Multilevel Analysis of Severe Anthropometric Failure among Under‑Five Children in Benin: A Cross‑Sectional Study Using 2017 to 2018 Demographic and Health Survey Data

Background: Child undernutrition remains a major global health challenge and a leading cause of child mortality in low- and middle-income countries. To our knowledge, the combined burden of severe malnutrition has not been assessed in Benin. This study aimed to assess the prevalence of severe anthropometric failure and identify associated risk factors among children under five in Benin. Methods: A cross-sectional study was conducted using data from the BDHS 2017–18, including a weighted sample of 11,568 children under five years old. The Composite Index of Severe Anthropometric Failure (CISAF) was used to classify children based on severe stunting, wasting, and underweight. Multilevel logistic regression was employed to identify factors associated with CISAF. Results: The prevalence of CISAF was 12.02%. Factors significantly linked to CISAF included children aged 12–23 months (AOR = 1.62), multiple births (AOR = 3.60), small birth size (AOR = 2.11), having diarrhea (AOR = 1.25), lack of improved water sources (AOR = 1.21), having healthcare access problems (AOR = 1.16), rich wealth index (AOR = 0.52), female children (AOR = 0.66), institutional delivery (AOR = 0.61), having media exposure (AOR = 0.83), urban residents (AOR = 0.85), and high community literacy level (AOR = 0.79). Conclusions: This study found that 12.02% of children under five experienced CISAF. To reduce this burden, stakeholders should expand access to maternal and child healthcare, improve access to safe water, strengthen poverty alleviation programs, and enhance community education and media-based health awareness.