Abstract:
Background Malnutrition causes nutrient deficiencies that have both physical and clinical consequences in severe
acute malnutrition children. Globally, there were 47 million wasted children under the age of five in 2019. One in
four were located in sub-Saharan Africa, with half being in South Asia. This study aims to apply the Boruta algorithm
to identify the determinants of undernutrition among children under five living in Dera Ghazi Khan, one of the
marginalized districts of densely populated Punjab Province in Pakistan.
Methods A multicenter cross-sectional study design was used to collect data from 185 children with severe acute
malnutrition aged under five years visiting the OTPs centers located in Dera Ghazi Khan, Punjab, Pakistan. A purposive
sampling technique was used to collect data using a pretested structured questionnaire from parents/caregivers
regarding family sociodemographic characteristics, child nutrition, and biological and healthcare characteristics.
Anthropometric measurements, including height, weight, and mid-upper arm circumference, were collected.
The Boruta models were used to incorporate the children’s anthropometric, nutritional, and household factors to
determine the important predictive variables for undernutrition using the Boruta package in R studio.
Results This study included 185 children, with a mean age of 15.36 ± 10.23 months and an MUAC of 10.19 ± 0.96 cm.
The Boruta analysis identifies age, mid-upper arm circumference, weaning practices, and immunization status as
important predictors of undernutrition. Income per month, exclusive breastfeeding, and immunization status were
found to be key factors of undernutrition in children under the age of five.
Conclusion This study highlights age, mid-upper arm circumference, weaning practices, and immunization status as
key determinants of weight-for-height and weight-for-age in children under five years. It also suggests that economic
context may influence undernutrition. The findings can guide targeted strategies for combating undernutrition.
