Malnutrition includes both undernutrition and overnutrition. Undernutrition, which results from insufficient intake of energy and other important nutrients, is often used interchangeably with malnutrition in many literatures [1]. Undernutrition includes wasting (low weight-for-height ratio), stunting (low height-for-age ratio), and underweight (low weight-for-age ratio) [2].
Severe acute malnutrition (SAM) or severe wasting still remains a major public health problem worldwide. This is more prevalent in low-income countries where it represents a significant burden in terms of morbidity and mortality among children under 5 years of age [3]. This burden includes hindering children's physical and cognitive development and impacting both individual and community financial growth [4]. SAM can affect children of any age; however, its impact is most severe during the first two years of life. During this period, the child's brain and nervous system are developing and nutritional deficiencies could cause irreversible physical and mental damages [5].
Globally, 45.4 million children under the age of 5 suffer from wasting. Malnutrition plays a role in approximately 45% of deaths among children under 5 years of age, occurring primarily in low- and middle-income countries [1, 6].
At the continental scale, the prevalence of undernourishment in Africa was estimated at 21% in 2020. However, a large disparity is noted between North Africa with a prevalence of 7.1% and on the other hand, sub-Saharan Africa which presents higher proportions, i.e. 24.1%. As for Central Africa, the prevalence of this scourge was estimated at 31.8% [6, 7, 8].
The situation in the Democratic Republic of Congo (DRC) remains worrying as shown by various surveys carried out in the country. According to the second demographic and health survey (DHS) of 2013–2014, overall, 8% of children aged 0 to 59 months are affected by acute malnutrition and 3% in its severe form [9]. The 2018 Multiple Indicator Cluster Survey Malaria (MICS) report found that the proportion of children under 5 years of age with a weight-for-height ratio of -2 SD and − 3 SD was 6.5% and 2.0% respectively for the whole country [10].
The province of Lomami is among the provinces most affected by malnutrition. Indeed, the MICS-Palu 2018 survey reported that the prevalence of children under 5 years of age suffering from global acute malnutrition was 6.0% and 2.7% for the severe form [11].
Estimates of the burden of acute malnutrition at the local level are made through nutritional surveillance and monitoring of early warnings (NSMEW), based on indicators calculated from nutritional data collected in the sentinel sites of healthcare structures. In the health zone (HZ) of Kabinda, the proportion of children under 5 years old with a mid-upper arm circumference (MUAC) less than 125 mm was 16% (threshold greater than 20%) while that of children under 5 years of age with nutritional edema was 4% (threshold greater than 5%) in 2021 [11]. In response to this situation, several interventions have been implemented under the leadership of the provincial coordination of the national nutrition program. These interventions are part of the commitments made by the government of the DRC to achieve the Sustainable Development Goals (SDGs) related to nutrition, in particular SDG 2.2 [12, 13].
Malnutrition is the result of several factors, notably socio-economic, behavioral and cultural. In their conceptual framework, the United Nations Children's Fund (UNICEF) classifies the determinants of malnutrition into fundamental or distal (poverty, socio-cultural, economic and political context), intermediate (food insecurity, dietary practices and care practices such as access to clean water, hygienic toilets and health services, education) and immediate factors (acting on the individual such as inadequate dietary intake and infectious diseases) [6].
The determinants of SAM may vary over time depending on regions and communities. Although the NSMEW indicators place the Kabinda HZ among the areas to be closely monitored, to our knowledge there are no studies that evaluated risk factors of SAM in this region. Therefore, the aim of this study is to identify risk factors of SAM among children aged 12 to 23 months in the Kabinda HZ.