{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T04:05:17Z","timestamp":1774929917202,"version":"3.50.1"},"reference-count":55,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health of Djibouti"},{"name":"UNICEF"},{"name":"WFP"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Child undernutrition remains a major public health in Djibouti, yet conventional anthropometric indicators may underestimate its true burden by failing to capture overlapping forms of malnutrition. The Composite Index of Anthropometric Failure (CIAF) provides a more comprehensive assessment by identifying children experiencing one or multiple anthropometric deficits. This study aimed to estimate the prevalence and determinants of undernutrition among children under five years of age in Djibouti using the CIAF. Methods: This study is a secondary analysis of data from the nationally representative 2023 Multisectoral Survey conducted in Djibouti. A cross-sectional design with a two-stage stratified cluster sampling method was used to collect data on a national random sample (n = 2103) of children aged 6\u201359 months. Standardized anthropometric measurements were used to derive conventional indicators (stunting, wasting, and underweight) and the CIAF. Binary logistic regression analyses were performed to identify factors associated with anthropometric failures, adjusting for child, household, and contextual characteristics. Results: Based on conventional indicators, 23.4% of children were stunted, 20.0% were underweight, and 9.9% were wasted. Using the CIAF, 36.9% of children experienced at least one anthropometric failure, including 18.8% with multiple concurrent failures. Boys, children aged 6\u201347 months, those living in nomadic households, and those residing in specific regions had significantly higher risks of undernutrition. Socioeconomic indicators and household food security were not independently associated with undernutrition after adjustment. Conclusions: More than one-third of children under five in Djibouti experience undernutrition when assessed using the CIAF, revealing a substantial hidden burden not captured by conventional indicators alone. Incorporating the CIAF into routine nutrition surveillance could improve identification of vulnerable children and support more targeted, context-specific interventions.<\/jats:p>","DOI":"10.3390\/nu18020306","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T09:57:02Z","timestamp":1768816622000},"page":"306","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Malnutrition Among Children Under Five in Djibouti: A Composite Index of Anthropometric Failure Analysis from the 2023 Multisectoral Survey"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3094-7228","authenticated-orcid":false,"given":"Hassan Abdourahman","family":"Awaleh","sequence":"first","affiliation":[{"name":"Department of Health, University of Senghor, Quartier des Universit\u00e9s, Axe Central, Ville Borg El-Arab El-Gedida 5220220, Egypt"},{"name":"National Nutrition Program, Ministry of Health, Djibouti City P.O. Box 296, Djibouti"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7721-9176","authenticated-orcid":false,"given":"Tony","family":"Byamungu","sequence":"additional","affiliation":[{"name":"Unicef, Djibouti City P.O. Box 583, Djibouti"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Hsairi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8715-455X","authenticated-orcid":false,"given":"Jalila","family":"El Ati","sequence":"additional","affiliation":[{"name":"SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, INNTA (National Institute of Nutrition and Food Technology), 11 Rue Jebel Lakhdar, Bab Saadoun, Tunis 1007, Tunisia"},{"name":"University of Tunis El Manar, Tunis 1068, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"ref_1","unstructured":"The Global Health Observatory (2025, November 15). Explore a World of Health Data. 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