Malnutrition among children under five remains one of sub-Saharan Africa’s most persistent public health challenges. Countries and development partners have introduced numerous nutrition programmes. Yet millions of young children continue to suffer from poor nutrition.
Drawing on our expertise in public health, nutrition and health systems research, we conducted a review of recent evidence about child malnutrition from across the sub-Saharan Africa region. The review examined 50 studies published between 2015 and 2025 that covered the forms of malnutrition and intervention strategies for children under the age of five.
The research shows that malnutrition is a complex problem. It isn’t caused solely by a lack of food. Other influences are disease, poor sanitation, climate pressures, limited access to healthcare, gaps in caregiver knowledge, and socio-cultural and behavioural factors.
Our review found that undernutrition – particularly stunting, wasting and underweight – is the main form of child malnutrition in the region. Malnutrition is a broad term that refers to deficiencies, excesses or imbalances in a person’s intake of nutrients. Undernutrition is a specific form of malnutrition that occurs when children do not receive enough essential nutrients to support healthy growth and development.
This finding highlights the need to strengthen existing efforts. At the same time, the wider social, economic and environmental factors that contribute to poor nutrition must also be addressed. Understanding which forms of malnutrition remain most common can help policymakers and practitioners decide how to intervene and what resources they will need. Lasting solutions must combine nutrition support with action on poverty, food systems, health and community needs.
Undernutrition remains a major concern
Stunting was the most frequently reported form of malnutrition in the studies we reviewed. The condition occurs when children are too short for their age, owing to long-term nutritional deprivation.
More than 25% of children under five were reported to be stunted in many African countries. Tanzania, Uganda, Ethiopia, Liberia and the Central African Republic were some of them.
The first two years of life are particularly important. Many children experience nutritional setbacks when exclusive breastfeeding ends and the new foods introduced are insufficient in quantity or quality.
Across the reviewed studies, about 20% of children under five in 12 sub-Saharan African countries were underweight. Nutrition programmes reduced underweight rates. But illness, poor diet, unsafe water, poverty and limited maternal education increased the risk.
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Wasting was also widely reported. This form of acute malnutrition comes with rapid weight loss and increased risk of illness. It is strongly linked to food insecurity, poverty, poor sanitation and limited access to healthcare services.
At the same time, the region is beginning to face another challenge: children who are overweight. It is reported less frequently in the reviewed studies. But childhood overweight is increasing in some countries, especially where urbanisation and changing food systems have increased access to highly processed foods.
Undernutrition and overweight can exist together, creating a double burden.
What interventions work?
Our review grouped responses to child malnutrition into three broad categories: nutrition-specific, nutrition-sensitive and integrated approaches.
Nutrition-specific interventions directly address nutritional deficiencies. They make sure children get more nutritious food (including breast milk). Programmes like this have shown positive results, particularly in treating acute malnutrition and improving child growth outcomes. Screening and treating children in their communities has become an important way to reach families.
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But that doesn’t solve the underlying causes of malnutrition.
Nutrition-sensitive interventions address wider factors that influence children’s health. Agricultural programmes, water and sanitation improvements, disease prevention, cash transfers and maternal education are examples.
Home gardens can help households to get enough food and a variety of food in their diets. Their effects on children’s physical growth have been mixed, however. Having food does not always mean better nutrition. Care practices such as exclusive breastfeeding and appropriate complementary feeding must improve. In addition, families also need access to nutrition counselling, immunisation and safe water.
Integrated solutions are best
We found that combining approaches may provide the most sustainable results. Integrated programmes bring together direct nutrition support and interventions addressing poverty, food security, health services and environmental conditions.
Examples include programmes that combine breastfeeding promotion, nutrient supplementation, agricultural support and caregiver education. These approaches recognise that children’s nutrition depends on the wider conditions in which families live.
Strong community involvement is also essential. Local knowledge, cultural practices and community participation can determine whether programmes are accepted and sustained over time.
A broader response is needed
Reducing child malnutrition in sub-Saharan Africa will require coordinated action. Governments, communities, health systems, the agricultural sector and development organisations must all get involved.
Policies must address immediate nutritional needs, and also drivers such as poverty, climate change, food insecurity and unequal access to services.
The evidence shows that no single intervention can end child malnutrition. Sustainable progress will depend on combining nutrition programmes with investments in resilient food systems, education, sanitation and healthcare.
Improving child nutrition is an investment in Africa’s future human development.
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