ABSTRACT:
Child malnutrition remains a critical public health concern in South Africa, with persistent implications for child survival, growth, and long-term human capital development. This study quantifies the burden of child malnutrition using key anthropometric indicators and examines associated socio-demographic determinants. Drawing on nationally representative data from the South Africa Demographic and Health Survey (DHS), the analysis focuses on children under five years of age (n = 14 266). Anthropometric outcomes, including stunting, wasting, underweight, and overweight, were assessed using World Health Organization growth standards. A composite Child Health Index was constructed using Multiple Correspondence Analysis to classify children into healthy and unhealthy overall nutritional status. Descriptive statistics were used to estimate the prevalence of malnutrition outcomes, and multivariable regression models were used to identify factors associated with adverse anthropometric status. The results indicate that stunting remains the most prevalent form of malnutrition, affecting 24.3% of children. A substantial proportion of children are classified as overweight (12.9%), reflecting the coexistence of undernutrition and overnutrition. Overall, 37% of children were classified as unhealthy based on the Child Health Index. Higher household socioeconomic status (upper wealth quintile: AOR = 3.02), maternal education (primary: AOR = 1.99; secondary: AOR = 2.59; tertiary: AOR = 2.87), and selected household characteristics emerged as significant predictors of child health status. In conclusion, the findings reveal persistent socioeconomic inequalities and a pronounced dual burden of malnutrition among children in South Africa, posing challenges to the achievement of Sustainable Development Goal 2 (Zero Hunger) and SDG 3 (Good Health and Well-being). The study underscores the need for integrated, equity-sensitive nutrition interventions that simultaneously address chronic undernutrition and the rising prevalence of childhood overweight. Policy efforts should prioritise maternal education, household economic strengthening, and context-specific nutrition programmes to accelerate progress towards improved child health and sustainable development outcomes.