Malnutrition happens when there are insufficient amounts of nutrients and energy consumed improperly. Included are both undernutrition and overnutrition [1, 2]. Under-five children who are malnourished experience nutritional deficits as a result of the interaction between illness and poor nutrition [3, 4]. Stunting, wasting, and underweight are disorders connected to undernutrition. It is impacted by a lack of health services; a terrible environment; insufficient financial, physical, and social capital; inadequate food consumption; infection; poor food access; bad care and feeding habits; and poor care feeding habits [5,6,7,8,9]. It is also one of the leading causes of illness and death among under-five children in developing countries like Gambia [10]. Furthermore, malnutrition remains the leading cause of disease [11, 12], with long-term consequences such as impaired cognitive development, insufficient growth, and poor academic performance [13]. Under-five children are the most vulnerable to undernutrition in developing countries due to inadequate nutritional intake, lack of appropriate care, and unbalanced food distribution within the household [14]. The occurrence of undernutrition symptoms in children is a close indicator of overall nutrition and nutrition security conditions in low and middle-income countries [15].
Children who receive nourishing food are more likely to survive and thrive. When children are well-nourished, they develop, learn, play, participate, and contribute; however, when they are malnourished, they do not attain their full potential, which has an impact on the world’s children, nations, and societies [16]. The three widely accepted indicators of malnutrition in under-five children are stunting, wasting, and underweight [17]. Stunting and wasting signify, respectively, chronic and acute malnutrition. Undernutrition that is both acute (wasting) and chronic (stunting) may be indicated by underweight [17]. Children may experience multiple forms of malnutrition at the same time [17]. A baby who is simply too short for his or her age (low height-for-age) has been referred to as stunting [18]. Wasting is also defined as a baby who is simply too small for his or her height (low weight-for-height). Underweight refers to a baby who is simply too small for his or her age (low weight-for-age), which means that the weight for age is less than negative two standard deviations (SD) below the WHO Child Growth Standards median [18, 19].
Malnutrition has various causes, which include illnesses, inadequate diets, and environmental and socioeconomic characteristics [20]. The age of the child in a month [20,21,22,23], gender of the child [24, 25], birth size of the child [26, 27], birth order [4, 28], maternal education [28, 29], mother’s body mass index [24, 29], household wealth index [4, 21, 30], source of drinking water [22, 30], family size [24], region [22], residence [24], religion [31], ethnicity [32], sex of household head [30], husband education level [4, 30], breastfeeding status [32, 33], sex of children [34, 35], diarrhea [32, 36], fever and cough [31, 32] in the last 2 weeks prior to the survey, birth type of children [22, 28], number of under-five children [27], maternal anemia [9] and child anemia [22] were the determinants of children’s nutritional status in Gambia which have been identified.
According to the United Nations Children’s Fund [16], undernutrition is responsible for nearly half of all deaths among children under the age of five worldwide in 2020; 22% of children under the age of five were stunted, 12.6% were underweight, and 6.7% were wasted [16]. In the same year, approximately 149.2 million under-five children were affected by stunting. Asia was responsible for 30.7% of all stunted children [16]. Wasting will have contributed to the extinction of 45.4 million children under the age of five. More than two-thirds of all wasted children are found in Asia, with Africa accounting for more than a quarter [16]. However, a closer look at the distribution of stunting in the African region reveals that Eastern Africa (32.6%) has a higher incidence of stunting than Western Africa (30.9%), Central Africa (36.8%), Northern Africa (21.4%), and Southern Africa (23.3%) [16]. While Western Africa has a higher rate of wasting than the rest of Africa, Southern Africa (3.2%), Central Africa (6.2%), Northern Africa (6.6%), and Eastern Africa (5.2%) have lower rates [16].
Gambia, which stretches 400 km from the Atlantic Ocean to the east along the Gambia River, is one of the poorest Western African countries in the world, ranking 165 on the UNDP Human Development Index [20]. The newborn mortality rate is 42 deaths per 1000 live births [37]. Underweight, wasting, and stunting affected 12, 5, and 18% of children under the age of five, respectively [37].
To the best of the researchers’ knowledge, no study has been conducted on the determinants of the coexistence of undernutrition indicators in Gambia. In Nepal, Ethiopia, Uganda, Bangladesh, East Africa, Cameron, Ghana, Sub-Sahara Africa, Gambia, Tanzania, and Mozambique [4, 10, 20, 22, 27, 28, 33,34,35, 37,38,39], stunting, underweight, and wasting have all been extensively studied. However, little attention has been paid to their association, and literature is scarce, particularly in Gambia, so we will conduct a separate analysis of stunting, underweight, and wasting in children under the age of five, as previously done by studies [4, 10, 20, 22, 27, 28, 33,34,35, 37,38,39], using ordinal or binary logistic regression. However, when using binary or ordinal logistic regression, the association between stunting, underweight, and wasting is ignored. To do so, we consider the correlation between the indicators of undernutrition and, as a result, assess the special effects of other predictors. As a result, multivariate logistic regression may be a better option. This statistical model is used to simulate two or more binary outcome variables at the same time and assess their relationship in relation to other predictors [40, 41]. It meets the criteria for modeling marginal likelihood as a function of explanatory variables. At the same time, the model examines the relationship between stunting, underweight, and wasting in children under the age of five.
Though stunting and wasting are commonly presented as two distinct types of undernutrition that necessitate different interventions for prevention and/or treatment, they are closely related and frequently occur together in the same people and frequently in identical children. Stunting and wasting are associated with an increased risk of death, particularly when both occur in the same child [42]. A study was done in India, Malawi, and Ethiopia [43,44,45] looked at the link between stunting, underweight, and wasting. However, the effect of other predictors associated with stunting, underweight, and wasting was not taken into account when measuring the relationship. Thus, using multivariate binary logistic regression analysis, this study aims to assess the relationship between stunting, underweight, and wasting in under-five children in relation to other predictors.
During this study, two hypotheses were tested. The first hypothesis asserts that there is no relationship between the three undernutrition indicators among children under the age of five, while the second asserts that there is no relationship between predictors and undernutrition indicators. As a result, a better understanding of the relationship between stunting, underweight, and wasting will aid the concerned body in developing targeted interventions to improve child health and survival. As a result, the current study will benefit policymakers at both the governmental and personal levels by providing evidence on which interventions and policy actions are frequently formulated and implemented for children under the age of five.