The present study aimed to identify the important determinants for predicting weight-for-height, weight-for-age, and undernutrition using the Boruta algorithm. The findings from the Boruta analysis provided valuable insights into the factors influencing these anthropometric measurements. For weight-for-height, the Boruta analysis identified D1, D3, D10, and D11 as confirmed determinants. D1, with the highest importance score, consistently demonstrated its significance across multiple iterations. For weight-for-age, the Boruta analysis revealed D3, D4, and D7 as confirmed determinants. D3 and D4 consistently displayed significant importance scores, highlighting their influence on weight-for-age prediction. In the case of undernutrition, the Boruta analysis confirmed D1, D4, D9, and D11 as important determinants. D1, D4, and D11 consistently demonstrated significant importance, suggesting their strong association with undernutrition.
Children of poor families with a monthly income less than 15,000 PKR were more prone to wasting as compared to relatively higher monthly income (15,000–35,000 PKR). This result is consistent with previous research that highlights a strong relationship between poverty and malnutrition (21). Monthly family income can impact food intake, malnutrition, and limited resources for low-income families (22). Financial limitations often make it difficult for people to get healthy food, medical care, and a healthy standard of living, which affects the nutrition of children (23).
Stunting and undernutrition have been strongly associated with complementary feeding practices. A higher rate of stunting and undernutrition was observed in children who received inadequate supplemental feeding. This finding is in alignment with other research emphasizing the need for adequate and timely introduction of supplementary foods in promoting optimal growth and development (24). Improper supplemental feeding and weaning practices lead to chronic malnutrition in children.
Children that have a balanced diet or enough food have a positive tendency towards healthy development and growth. Malnutrition results from improper weaning procedures and can significantly impair nutritional status (4). Breastfeeding for the first 24 months of a child’s life, together with complementary feeding, ensures that they receive a sufficient amount of nutrients and a balanced diet, both of which are essential to the child’s growth and the prevention of malnutrition (18). Mother’s milk alone cannot meet the nutritional requirements of growing children, so breastfeeding should start at birth and continue until the child’s second birthday in combination with supplemental feeding to prevent acute and chronic malnutrition (18, 25, 26). Due to the lack of vital nutrients required for children’s healthy growth and development, continuing to breastfeed without complementary feeding after six months of age may increase the risk of malnutrition (18).
Malnutrition, both acute and chronic, can result from improper and non-exclusive breastfeeding. According to research conducted in Pakistan, 45.8% of mothers started breastfeeding their children as soon as they were born, and 48.4% of infants were exclusively breastfed (5). Because the mother’s milk contains an appropriate proportion of the nutrients the infant needs, exclusive nursing should begin within the first hour of delivery (18, 27). Malnutrition in children caused by infectious diseases could also affect their growth and development (28, 29). Inflammation increased the likelihood of stunting and malnutrition in children with a history of TB (28).
Compared to children with one or two siblings, children with three or more siblings are more likely to be stunted. Increased family size may affect food availability, resulting in underweight or stunted children (4, 25, 26). Acute or chronic malnutrition is more likely to develop in children with birth intervals of less than two years (25). The resources needed to appropriately feed every child become more scarce as the number of children under five in a family increases (4, 29, 30).
The healthy growth and development of newborns and young children are significantly influenced by the education of mothers. The majority of the mothers in the present study were uneducated, and the children they raised had higher nutrient deficiencies. Stunting and wasting may be avoided by an educated mother as she will be more aware of her child’s nutritional requirements (31).
The cross-sectional design of this study has certain drawbacks. Anthropometric measurements have been carried out by qualified individuals, which supports the integrity of the data. A deeper understanding of the dynamic nature of a child’s growth and development could be achieved by carefully examining children’s nutritional status.