OSASUMWEN OJO

Background: Malnutrition among children under five years remains a critical public health issue in Nigeria, contributing substantially to under-five morbidity and mortality. Despite various interventions, limited evidence exists on the specific determinants of malnutrition in semi-urban settings such as Egor Local Government Area, Edo State, Nigeria. Objective: This study assessed the prevalence and determinants of malnutrition among children under five years in Egor LGA, specifically evaluating caregiver knowledge, feeding practices, sources of nutritional information, and socioeconomic factors influencing nutritional outcomes. Methods: A descriptive cross-sectional study was conducted among 400 caregiver- child pairs selected through multi-stage stratified systematic random sampling from primary healthcare centres, immunization clinics, and child welfare services in Egor LGA between January and March 2026. Data were collected using a structured interviewer-administered questionnaire covering sociodemographic characteristics, caregiver knowledge (27-point scale), child feeding practices (12-point scale), information sources, and household factors. Anthropometric measurements (weight, height/length, mid-upper arm circumference) were taken following WHO standardized protocols. Nutritional status was classified using WHO 2006 Child Growth Standards (Z-scores). Data were analysed using IBM SPSS version 25, with chi-square tests and multivariate binary logistic regression (p < 0.05 significance level). Results: The majority of caregivers were mothers (73.3%), aged 29–38 years (38.8%), with secondary (47.0%) or tertiary (41.5%) education. Good knowledge of child nutrition was demonstrated by 65.6% of caregivers, with 96.3% correctly identifying exclusive breastfeeding duration (6 months) and 91.3% knowing appropriate complementary feeding age (6 months). However, only 47.5% exhibited good feeding practices. A significant knowledge-practice gap was identified: caregivers with good knowledge were significantly less likely to have good feeding practices (AOR = 0.625, 95% CI: 0.409–0.955, p = 0.030). Health workers were the most utilized (94.5%) and trusted (44.8%) information source, yet only 13.0% had attended formal nutrition education. Overall malnutrition prevalence was 20.7% (underweight 14.5%, moderate malnutrition 4.0%, wasting 1.3%, stunting 1.0%). Recent child illness (AOR = 1.891, 95% CI: 1.101–3.250, p = 0.021) and good feeding practices (AOR = 2.042, 95% CI: 1.167–3.571, p = 0.012) were significant risk factors for malnutrition, while good caregiver knowledge (AOR = 0.419, 95% CI: 0.245–0.717, p = 0.001), male caregiver sex (AOR = 0.305, 95% CI: 0.112–0.831, p = 0.020), and household food insecurity (AOR = 0.382, 95% CI: 0.204–0.712, p = 0.002) were protective. Conclusion: Despite relatively high caregiver knowledge and lower malnutrition prevalence than national averages in Egor LGA, a substantial knowledge-practice gap persists, and child feeding practices remain suboptimal with low dietary diversity and high consumption of sugary drinks and packaged snacks. Health workers are trusted information sources but structured nutrition education is underutilized. Interventions must address economic and structural barriers limiting knowledge translation, integrate practical skills-based nutrition counselling into routine health services, and target modifiable risk factors including childhood illnesses.