# Factors Associated With Composite Anthropometric Failures (CIAF) Among Under Five Children in Lesotho: An Insight From the 2023 to 2024 Demographic and Health Survey Data

## TL;DR

This study identifies factors linked to poor nutrition in children under five in Lesotho using a combined measure of growth indicators.

## Contribution

The study introduces the use of Composite Index of Anthropometric Failure (CIAF) in Lesotho to assess child malnutrition comprehensively.

## Key findings

- The prevalence of CIAF among under-five children in Lesotho was 34.68%.
- Factors like child age, sex, birth type, and household wealth significantly influence CIAF.
- CIAF is suggested as a better metric than individual indicators like stunting or underweight.

## Abstract

Under nutrition is the main cause of child death in developing countries. The Composite Index of Anthropometric Failure (CIAF) combines all three forms of anthropometric failures to assess the nutrition status of children. Thus, the objective of this was to identify factors associated with CIAF of under‐five children in Lesotho. A secondary analysis of the Lesotho Demographic and Health Survey 2023–24 was conducted, using the data for 1089 children under the age of 5 years. The CIAF was used to classify children based on stunting, wasting, and underweight. Descriptive summary statistics were computed. A binary logistic regression model was employed to identify predictors of CIAF for under‐five children. Adjusted odds ratio with 95% confidence interval was estimated. The prevalence of CIAF in Lesotho was 34.68% (95% CI: 31.76–37.73). Female child 0.54 (AOR = 0.54; 95% CI: 0.375, 0.776), age group 24–59 months 2.42 (AOR = 2.42; 95% CI: 1.149, 5.109), rich households 0.29 (AOR = 0.29; 95% CI: 0.151, 0.554), multiple births 12.02 (AOR = 12.02; 95% CI: 1.199, 120.426), rural residence (AOR = 0.56: 95% CI: 0.335, 0.946), living children 3 to 4 were 2.54 (AOR = 2.54; 95% CI: 1.522, 4.226), and larger size at birth were 0.38 (AOR = 0.38; 95% CI: 0.211, 0.683) were found to be significantly associated with CIAF. The prevalence of CIAF among children under five in Lesotho was high. Child's age, child's sex, child's type of birth, wealth tercile, residence, number of living children, and child's birth size were found to be significantly associated with CIAF. We suggest that the government adapt CIAF as a metric for assessing children's nutritional status in order to estimate the overall prevalence of malnutrition and strengthening adequate nutrition intervention programs in rural areas. Furthermore, highlighting the factors influencing child CIAF will help inform future policies and programs designed to approach this major problem in Lesotho.

Prevalence of seven categories of CIAF classification of nutritional status among children under five in Lesotho. This study assessed anthropometric failures among under‐five children in Lesotho using the Composite Index of Anthropometric Failure (CIAF). The prevalence of the Composite Index of Anthropometric Failure (CIAF), stunting, wasting, and underweight was 34.68%, 23.54%, 0.39%, and 0.63%, respectively and significant predictors included child's age, sex, type of birth, wealth status, residence, number of living children, and birth size. These findings highlight the importance of adopting CIAF as a comprehensive indicator of malnutrition and inform policy for targeted nutrition interventions in Lesotho.