Recorded Malnutrition and Associated Factors Among Children Under Five
Attending ELWA Hospital, Liberia: A Cross-Sectional Analysis

Allen S. Kpehe; Germue M. Gbawoquiya

doi:10.46609/IJSSER.2026.v11i10.004

Title: Recorded Malnutrition and Associated Factors Among Children Under Five Attending ELWA Hospital, Liberia: A Cross-Sectional Analysis
Authors: Allen S. Kpehe and Germue M. Gbawoquiya
Journal: International Journal of Social Science and Economic Research (IJSSER) ISSN: 2455-8834 Volume: 11 Issue: 10 Publication Date: October 2026 DOI: 10.46609/IJSSER.2026.v11i10.004
\|\| \|\|
Allen S. Kpehe1 and Germue M. Gbawoquiya2 1,2. Department of Epidemiology, School of Health Sciences, Cuttington University School of Graduate & Professional Studies, Monrovia, Liberia.
MLA 8 Kpehe, Allen S., and Germue M. Gbawoquiya. "Recorded Malnutrition and Associated Factors Among Children Under Five Attending ELWA Hospital, Liberia: A Cross-Sectional Analysis." Int. j. of Social Science and Economic Research, vol. 11, no. 10, Oct. 2026, pp. 5425-5444, doi.org/10.46609/IJSSER.2026.v11i10.004. Accessed Oct. 2026. APA 6 Kpehe, A., & Gbawoquiya, G. (2026, October). Recorded Malnutrition and Associated Factors Among Children Under Five Attending ELWA Hospital, Liberia: A Cross-Sectional Analysis. Int. j. of Social Science and Economic Research, 11(10), 5425-5444. Retrieved from https://doi.org/10.46609/IJSSER.2026.v11i10.004 Chicago Kpehe, Allen S., and Germue M. Gbawoquiya. "Recorded Malnutrition and Associated Factors Among Children Under Five Attending ELWA Hospital, Liberia: A Cross-Sectional Analysis." Int. j. of Social Science and Economic Research 11, no. 10 (October 2026), 5425-5444. Accessed October, 2026. https://doi.org/10.46609/IJSSER.2026.v11i10.004.
References [1] . UNICEF, World Health Organization, & World Bank Group. (2025). Levels and trends in child malnutrition: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates, 2025 edition. World Health Organization. https://www.who.int/publications/b/78252 [2] . Liberia Institute of Statistics and Geo-Information Services (LISGIS), Ministry of Health [Liberia], & ICF. (2021). Liberia Demographic and Health Survey 2019–20. Monrovia, Liberia, and Rockville, Maryland, USA: LISGIS, Ministry of Health, and ICF. https://dhsprogram.com/pubs/pdf/FR362/FR362.pdf [3] . UNICEF Liberia. (2026). The situation analysis of children and adolescents in Liberia. UNICEF Liberia. https://www.unicef.org/liberia/reports/situation-analysis-children-and-adolescents-liberia [4] . World Health Organization. (2006). WHO child growth standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. World Health Organization. https://www.who.int/publications/i/item/924154693X [5] . World Health Organization, & UNICEF. (2019). Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. World Health Organization. https://www.who.int/publications/i/item/9789241515559 [6] . World Health Organization. (2023). WHO guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition) in infants and children under 5 years. World Health Organization. https://www.who.int/publications/i/item/9789240082830 [7] . Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., de Onis, M., Ezzati, M., Grantham-McGregor, S., Katz, J., Martorell, R., & Uauy, R. (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 382(9890), 427–451. https://doi.org/10.1016/S0140-6736(13)60937-X [8] . Smith, L. C., & Haddad, L. (2015). Reducing child undernutrition: Past drivers and priorities for the post-MDG era. World Development, 68, 180–204. https://doi.org/10.1016/j.worlddev.2014.11.014 [9] . Rezaeizadeh, G., Mansournia, M. A., Keshtkar, A., Farahani, Z., Zarepour, F., Sharafkhah, M., Kelishadi, R., & Poustchi, H. (2024). Maternal education and its influence on child growth and nutritional status during the first two years of life: A systematic review and meta-analysis. EClinicalMedicine, 71, 102574. https://doi.org/10.1016/j.eclinm.2024.102574 [10] . Vollmer, S., Bommer, C., Krishna, A., Harttgen, K., & Subramanian, S. V. (2017). The association of parental education with childhood undernutrition in low- and middle-income countries: Comparing the role of paternal and maternal education. International Journal of Epidemiology, 46(1), 312–323. https://doi.org/10.1093/ije/dyw133 [11] . Saputro Wijayanto, F. P., Theodora Simanjuntak, A. M., Chang, J., Asrar, M. M., Swastidharmistha, A. P., Haq, R. A., Gandhy, M. A. K., Rabih, M. Z., Putra, M. G. D., & Girsang, R. T. (2026). Association between water, sanitation, and hygiene (WASH) practices and childhood stunting in low- and middle-income countries: A systematic review and meta-analysis. BMC Public Health, 26, 1960. https://doi.org/10.1186/s12889-026-27639-z [12] . Patlan-Hernandez, A. R., Stobaugh, H. C., Cumming, O., Angioletti, A., Pantchova, D., Lapegue, J., Stern, S., & N'Diaye, D. S. (2022). Water, sanitation and hygiene interventions and the prevention and treatment of childhood acute malnutrition: A systematic review. Maternal & Child Nutrition, 18(1), e13257. https://doi.org/10.1111/mcn.13257 [13] . Sarfo, O. J., Amoadu, M., Kordorwu, P. Y., Adams, A. K., Gyan, T. B., Osman, A.-G., Asiedu, I., & Ansah, E. W. (2023). Malaria amongst children under five in sub-Saharan Africa: A scoping review of prevalence, risk factors and preventive interventions. European Journal of Medical Research, 28, 80. https://doi.org/10.1186/s40001-023-01046-1 [14] . Das, J. K., Salam, R. A., Saeed, M., Kazmi, F. A., & Bhutta, Z. A. (2020). Effectiveness of interventions for managing acute malnutrition in children under five years of age in low-income and middle-income countries: A systematic review and meta-analysis. Nutrients, 12(1), 116. https://doi.org/10.3390/nu12010116 [15] . O'Donovan, G., Allen, D., Nkosi-Gondwe, T., Anujuo, K., Abera, M., Kirolos, A., Olga, L., Thompson, D., McKenzie, K., Wimborne, E., Cole, T. J., Koulman, A., Lelijveld, N., Crampin, A. C., Opondo, C., & Kerac, M. (2025). Weight gain among children under five with severe malnutrition in therapeutic feeding programmes: A systematic review and meta-analysis. EClinicalMedicine, 81, 103083. https://doi.org/10.1016/j.eclinm.2025.103083 [16] . Zou, G. (2004). A modified Poisson regression approach to prospective studies with binary data. American Journal of Epidemiology, 159(7), 702–706. https://doi.org/10.1093/aje/kwh090 [17] . von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Medicine, 4(10), e296. https://doi.org/10.1371/journal.pmed.0040296
ABSTRACT: Child malnutrition remains an important public health concern in Liberia. This facility-based cross-sectional analysis examined recorded malnutrition among 272 children represented in the ELWA Hospital clinical and nutrition dataset. The source-recorded malnutrition variable was used as the primary outcome, while recorded WAZ, HAZ, WHZ and MUAC indicators were summarized descriptively. Modified Poisson regression with robust variance was used to estimate prevalence ratios, with a reduced adjusted model because only 14 children were recorded as not malnourished. Among 269 children with a recorded malnutrition status, 255 (94.8%) were classified as malnourished. Recorded WAZ below ?2 SD was present in 255 of 271 children (94.1%), HAZ below ?2 SD in 255 of 271 (94.1%), WHZ below ?2 SD in 254 of 269 (94.4%), and MUAC below 12.5 cm in 51 of 262 children with valid MUAC (19.5%). None of the six factors in the reduced adjusted model showed clear evidence of association at the 5% level. Among 23 children with a recorded nutritional intervention, mean weight increased by 0.46 kg (paired Wilcoxon p=0.010), while mean height changed by 0.02 cm (p=0.317). Seventeen of 22 children with known treatment outcomes were recorded as improved. The findings describe a high recorded burden of malnutrition in this facility-based dataset, but the available records do not permit independent verification of WHO growth z-scores because exact age in months is unavailable.

IJSSER is Member of