Nutritional status and dietary adequacy among school-aged children living with HIV on antiretroviral therapy in Nsanje district, Malawi

Background HIV infection remains a major public health challenge in sub-Saharan Africa. Children living with HIV are vulnerable to poor nutritional outcomes, particularly in rural settings affected by food insecurity and climate-related shocks. This study assessed the nutritional status and dietary adequacy of school-aged children living with HIV receiving antiretroviral therapy (ART) in Nsanje District, Malawi. Methods A facility-based cross-sectional study was conducted from January to June 2026 among children aged 5–15 years attending Kalemba Mission Hospital. Of 111 children selected, 102 participated, giving a 91.9% recruitment rate. Nutritional status was measured using WHO anthropometric indicators, while dietary intake was assessed using 24-hour recalls, a semi-quantitative food frequency questionnaire, and dietary diversity analysis. The IBM™ SPSS Statistics version 29 was utilised for descriptive and inferential statistics. Results Among the 102 children, the mean height-for-age Z-score was − 1.74 and the mean BMI-for-age Z-score was − 1.21. Stunting affected 44.1% of participants, thinness 35.3%, and overweight 5.9%. Most children (70.6%) had adequate dietary diversity, but 29.4% had low dietary diversity. Energy and protein inadequacy were common, with 67.6% and 58.8% of children falling below the EAR, respectively. Mean NAR was highest for iron (0.91), and overall MAR was 0.783. Low dietary diversity (AOR = 2.41, 95% CI: 1.15–5.08) and unsuppressed viral load (AOR = 3.48, 95% CI: 1.42–8.51) were associated with thinness, while children aged 11–15 years had lower odds of thinness than those aged 5–10 years (AOR = 0.57, 95% CI: 0.30–0.99). Conclusion Poor nutritional status remained common despite ART, highlighting the need for routine nutritional screening, dietary counselling, and regular viral load monitoring.