Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Introduction Malnutrition among children under 5 is a major public health challenge that urgently needs to be addressed in Africa. Its threat to children's survival, health, and regional development far exceeds the global average. This issue not only directly increases the risk of death from infectious diseases in children but also causes a series of long-term and irreversible developmental damage. 1 For example, it can cause lifelong limitations in children's cognitive abilities, sustained low immunity, and significantly increase their risk of developing non-communicable diseases in adulthood. This poses a profound and heavy impact on the health of individuals throughout their life cycle and the sustainable socio-economic development of Africa. 2 , 3 What is more challenging is that some African countries are trapped in the predicament of the "double burden of malnutrition" — undernutrition (stunting, underweight, wasting, severe wasting) and overnutrition (overweight). 4 This phenomenon exists simultaneously within the same country, the same community, and even the same family, resulting in a contradictory and complex nutritional and health situation. According to relevant data from the World Health Organization (WHO), in 2022, the problem of malnutrition among children under 5 in Africa showed a high incidence trend, among which the number of children with stunting and wasting accounted for a relatively large proportion of the global. 5 , 6 At the same time, the problem of childhood overweight in the African region cannot be underestimated either. 7 It is highly alarming that if the current nutritional and health trends are not effectively curbed, it is expected that by 2030, the African region will face the dual problem of severe malnutrition and overnutrition, which will further exacerbate the nutritional and health crisis in Africa. Previous studies on the nutritional status, Mostly limited to the analysis of a single nutritional indicator (such as stunting), it lacks exploration of the long-term changing trends of multiple nutritional indicators in a region, and also fails to conduct a comprehensive quantitative comparison across dimensions such as place of residence, gender, economic income, and maternal education level. 1 , 8 This study aims to analyze the annual trends of five nutritional indicators (stunting, underweight, wasting, severe wasting, and overweight) among children under 5 years old in the African region from 1990 to 2024. Based on the WB 2025 income level classification, it focuses on whether there are differences in the five nutritional indicators among three countries with different income levels, namely Algeria, Senegal, and Niger, across dimensions such as age, gender, place of residence, economy, and maternal education level. Additionally, based on the changing trends, targeted recommendations are provided for different countries to implement public health intervention measures. Materials and Methods Data Source The dataset is sourced from the WHO Health Inequality Data Repository - Child Nutrition, provided by UNICEF, the World Health Organization, and the WB (data URL: https://www.who.int/data/sets/health-inequality-monitor-dataset#nut ). From this, data containing African regions were screened out, involving 36,110 records from 46 countries and regions. The main variables include: outcome variables, which mainly involve five indicators: stunting, underweight, wasting, severe wasting, and overweight; stratification variables, which mainly involve age, gender, place of residence, economy, mother's education level, etc.; time variable, ranging from 1990 to 2024. Key Evaluation Indicators The evaluation criteria for health inequalities mainly involve the following indicators: Stunting: The core indicator of chronic malnutrition focuses on "stunting (height lag relative to age)". It is caused by factors such as long-term nutritional deficiencies, repeated infections, and poor hygiene conditions. It can affect children's cognitive development and lifelong health, and is an important indicator reflecting the long-term living environment of a population. 8 , 9 Underweight: A comprehensive indicator of nutritional deficiency, reflecting the lag in weight relative to age, covering the overlapping conditions of acute and chronic malnutrition. 10 Wasting: The core indicator of acute malnutrition focuses on "insufficient weight for a fixed height" and is used to determine the short-term deterioration of nutritional status. 11 Severe Wasting: The extreme state of emaciation is an acute, life-threatening form of malnutrition, indicating a severe deficiency of energy and protein in the body, and is an important risk factor for increased mortality in children. 12 Overweight: It reflects the degree of fat accumulation in the body and is directly related to energy intake exceeding consumption. 13 Statistical analysis Data analysis was performed using R (version 4.5.2) and related packages. The methods adopted include: Descriptive statistics: Statistics are conducted on the changes in the average values of five nutritional indicators (stunting, underweight, wasting, severe wasting, and overweight) among children under 5 years old in African regions based on different years. Analysis from different dimensions: Three countries, Algeria, Senegal, and Niger, with different income levels, were selected and stratified by dimensions such as age, gender, place of residence, economy, and mother's education level. Two-way analysis of variance was used to compare whether there are differences in the five nutritional indicators under different dimensions. Results Changes in five nutritional indicators for children under 5 in Africa From 1990 to 2024, the five nutritional indicators for children under 5 in Africa showed a "wavelike" change over the years. Among them, the four indicators of stunting, underweight, wasting, and severe wasting decreased compared with 1990, while the indicator of overweight increased slightly (Fig. 1 ). Comparison of various health indicators between 1990 and 2024: Stunting decreased by 17.45%, with a relative decrease of 35.85%; Underweight decreased by 13.67%, with a relative decrease of 46.58%; Wasting decreased by 0.87%, with a relative decrease of 9.93%. Severe wasting decreased by 0.67%, with a relative decrease of 22.48%. Overweight was the only indicator that increased, rising by 2.01%, with a relative increase of 62.62% (Table 1 ). Table 1 Five nutritional indicators for children under 5 in Africa in 1990 and 2024 Year stunting underweight wasting sevwasting overweight 1990 48.67 33.14 11.66 4.44 3.26 2024 40.1 20.76 5.73 1.35 4.05 Situation of five nutritional indicators for children under 5 in Algeria Basic changes in various nutritional indicators: Stunting decreased by 13.1%, with a relative decrease of 57.2%; underweight decreased by 6.5%, with a relative decrease of 70.7%. Wasting decreased by 4.4%, with a relative decrease of 62.0%; severe wasting decreased by 1.7%, with a relative decrease of 56.7%. Overweight was the only indicator that increased, rising by 4.1%, with a relative increase of 47.1%. Hierarchical situation of each dimension Age: In the 0–1 year age group, the indicators of stunting, underweight, and wasting were lower than those in the 2–5 year age group (P < 0.05); the overweight indicator in the 0–1 year age group was higher than that in the 2–5 year age group (P < 0.05) (Figs. 2 – 5 ). Residence: The overweight index of the rural group was higher than that of the urban group (P < 0.05). Gender: The indicators of stunted growth, underweight, and emaciation in the male group were higher than those in the female group (P < 0.05). Economic: The stunting index of the poorest group (Q1) is higher than that of the richest group (Q5) (P < 0.05); the underweight index of the poor groups (Q1, Q2) is higher than that of the wealthy groups (Q3, Q4, Q5) (P < 0.05); the overweight index of the poor groups (Q1, Q2) is higher than that of the wealthy groups (Q4, Q5) (P < 0.05). Mother's education: The underweight index of the no education group was higher than that of the secondary or higher education group (P < 0.05). Situation of five nutritional indicators for children under 5 in Senegal Basic changes in various nutritional indicators: Stunting decreased by 7.3%, with a relative decrease of 24.5%; underweight decreased by 6.2%, with a relative decrease of 32.6%. Wasting decreased by 2.2%, with a relative decrease of 23.4%; severe wasting decreased by 0.9%, with a relative decrease of 30.0%. Overweight was the only indicator that increased, rising by 2.5%, with a relative increase of 62.5%. Hierarchical situation of each dimension Age: The indicators of stunting and underweight in the 0–1 year age group were lower than those in the 2–5 year age group (P < 0.05); the indicators of wasting, severe wasting, and overweight in the 0–1 year age group were higher than those in the 2–5 year age group (P < 0.05). Residence: The indicators of stunting (Fig. 6 ), underweight, and severe wasting in the rural group were higher than those in the urban group (P < 0.05). Gender: The indicators of stunting (Fig. 7 ), underweight, and wasting in the male group were higher than those in the female group (P < 0.05). Economic: There were significant differences in the stunting (Fig. 8 ) and underweight (Fig. 9 ) indicators between every two economic groups (P < 0.05), with the poorest group (Q1) having higher rates than the richest group (Q5); the rates of wasting and severe wasting in the poorest group (Q1) were higher than those in the middle-high income groups (Q3-Q5) (P < 0.05); the rate of overweight in the poorest group (Q1) was lower than that in the high-income groups (Q4-Q5) (P < 0.05). Mother's education: The differences in stunting indicators between each pair of education level groups were significant (P < 0.05), with the no education group having the highest rate and the secondary or higher education group having the lowest. The underweight indicators of the no education group and the primary education group were higher than those of the secondary or higher education group (P < 0.05). The wasting indicator of the no education group was higher than that of the secondary or higher education group (P < 0.05). The severe wasting indicator of the no education group was higher than that of the primary education group (P < 0.05). The overweight indicator of the no education group was higher than that of the primary education group and the secondary or higher education group (P < 0.05). Situation of five nutritional indicators for children under 5 in Niger Basic changes in various nutritional indicators: Stunting decreased by 0.1% with a relative decrease of 0.2%; underweight increased by 1.1% with a relative increase of 3.3%. Wasting decreased by 0.3% with a relative decrease of 2.7%; severe wasting decreased by 0.7% with a relative decrease of 25.0%. There was no change in overweight. Hierarchical situation of each dimension Age: In the 0–1 year age group, the indicators of developmental delay and underweight were lower than those in the 2–5 year age group (P < 0.05); the indicators of emaciation and severe emaciation in the 0–1 year age group were higher than those in the 2–5 year age group (P < 0.05). Residence: The indicators of stunting, underweight, wasting, and severe wasting in the rural group were higher than those in the urban group (P < 0.05). Gender: The indicators of stunting, underweight, wasting, and severe wasting in the male group were higher than those in the female group (P 0.05). Mother's education: The indicators of stunting in the no education group and the primary education group were higher than the secondary or higher education group (P < 0.05) (Fig. 10 ); the indicators of underweight in the no education group and the primary education group were higher than the secondary or higher education group (P < 0.05) (Fig. 11 ). Discussion This study systematically analyzed the changing trends of nutritional status among children under 5 years old in 46 African countries based on data from the GHO database from 1990 to 2024. Focusing on three countries with different income levels: Algeria, Senegal, and Niger, this study explores the mechanism of differences by combining stratified factors such as age, place of residence, gender, and mothers' educational level, providing data support for regional precise nutrition interventions. From 1990 to 2024, the four core malnutrition indicators for children under 5 in Africa, namely stunting, underweight, wasting, and severe wasting, all showed varying degrees of decline. Among them, the relative decline in underweight was the largest (46.58%), the absolute decline in stunting was the most significant (17.45%), while the overweight rate relatively increased by 62.62%. This trend reflects that the African region has made substantial progress in improving the supply of basic nutrition for children and preventing and controlling acute and chronic malnutrition, which may be closely related to factors such as global health assistance, the advancement of regional public health projects, and the enhancement of food security guarantees. For example, intervention measures such as the promotion of breastfeeding, 14 guidance on complementary food addition, 15 and prevention and control of infectious diseases, 16 which are promoted by international organizations like the WHO and United Nations Children's Fund (UNICEF) in Africa, have effectively reduced the risks of insufficient nutritional intake and excessive nutritional consumption in children, laying the foundation for the decline in malnutrition indicators. However, the significant increase in the overweight rate also reveals that the African region is facing the severe challenge of a "double burden of malnutrition" 17 —— the traditional problem of malnutrition has not been completely solved, while issues related to overnutrition have rapidly become prominent. This phenomenon is consistent with the overall trend of the global nutritional transition, 18 and is particularly evident in middle- and high-income countries and urban areas in Africa. With the economic development and accelerated urbanization in some African countries, children's dietary structures have gradually shifted towards processed foods high in energy, fat, and sugar. At the same time, physical activity has decreased, leading to an imbalance between energy intake and consumption, which ultimately drives up the overweight rate. If this trend continues, the African region will face the dual pressure of malnutrition and obesity-related diseases 19 (such as cardiovascular diseases and diabetes) in the future, posing long-term challenges to children's lifelong health and the allocation of regional medical resources. Differences in nutritional status among countries with different income levels and the impact of stratification factors High-income country (Algeria): Significant improvement in nutrition, with stratification differences focusing on economy and age As a relatively high-income country, Algeria has seen a relative decrease of over 50% in all four malnutrition indicators, achieving the most remarkable results in improving nutrition. Hierarchical analysis shows that economic status is the core factor affecting their nutritional status: the overweight rate of the affluent group is significantly higher than that of the poor group, while the rates of underweight and stunting in the poor group are higher than those in the affluent group. This is closely related to the differences in dietary structure caused by the wealth gap within high-income countries. 20 Children from affluent families are more likely to have access to high-energy, highly refined carbohydrate foods, while children from poor families still face the risk of insufficient supply of basic nutrients. The impact of age factors is equally significant. The malnutrition indicators (stunting, underweight, wasting) in the 0–1 year age group are all lower than those in the 2–5 year age group, but the overweight rate is higher. This may be related to the higher breastfeeding rate during infancy and the relatively balanced energy intake. In contrast, children aged 2–5 have increased dietary autonomy and are more affected by unhealthy eating environments. In addition, male children have higher indicators of multiple forms of malnutrition than female children, which reflects potential gender-related differences in the distribution of nutritional resources or differences in physiological susceptibility. These issues need to be addressed in intervention efforts. Middle-income country (Senegal): Balanced improvement in nutrition, with multiple factors working together The relative reduction range of various malnutrition indicators in Senegal is between 23.4% and 32.6%. The improvement range is between that of Algeria and Niger, and the impact of stratification factors is more comprehensive. The difference in residential areas is particularly significant. The rates of stunting, underweight, and severe wasting in the rural group are all higher than those in the urban group, which is related to the current situation in rural areas such as insufficient food resources, poor sanitation conditions, and inadequate medical resources. 21 Economic status and educational level have a significant impact on all nutritional indicators, showing a gradient difference. With the improvement of economic level and educational attainment, the indicators of malnutrition have gradually decreased, while the overweight rate has increased. This suggests that the improvement of educational attainment may promote families' attention to children's nutrition, 22 but it may also lead to neglect of the risk of overweight due to insufficient awareness of nutritional excess. Gender differences also exist, with the rates of underweight, wasting, and stunting being higher among male children than among female children. This is consistent with the trend in Algeria and may reflect the widespread gender-related biases in nutritional interventions or physiological differences in the African region. Low-income country (Niger): Nutritional improvement is slow, and traditional malnutrition problems are prominent. As a low-income country, Niger has achieved the most limited results in improving nutritional status. The relative decrease in developmental delay was only 0.2%, the rate of underweight even increased slightly (3.3%), and there was no significant change in the rate of overweight. This phenomenon is closely related to Niger's weak economic foundation, severe food security situation, and lack of medical resources. Its nutritional improvement is still constrained by the core contradiction of insufficient basic nutritional supply. 23 Hierarchical analysis shows that place of residence is a key influencing factor. All malnutrition indicators in the rural group are significantly higher than those in the urban group, reflecting the profound impact of the urban-rural development gap on children's nutrition. Gender differences comprehensively cover all nutritional indicators. The various malnutrition indicators of male children are all higher than those of female children, which may be related to the neglect of female children in resource allocation in low-income countries. The imbalanced state of resource tilt has instead exacerbated the nutritional problems of male children. Educational level has a significant impact on stunting and underweight. Children from families where parents have no education or only primary education have poorer nutritional status, which suggests the importance of improving parents' educational level in enhancing children's nutrition. 22 It is worth noting that Niger's economic situation has no significant impact on nutritional indicators. This may be because its overall economic level is relatively low, and families in different economic groups all face severe nutritional supply shortages, so the differentiation of nutritional status caused by economic differences has not yet formed. 23 , 24 Limitations and future outlook The strengths of this study lie in its systematic analysis of the temporal trends and stratified differences in children's nutritional status in the African region based on long-term, large-sample data. However, there are still certain limitations. First of all, the data comes from a multinational joint database. Records from some countries and years are missing or biased, which affects the accuracy of the results. Secondly, the study did not include specific behavioral and environmental factors such as dietary structure, eating habits, and medical resources, making it difficult to comprehensively reveal the mechanism behind changes in nutritional status. Future research should further supplement multi-dimensional influencing factor data and conduct in-depth analysis of the mechanisms by which dietary structure transformation, health education interventions, and policy implementation effects affect children's nutritional status. Formulate differentiated intervention strategies based on different income levels and regional characteristics: High-income countries need to focus on the prevention and control of overweight, and strengthen guidance on healthy diets and physical activities; Middle-income countries need to balance the prevention and control of malnutrition with the intervention of overweight, with a focus on rural areas and families with low educational levels; Low-income countries need to prioritize ensuring the supply of basic nutrition, improve hygiene and medical conditions in rural areas, and enhance parents' awareness of nutrition. At the same time, a dynamic monitoring system for children's nutritional status in the African region should be established to timely adjust intervention measures, promote the continuous improvement of children's nutritional status, and help achieve the global nutrition improvement goals put forward by the WHO. Declarations Funding The authors declare that no financial support was received for the research. Author Contribution Yonghao Li and Wenping Li wrote the main manuscript text and Mengdi Chen prepared figures. Yonghao Li, Wenping Li and Mengdi Chen contributed equally. Lulu Zhang conducted comprehensive revision and language polishing of the initial manuscript. All authors reviewed the manuscript. Acknowledgement Thanks to the United Nations Children's Fund, the World Health Organization and the World Bank for providing the public databases. 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Nutrients 17 (12), 2038 (2025). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 22 Apr, 2026 Reviews received at journal 21 Apr, 2026 Reviews received at journal 20 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviewers agreed at journal 04 Apr, 2026 Reviewers invited by journal 30 Mar, 2026 Editor invited by journal 23 Mar, 2026 Editor assigned by journal 18 Mar, 2026 Submission checks completed at journal 18 Mar, 2026 First submitted to journal 15 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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11:37:20","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":351513,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9132517/v1/d0679446aeb2cc800f246aba.jpg"},{"id":105929549,"identity":"72d2f71f-e547-45bd-9977-b558475aa66b","added_by":"auto","created_at":"2026-04-01 13:58:38","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":176957,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9132517/v1/c0f4b6e7d6591751d0f36e4f.jpg"},{"id":105929550,"identity":"5d7bf7ff-7059-4565-afb4-70580ba51f58","added_by":"auto","created_at":"2026-04-01 13:58:38","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":184754,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9132517/v1/ef2b95f79dc043210c2958d6.jpg"},{"id":106093154,"identity":"882970d5-8014-4908-800a-17aeb7292c37","added_by":"auto","created_at":"2026-04-03 11:35:16","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":162381,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9132517/v1/887d7c595ab81a481cdf5499.jpg"},{"id":105929553,"identity":"596e7ec5-852a-4e6d-aef1-19aff78871f6","added_by":"auto","created_at":"2026-04-01 13:58:38","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":208831,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9132517/v1/a1b1c05ff65089a3f6b14dc9.jpg"},{"id":106093417,"identity":"73d123f8-9c50-4006-b0c8-750681019244","added_by":"auto","created_at":"2026-04-03 11:37:17","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":182520,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9132517/v1/ea4d95509a764fd2a0faa849.jpg"},{"id":106093157,"identity":"fbd7042b-9e9c-4a36-acf5-0422c5df3fe5","added_by":"auto","created_at":"2026-04-03 11:35:16","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":181628,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9132517/v1/14211f4b5daee49ae7e55db0.jpg"},{"id":105929559,"identity":"ec24ab6f-8ebf-4819-8427-8402868663d9","added_by":"auto","created_at":"2026-04-01 13:58:38","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":251151,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9132517/v1/dd9e943cebb97497ae84537b.jpg"},{"id":105929556,"identity":"ec8d9eff-4509-4682-a6f1-05c3cbb8f53c","added_by":"auto","created_at":"2026-04-01 13:58:38","extension":"jpg","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":226342,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure9.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9132517/v1/b011a0d527cd2336e424cda0.jpg"},{"id":105929558,"identity":"0e066dee-8fb7-4f60-bfd3-9bf759d9a046","added_by":"auto","created_at":"2026-04-01 13:58:38","extension":"jpg","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":185446,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure10.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9132517/v1/b78cd0f6b0c40bd32cbcf90d.jpg"},{"id":105929557,"identity":"15dfe916-4418-40bf-adec-bb63322c6e74","added_by":"auto","created_at":"2026-04-01 13:58:38","extension":"jpg","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":206216,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure11.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9132517/v1/93411888b8705adec29ea930.jpg"},{"id":106095582,"identity":"3de78c15-c6a6-48b9-8ccb-24047e35e836","added_by":"auto","created_at":"2026-04-03 11:49:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3108051,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9132517/v1/5e078f71-c2a0-480c-90d8-8d0d0c212cae.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trends in the Nutritional Status of Children Under 5 in Africa (1990–2024): A Multidimensional Analysis by Country Income Level","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMalnutrition among children under 5 is a major public health challenge that urgently needs to be addressed in Africa. Its threat to children's survival, health, and regional development far exceeds the global average. This issue not only directly increases the risk of death from infectious diseases in children but also causes a series of long-term and irreversible developmental damage.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e For example, it can cause lifelong limitations in children's cognitive abilities, sustained low immunity, and significantly increase their risk of developing non-communicable diseases in adulthood. This poses a profound and heavy impact on the health of individuals throughout their life cycle and the sustainable socio-economic development of Africa.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e What is more challenging is that some African countries are trapped in the predicament of the \"double burden of malnutrition\" \u0026mdash; undernutrition (stunting, underweight, wasting, severe wasting) and overnutrition (overweight).\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e This phenomenon exists simultaneously within the same country, the same community, and even the same family, resulting in a contradictory and complex nutritional and health situation. According to relevant data from the World Health Organization (WHO), in 2022, the problem of malnutrition among children under 5 in Africa showed a high incidence trend, among which the number of children with stunting and wasting accounted for a relatively large proportion of the global.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e At the same time, the problem of childhood overweight in the African region cannot be underestimated either.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e It is highly alarming that if the current nutritional and health trends are not effectively curbed, it is expected that by 2030, the African region will face the dual problem of severe malnutrition and overnutrition, which will further exacerbate the nutritional and health crisis in Africa.\u003c/p\u003e \u003cp\u003ePrevious studies on the nutritional status, Mostly limited to the analysis of a single nutritional indicator (such as stunting), it lacks exploration of the long-term changing trends of multiple nutritional indicators in a region, and also fails to conduct a comprehensive quantitative comparison across dimensions such as place of residence, gender, economic income, and maternal education level.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study aims to analyze the annual trends of five nutritional indicators (stunting, underweight, wasting, severe wasting, and overweight) among children under 5 years old in the African region from 1990 to 2024. Based on the WB 2025 income level classification, it focuses on whether there are differences in the five nutritional indicators among three countries with different income levels, namely Algeria, Senegal, and Niger, across dimensions such as age, gender, place of residence, economy, and maternal education level. Additionally, based on the changing trends, targeted recommendations are provided for different countries to implement public health intervention measures.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eData Source\u003c/p\u003e \u003cp\u003eThe dataset is sourced from the WHO Health Inequality Data Repository - Child Nutrition, provided by UNICEF, the World Health Organization, and the WB (data URL: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/data/sets/health-inequality-monitor-dataset#nut\u003c/span\u003e\u003cspan address=\"https://www.who.int/data/sets/health-inequality-monitor-dataset#nut\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). From this, data containing African regions were screened out, involving 36,110 records from 46 countries and regions. The main variables include: outcome variables, which mainly involve five indicators: stunting, underweight, wasting, severe wasting, and overweight; stratification variables, which mainly involve age, gender, place of residence, economy, mother's education level, etc.; time variable, ranging from 1990 to 2024.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eKey Evaluation Indicators\u003c/h2\u003e \u003cp\u003eThe evaluation criteria for health inequalities mainly involve the following indicators:\u003c/p\u003e \u003cp\u003eStunting: The core indicator of chronic malnutrition focuses on \"stunting (height lag relative to age)\". It is caused by factors such as long-term nutritional deficiencies, repeated infections, and poor hygiene conditions. It can affect children's cognitive development and lifelong health, and is an important indicator reflecting the long-term living environment of a population.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eUnderweight: A comprehensive indicator of nutritional deficiency, reflecting the lag in weight relative to age, covering the overlapping conditions of acute and chronic malnutrition.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWasting: The core indicator of acute malnutrition focuses on \"insufficient weight for a fixed height\" and is used to determine the short-term deterioration of nutritional status.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSevere Wasting: The extreme state of emaciation is an acute, life-threatening form of malnutrition, indicating a severe deficiency of energy and protein in the body, and is an important risk factor for increased mortality in children.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOverweight: It reflects the degree of fat accumulation in the body and is directly related to energy intake exceeding consumption.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed using R (version 4.5.2) and related packages. The methods adopted include:\u003c/p\u003e \u003cp\u003eDescriptive statistics: Statistics are conducted on the changes in the average values of five nutritional indicators (stunting, underweight, wasting, severe wasting, and overweight) among children under 5 years old in African regions based on different years.\u003c/p\u003e \u003cp\u003eAnalysis from different dimensions: Three countries, Algeria, Senegal, and Niger, with different income levels, were selected and stratified by dimensions such as age, gender, place of residence, economy, and mother's education level. Two-way analysis of variance was used to compare whether there are differences in the five nutritional indicators under different dimensions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eChanges in five nutritional indicators for children under 5 in Africa\u003c/p\u003e \u003cp\u003eFrom 1990 to 2024, the five nutritional indicators for children under 5 in Africa showed a \"wavelike\" change over the years. Among them, the four indicators of stunting, underweight, wasting, and severe wasting decreased compared with 1990, while the indicator of overweight increased slightly (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Comparison of various health indicators between 1990 and 2024: Stunting decreased by 17.45%, with a relative decrease of 35.85%; Underweight decreased by 13.67%, with a relative decrease of 46.58%; Wasting decreased by 0.87%, with a relative decrease of 9.93%. Severe wasting decreased by 0.67%, with a relative decrease of 22.48%. Overweight was the only indicator that increased, rising by 2.01%, with a relative increase of 62.62% (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFive nutritional indicators for children under 5 in Africa in 1990 and 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003estunting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eunderweight\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ewasting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevwasting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eoverweight\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eSituation of five nutritional indicators for children under 5 in Algeria\u003c/h3\u003e\n\u003cp\u003eBasic changes in various nutritional indicators: Stunting decreased by 13.1%, with a relative decrease of 57.2%; underweight decreased by 6.5%, with a relative decrease of 70.7%. Wasting decreased by 4.4%, with a relative decrease of 62.0%; severe wasting decreased by 1.7%, with a relative decrease of 56.7%. Overweight was the only indicator that increased, rising by 4.1%, with a relative increase of 47.1%.\u003c/p\u003e \u003cp\u003eHierarchical situation of each dimension\u003c/p\u003e \u003cp\u003eAge: In the 0\u0026ndash;1 year age group, the indicators of stunting, underweight, and wasting were lower than those in the 2\u0026ndash;5 year age group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); the overweight indicator in the 0\u0026ndash;1 year age group was higher than that in the 2\u0026ndash;5 year age group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResidence: The overweight index of the rural group was higher than that of the urban group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eGender: The indicators of stunted growth, underweight, and emaciation in the male group were higher than those in the female group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eEconomic: The stunting index of the poorest group (Q1) is higher than that of the richest group (Q5) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); the underweight index of the poor groups (Q1, Q2) is higher than that of the wealthy groups (Q3, Q4, Q5) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); the overweight index of the poor groups (Q1, Q2) is higher than that of the wealthy groups (Q4, Q5) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eMother's education: The underweight index of the no education group was higher than that of the secondary or higher education group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \n\u003ch3\u003eSituation of five nutritional indicators for children under 5 in Senegal\u003c/h3\u003e\n\u003cp\u003eBasic changes in various nutritional indicators: Stunting decreased by 7.3%, with a relative decrease of 24.5%; underweight decreased by 6.2%, with a relative decrease of 32.6%. Wasting decreased by 2.2%, with a relative decrease of 23.4%; severe wasting decreased by 0.9%, with a relative decrease of 30.0%. Overweight was the only indicator that increased, rising by 2.5%, with a relative increase of 62.5%.\u003c/p\u003e \u003cp\u003eHierarchical situation of each dimension\u003c/p\u003e \u003cp\u003eAge: The indicators of stunting and underweight in the 0\u0026ndash;1 year age group were lower than those in the 2\u0026ndash;5 year age group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); the indicators of wasting, severe wasting, and overweight in the 0\u0026ndash;1 year age group were higher than those in the 2\u0026ndash;5 year age group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eResidence: The indicators of stunting (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e), underweight, and severe wasting in the rural group were higher than those in the urban group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eGender: The indicators of stunting (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e), underweight, and wasting in the male group were higher than those in the female group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eEconomic: There were significant differences in the stunting (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e) and underweight (Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e) indicators between every two economic groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with the poorest group (Q1) having higher rates than the richest group (Q5); the rates of wasting and severe wasting in the poorest group (Q1) were higher than those in the middle-high income groups (Q3-Q5) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); the rate of overweight in the poorest group (Q1) was lower than that in the high-income groups (Q4-Q5) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eMother's education: The differences in stunting indicators between each pair of education level groups were significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with the no education group having the highest rate and the secondary or higher education group having the lowest. The underweight indicators of the no education group and the primary education group were higher than those of the secondary or higher education group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The wasting indicator of the no education group was higher than that of the secondary or higher education group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The severe wasting indicator of the no education group was higher than that of the primary education group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The overweight indicator of the no education group was higher than that of the primary education group and the secondary or higher education group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSituation of five nutritional indicators for children under 5 in Niger\u003c/h2\u003e \u003cp\u003eBasic changes in various nutritional indicators: Stunting decreased by 0.1% with a relative decrease of 0.2%; underweight increased by 1.1% with a relative increase of 3.3%. Wasting decreased by 0.3% with a relative decrease of 2.7%; severe wasting decreased by 0.7% with a relative decrease of 25.0%. There was no change in overweight.\u003c/p\u003e \u003cp\u003eHierarchical situation of each dimension\u003c/p\u003e \u003cp\u003eAge: In the 0\u0026ndash;1 year age group, the indicators of developmental delay and underweight were lower than those in the 2\u0026ndash;5 year age group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); the indicators of emaciation and severe emaciation in the 0\u0026ndash;1 year age group were higher than those in the 2\u0026ndash;5 year age group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eResidence: The indicators of stunting, underweight, wasting, and severe wasting in the rural group were higher than those in the urban group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eGender: The indicators of stunting, underweight, wasting, and severe wasting in the male group were higher than those in the female group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eEconomic: There were no significant differences in all indicators between groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eMother's education: The indicators of stunting in the no education group and the primary education group were higher than the secondary or higher education group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e); the indicators of underweight in the no education group and the primary education group were higher than the secondary or higher education group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study systematically analyzed the changing trends of nutritional status among children under 5 years old in 46 African countries based on data from the GHO database from 1990 to 2024. Focusing on three countries with different income levels: Algeria, Senegal, and Niger, this study explores the mechanism of differences by combining stratified factors such as age, place of residence, gender, and mothers' educational level, providing data support for regional precise nutrition interventions.\u003c/p\u003e \u003cp\u003eFrom 1990 to 2024, the four core malnutrition indicators for children under 5 in Africa, namely stunting, underweight, wasting, and severe wasting, all showed varying degrees of decline. Among them, the relative decline in underweight was the largest (46.58%), the absolute decline in stunting was the most significant (17.45%), while the overweight rate relatively increased by 62.62%. This trend reflects that the African region has made substantial progress in improving the supply of basic nutrition for children and preventing and controlling acute and chronic malnutrition, which may be closely related to factors such as global health assistance, the advancement of regional public health projects, and the enhancement of food security guarantees. For example, intervention measures such as the promotion of breastfeeding,\u003csup\u003e14\u003c/sup\u003e guidance on complementary food addition,\u003csup\u003e15\u003c/sup\u003e and prevention and control of infectious diseases,\u003csup\u003e16\u003c/sup\u003e which are promoted by international organizations like the WHO and United Nations Children's Fund (UNICEF) in Africa, have effectively reduced the risks of insufficient nutritional intake and excessive nutritional consumption in children, laying the foundation for the decline in malnutrition indicators.\u003c/p\u003e \u003cp\u003eHowever, the significant increase in the overweight rate also reveals that the African region is facing the severe challenge of a \"double burden of malnutrition\"\u003csup\u003e17\u003c/sup\u003e \u0026mdash;\u0026mdash; the traditional problem of malnutrition has not been completely solved, while issues related to overnutrition have rapidly become prominent. This phenomenon is consistent with the overall trend of the global nutritional transition,\u003csup\u003e18\u003c/sup\u003e and is particularly evident in middle- and high-income countries and urban areas in Africa. With the economic development and accelerated urbanization in some African countries, children's dietary structures have gradually shifted towards processed foods high in energy, fat, and sugar. At the same time, physical activity has decreased, leading to an imbalance between energy intake and consumption, which ultimately drives up the overweight rate. If this trend continues, the African region will face the dual pressure of malnutrition and obesity-related diseases\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e (such as cardiovascular diseases and diabetes) in the future, posing long-term challenges to children's lifelong health and the allocation of regional medical resources.\u003c/p\u003e \u003cp\u003eDifferences in nutritional status among countries with different income levels and the impact of stratification factors\u003c/p\u003e\n\u003ch3\u003eHigh-income country (Algeria): Significant improvement in nutrition, with stratification differences focusing on economy and age\u003c/h3\u003e\n\u003cp\u003eAs a relatively high-income country, Algeria has seen a relative decrease of over 50% in all four malnutrition indicators, achieving the most remarkable results in improving nutrition. Hierarchical analysis shows that economic status is the core factor affecting their nutritional status: the overweight rate of the affluent group is significantly higher than that of the poor group, while the rates of underweight and stunting in the poor group are higher than those in the affluent group. This is closely related to the differences in dietary structure caused by the wealth gap within high-income countries.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Children from affluent families are more likely to have access to high-energy, highly refined carbohydrate foods, while children from poor families still face the risk of insufficient supply of basic nutrients. The impact of age factors is equally significant. The malnutrition indicators (stunting, underweight, wasting) in the 0\u0026ndash;1 year age group are all lower than those in the 2\u0026ndash;5 year age group, but the overweight rate is higher. This may be related to the higher breastfeeding rate during infancy and the relatively balanced energy intake. In contrast, children aged 2\u0026ndash;5 have increased dietary autonomy and are more affected by unhealthy eating environments. In addition, male children have higher indicators of multiple forms of malnutrition than female children, which reflects potential gender-related differences in the distribution of nutritional resources or differences in physiological susceptibility. These issues need to be addressed in intervention efforts.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMiddle-income country (Senegal): Balanced improvement in nutrition, with multiple factors working together\u003c/h2\u003e \u003cp\u003eThe relative reduction range of various malnutrition indicators in Senegal is between 23.4% and 32.6%. The improvement range is between that of Algeria and Niger, and the impact of stratification factors is more comprehensive. The difference in residential areas is particularly significant. The rates of stunting, underweight, and severe wasting in the rural group are all higher than those in the urban group, which is related to the current situation in rural areas such as insufficient food resources, poor sanitation conditions, and inadequate medical resources.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Economic status and educational level have a significant impact on all nutritional indicators, showing a gradient difference. With the improvement of economic level and educational attainment, the indicators of malnutrition have gradually decreased, while the overweight rate has increased. This suggests that the improvement of educational attainment may promote families' attention to children's nutrition,\u003csup\u003e22\u003c/sup\u003e but it may also lead to neglect of the risk of overweight due to insufficient awareness of nutritional excess. Gender differences also exist, with the rates of underweight, wasting, and stunting being higher among male children than among female children. This is consistent with the trend in Algeria and may reflect the widespread gender-related biases in nutritional interventions or physiological differences in the African region.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLow-income country (Niger): Nutritional improvement is slow, and traditional malnutrition problems are prominent.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAs a low-income country, Niger has achieved the most limited results in improving nutritional status. The relative decrease in developmental delay was only 0.2%, the rate of underweight even increased slightly (3.3%), and there was no significant change in the rate of overweight. This phenomenon is closely related to Niger's weak economic foundation, severe food security situation, and lack of medical resources. Its nutritional improvement is still constrained by the core contradiction of insufficient basic nutritional supply.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Hierarchical analysis shows that place of residence is a key influencing factor. All malnutrition indicators in the rural group are significantly higher than those in the urban group, reflecting the profound impact of the urban-rural development gap on children's nutrition. Gender differences comprehensively cover all nutritional indicators. The various malnutrition indicators of male children are all higher than those of female children, which may be related to the neglect of female children in resource allocation in low-income countries. The imbalanced state of resource tilt has instead exacerbated the nutritional problems of male children. Educational level has a significant impact on stunting and underweight. Children from families where parents have no education or only primary education have poorer nutritional status, which suggests the importance of improving parents' educational level in enhancing children's nutrition.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e It is worth noting that Niger's economic situation has no significant impact on nutritional indicators. This may be because its overall economic level is relatively low, and families in different economic groups all face severe nutritional supply shortages, so the differentiation of nutritional status caused by economic differences has not yet formed.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and future outlook\u003c/h2\u003e \u003cp\u003eThe strengths of this study lie in its systematic analysis of the temporal trends and stratified differences in children's nutritional status in the African region based on long-term, large-sample data. However, there are still certain limitations. First of all, the data comes from a multinational joint database. Records from some countries and years are missing or biased, which affects the accuracy of the results. Secondly, the study did not include specific behavioral and environmental factors such as dietary structure, eating habits, and medical resources, making it difficult to comprehensively reveal the mechanism behind changes in nutritional status.\u003c/p\u003e \u003cp\u003eFuture research should further supplement multi-dimensional influencing factor data and conduct in-depth analysis of the mechanisms by which dietary structure transformation, health education interventions, and policy implementation effects affect children's nutritional status. Formulate differentiated intervention strategies based on different income levels and regional characteristics: High-income countries need to focus on the prevention and control of overweight, and strengthen guidance on healthy diets and physical activities; Middle-income countries need to balance the prevention and control of malnutrition with the intervention of overweight, with a focus on rural areas and families with low educational levels; Low-income countries need to prioritize ensuring the supply of basic nutrition, improve hygiene and medical conditions in rural areas, and enhance parents' awareness of nutrition. At the same time, a dynamic monitoring system for children's nutritional status in the African region should be established to timely adjust intervention measures, promote the continuous improvement of children's nutritional status, and help achieve the global nutrition improvement goals put forward by the WHO.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors declare that no financial support was received for the research.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYonghao Li and Wenping Li wrote the main manuscript text and Mengdi Chen prepared figures. Yonghao Li, Wenping Li and Mengdi Chen contributed equally. Lulu Zhang conducted comprehensive revision and language polishing of the initial manuscript. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThanks to the United Nations Children's Fund, the World Health Organization and the World Bank for providing the public databases.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe dataset is sourced from the WHO Health Inequality Data Repository - Child Nutrition, provided by UNICEF, the World Health Organization, and the WB (data URL: https://www.who.int/data/sets/health-inequality-monitor-dataset#nut).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWali, N., Agho, K. E. \u0026amp; Renzaho, A. Wasting and Associated Factors among Children under 5 Years in Five South Asian Countries (2014\u0026ndash;2018): Analysis of Demographic Health Surveys. \u003cem\u003eIJERPH\u003c/em\u003e \u003cb\u003e18\u003c/b\u003e (9), 4578 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAguayo, V. 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Sci.\u003c/em\u003e \u003cb\u003e25\u003c/b\u003e (14), 7954 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLukwa, A. T., Siya, A., Zablon, K. N., Azam, J. M. \u0026amp; Alaba, O. A. Socioeconomic inequalities in food insecurity and malnutrition among under-five children: within and between-group inequalities in Zimbabwe. \u003cem\u003eBMC Public. Health\u003c/em\u003e. \u003cb\u003e20\u003c/b\u003e (1), 1199 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdulahi, A., Shab-Bidar, S., Rezaei, S. \u0026amp; Djafarian, K. Nutritional Status of Under Five Children in Ethiopia: A Systematic Review and Meta-Analysis. \u003cem\u003eEthiop. J. Health Sci.\u003c/em\u003e \u003cb\u003e27\u003c/b\u003e (2), 175\u0026ndash;188 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbuya, B. A., Ciera, J. \u0026amp; Kimani-Murage, E. Effect of mother\u0026rsquo;s education on child\u0026rsquo;s nutritional status in the slums of Nairobi. \u003cem\u003eBMC Pediatr.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e (1), 80 (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakele, B. A., Gezie, L. D. \u0026amp; Alamneh, T. S. Pooled prevalence of stunting and associated factors among children aged 6\u0026ndash;59 months in Sub-Saharan Africa countries: A Bayesian multilevel approach. Augusto O, ed. \u003cem\u003ePLoS ONE\u003c/em\u003e. ;17(10):e0275889. (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMathosi, M. M., Cele, L. P., Mathibe, M. \u0026amp; Modjadji, P. Acute Malnutrition in Under-Five Children in KwaZulu-Natal, South Africa: Risk Factors and Implications for Dietary Quality. \u003cem\u003eNutrients\u003c/em\u003e \u003cb\u003e17\u003c/b\u003e (12), 2038 (2025).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Africa, children under 5, nutritional status, socioeconomic factors, different dimensions, GHO","lastPublishedDoi":"10.21203/rs.3.rs-9132517/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9132517/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eChildren under the age of 5 are in a critical period for growth and development. Their nutritional status is directly related to an individual's lifelong health and the quality of the population in a country or region. The nutritional status in African regions is a global disaster area and one of the core areas of global health monitoring by the World Health Organization (WHO).\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aims to analyze the changing trends in the nutritional status of children under 5 years old in the African region from 1990 to 2024, based on the 2024 data from the World Health Organization's Global Health Observatory (GHO) database.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study uses data from the Global Health Observatory database in 2024 to conduct a retrospective analysis, covering the nutritional status of children under 5 years old in 46 countries in the African region from 1990 to 2024, and adopts descriptive statistics for the nutritional status. Based on the 2025 income level grouping by the World Bank (WB), three countries with different income levels, namely Algeria, Senegal, and Niger, were selected. Stratification was performed according to dimensions such as gender, education level, and place of residence, and two-way analysis of variance was used to compare whether there were differences in nutritional status across different dimensions and different years.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn African regions, indicators such as stunting, underweight, wasting, and severe wasting have decreased to varying degrees, while overweight has increased slightly. In Algeria, there are significant differences in child nutrition indicators among different ages, places of residence, genders, economic statuses, and maternal education levels. The overweight rate among children aged 0\u0026ndash;1 is high, and the problem of undernutrition is more prominent in groups such as males and those in poverty. In Senegal, various child nutrition indicators are significantly affected by multiple factors. Indicators such as overweight among children aged 0\u0026ndash;1 are relatively high, and undernutrition indicators are higher in rural areas, among males, in poverty-stricken groups, and in groups where mothers have low educational levels. In Niger, child nutrition indicators are significantly affected by multiple factors. Undernutrition indicators are higher in rural areas, among males, and in groups where mothers have low educational levels, while economic status has no significant impact on various indicators.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe nutritional status of children under 5 in Africa has improved significantly, but the improvement varies across different regions and income levels. The nutritional transition shows differentiation, and socioeconomic factors have different impacts on various nutritional indicators. Therefore, targeted intervention measures need to be formulated based on different dimensions in different countries.\u003c/p\u003e","manuscriptTitle":"Trends in the Nutritional Status of Children Under 5 in Africa (1990–2024): A Multidimensional Analysis by Country Income Level","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-01 13:58:33","doi":"10.21203/rs.3.rs-9132517/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-22T08:20:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T07:15:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-20T10:29:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"115571473894744261307625644569269480873","date":"2026-04-13T04:44:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"146614856103880881479962797020233363295","date":"2026-04-04T10:11:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-30T11:19:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-23T12:08:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-19T02:42:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-19T02:41:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-03-16T03:16:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0b4ac804-7d3f-4ec3-bd33-80384f692521","owner":[],"postedDate":"April 1st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":65409786,"name":"Health sciences/Diseases"},{"id":65409787,"name":"Health sciences/Health care"},{"id":65409788,"name":"Health sciences/Medical research"},{"id":65409789,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-05-11T04:38:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-01 13:58:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9132517","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9132517","identity":"rs-9132517","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}