Determinants of Nutritional Status of Under-five Children in Sub-Saharan Africa: A systematic review

Child undernutrition remains one of the most critical public health challenges in sub-Saharan Africa (SSA), contributing substantially to childhood morbidity, mortality, and impaired human development (Akombi et al., 2017; Riwa et al., 2025; UNICEF et al., 2023). Despite global progress in reducing malnutrition, SSA continues to experience disproportionately high levels of stunting, wasting, underweight, and micronutrient deficiencies among children under five years of age (Girma et al., 2025; Osborne et al., 2025). These manifestations of undernutrition not only threaten child survival but also have enduring consequences for cognitive development, educational attainment, and future economic productivity, thereby perpetuating intergenerational cycles of poverty and inequality (Deka et al., 2022; Higuera-Domínguez et al., 2025; Neerven, 2025). The burden of undernutrition in SSA reflects complex and interrelated biological, social, and environmental processes (Girma & Rahman, 2025). According to the UNICEF conceptual framework, child nutritional status is shaped by a hierarchy of determinants operating at multiple levels (UNICEF, 2021). Immediate determinants include inadequate dietary intake and childhood illness, while underlying determinants encompass household food security, caregiving and feeding practices, access to quality health services, and environmental conditions such as water, sanitation, and hygiene (WASH). At a broader structural level, factors such as household socioeconomic status, maternal education, gender norms, place of residence, and wider socio-economic inequalities play a decisive role in shaping children’s nutritional outcomes (Masili Banda, 2025; Russo & Pereira, 2025) . These determinants often interact synergistically, resulting in substantial heterogeneity in nutritional status across and within countries in the region (Musa et al., 2025). Although a substantial body of empirical research has examined child undernutrition in SSA (de Groot et al., 2020; Dukhi, 2020; Takhelchangbam et al., 2024), the existing evidence base remains fragmented. Many studies are limited to single countries or subnational contexts, focus on specific anthropometric outcomes (most commonly stunting), or examine isolated determinants such as maternal education, household wealth, or WASH conditions. Furthermore, existing reviews have often concentrated on selected risk factors or narrow geographic scopes, limiting their ability to capture the full complexity and regional diversity of determinants influencing under-five nutritional status across SSA (de Groot et al., 2020; John et al., 2018). As a result, policymakers and program implementers lack a comprehensive and integrated synthesis of evidence that reflects the multidimensional drivers of child undernutrition across diverse socio-economic and ecological settings within the region. Given the profound immediate and long-term consequences of child undernutrition for population health and socio-economic development (Takhelchangbam et al., 2024; Talukder et al., 2025), a comprehensive synthesis of evidence on its determinants is urgently needed. A systematic review that collates and critically evaluates empirical studies from across sub-Saharan Africa can provide a holistic understanding of the relative and contextual importance of key determinants, identify persistent gaps in the literature, and highlight areas requiring further research. Such synthesis is essential for informing the design of contextually appropriate, evidence-based policies and interventions aimed at reducing both chronic and acute forms of undernutrition among children under five years of age. This systematic review therefore aims to synthesize and critically appraise existing evidence on the determinants of nutritional status among children under five in sub-Saharan Africa. By systematically integrating findings across diverse settings and determinant domains, the review seeks to elucidate key drivers of undernutrition and support informed policy and programmatic responses to reduce nutritional inequalities and improve child health outcomes across the region.