Table 1
Classification of the Composite Index of Severe Anthropometric Failure.
| GROUP | CISAF | DESCRIPTION | STUNTING | WASTING | UNDERWEIGHT |
|---|---|---|---|---|---|
| A | No severe failure | Normal WAZ, HAZ, and WHZ | No | No | No |
| B | Severe wasting only | WHZ < −3SD, but normal HAZ and WAZ | No | Yes | No |
| C | Severe wasting and underweight | WAZ and WHZ < −3SD, but HAZ normal | No | Yes | Yes |
| D | Severe stunting, wasting, and underweight | WAZ, WHZ, and HAZ < −3SD | Yes | Yes | Yes |
| E | Severe stunting and underweight | HAZ and WAZ < −3SD, but normal WHZ | Yes | No | Yes |
| F | Severe stunting only | HAZ < −3SD, but normal WAZ and WHZ | Yes | No | No |
| G | Severe underweight only | WAZ < −3SD, but normal HAZ and WHZ | No | No | Yes |
| H | Severe stunting and wasting | HAZ and WHZ < −3SD, but normal WAZ | Yes | Yes | No |
Table 2
Characteristics of children under five by CISAF in Benin (N = 11,568).
| VARIABLE | CATEGORIES | CISAF | TOTAL | |
|---|---|---|---|---|
| NO SEVERE FAILURE N (%) | SEVERE FAILURE N (%) | |||
| Sex of child | Male | 5040 (86.3%) | 802 (13.7%) | 5842 |
| Female | 5138 (89.7%) | 588 (10.3%) | 5726 | |
| Child age (months) | 0–11 | 2571 (91.6%) | 236 (8.4%) | 2807 |
| 12–23 | 2097 (87.5%) | 299 (12.5%) | 2396 | |
| 24–35 | 1815 (84.6%) | 331 (15.4%) | 2146 | |
| 36–47 | 1877 (86.3%) | 298 (13.7%) | 2175 | |
| 48–59 | 1818 (88.9%) | 226 (11.1%) | 2044 | |
| Wealth quintile | Poorest | 2048 (83.0%) | 419 (17.0%) | 2467 |
| Poorer | 1934 (84.7%) | 350 (15.3%) | 2284 | |
| Middle | 2043 (88.6%) | 264 (11.4%) | 2307 | |
| Richer | 2059 (89.7%) | 236 (10.3%) | 2295 | |
| Richest | 2094 (94.5%) | 121 (5.5%) | 2215 | |
| Sex of household head | Male | 8555 (88.0%) | 1169 (12.0%) | 9724 |
| Female | 1623 (88.0%) | 221 (12.0%) | 1844 | |
| Marital status | Married/living with partner | 9617 (88.0%) | 1306 (12.0%) | 10,923 |
| Other | 561 (87.0%) | 84 (13.0%) | 645 | |
| Toilet type | Improved | 3007 (92.2%) | 256 (7.8%) | 3263 |
| Unimproved | 7171 (86.3%) | 1134 (13.7%) | 8305 | |
| Source of water | Improved | 5698 (89.3%) | 682 (10.7%) | 6380 |
| Unimproved | 4480 (86.3%) | 708 (13.7%) | 5188 | |
| Electricity access | Yes | 3482 (92.1%) | 299 (7.9%) | 3781 |
| No | 6696 (86.0%) | 1091 (14.0%) | 7787 | |
| Mobile phone access | Yes | 5250 (91.2% | 504 (8.8%) | 5754 |
| No | 4928 (84.8%) | 886 (15.2%) | 5814 | |
| Type of residence | Urban | 4280 (90.8%) | 434 (9.2%) | 4714 |
| Rural | 5898 (86.1%) | 956 (13.9%) | 6854 | |
| Region | Alibori | 1166 (83.4%) | 232 (16.6%) | 1398 |
| Atacora | 960 (84.7%) | 174 (15.3%) | 1134 | |
| Atlantic | 974 (88.9%) | 122 (11.1%) | 1096 | |
| Borgou | 1209 (86.0%) | 197 (14.0%) | 1406 | |
| Collines | 865 (93.3%) | 62 (6.7%) | 927 | |
| Couffo | 664 (87.8%) | 92 (12.2%) | 756 | |
| Donga | 749 (88.9%) | 94 (11.1%) | 843 | |
| Littoral | 709 (93.2%) | 52 (6.8%) | 761 | |
| Mono | 517 (88.5%) | 67 (11.5%) | 584 | |
| Ouémé | 812 (90.3%) | 87 (9.7%) | 899 | |
| Plateau | 589 (85.6%) | 99 (14.4%) | 688 | |
| Zou | 964 (89.6%) | 112 (10.4%) | 1076 | |
| Number of children under five | 1 | 2483 (90.0%) | 277 (10.0%) | 2760 |
| 2 | 4193 (89.2%) | 509 (10.8%) | 4702 | |
| ≥3 | 3502 (85.3%) | 604(14.7%) | 4106 | |
| Vitamin A supplement | Yes | 5241 (88.9%) | 654 (11.1%) | 5895 |
| No | 4937 (87.0%) | 736 (13.0%) | 5673 | |
| Recent diarrhea | Yes | 1097 (84.9%) | 195 (15.1%) | 1292 |
| No | 9081 (88.4%) | 1195 (11.6%) | 10,276 | |
| Type of birth | Single | 9836 (88.8%) | 1246 (11.2%) | 11,082 |
| Multiple | 342 (70.4%) | 144 (29.6%) | 486 | |
| Birth order | First | 2162 (88.7%) | 276 (11.3%) | 2438 |
| 2nd to 3rd | 3737 (88.6%) | 481 (11.4%) | 4218 | |
| 4th to 5th | 2421 (87.8%) | 337 (12.2%) | 2758 | |
| ≥6th | 1858 (86.3%) | 296 (13.7%) | 2154 | |
| Place of delivery | Home | 1368 (78.7%) | 370 (21.3%) | 1738 |
| Health institution | 8810 (89.6%) | 1020 (10.4%) | 9830 | |
| Mother’s education | No education | 6475 (86.2%) | 1036 (13.8%) | 7511 |
| Primary | 1889 (89.5%) | 221 (10.5) | 2110 | |
| Secondary and above | 1814 (93.2%) | 133 (6.8%) | 1947 | |
| Mother’s occupation | Has work | 8499 (88.1%) | 1144 (11.9%) | 9643 |
| No work | 1679 (87.2) | 246 (12.8%) | 1925 | |
| Mother’s breastfeeding status (during survey time) | Yes | 6227 (88.3%) | 825 (11.7%) | 7052 |
| No | 3951 (87.5%) | 565 (12.5%) | 4516 | |
| Healthcare access | Not a big problem | 4123 (89.6%) | 477 (10.4%) | 4600 |
| Big problem | 6055 (86.9%) | 913 (13.1%) | 6968 | |
| Mother’s age at first birth | ≤17 | 2614 (85.3%) | 452 (14.7%) | 3066 |
| 18–24 | 6436 (88.9%) | 808 (11.1%) | 7244 | |
| ≥25 | 1128 (89.7%) | 130 (10.3%) | 1258 | |
| Birth size | Large | 2926 (90.7%) | 301 (9.3%) | 3227 |
| Average | 5830 (88.6%) | 752 (11.4%) | 6582 | |
| Small | 1422 (80.8%) | 337 (19.2%) | 1759 | |
| ANC level | Not adequate | 6393 (86.2%) | 1020 (13.8%) | 7413 |
| Adequate | 3785 (91.1%) | 370 (8.9%) | 4155 | |
| Media exposure | Yes | 6358 (89.9%) | 714 (10.1%) | 7072 |
| No | 3820 (85.0%) | 676 (15.0%) | 4496 | |
| Community media exposure | Low | 4971 (85.7%) | 832 (14.3%) | 5803 |
| High | 5207 (90.3%) | 558 (9.7%) | 5765 | |
| Community literacy level | Low | 4920 (84.8%) | 882 (15.2%) | 5802 |
| High | 5258 (91.2%) | 508 (8.8%) | 5766 | |
| Community poverty level | Low | 5296 (91.1%) | 516 (8.9%) | 5812 |
| High | 4882 (84.8%) | 874 (15.2%) | 5756 | |
[i] Note: Percentages are calculated within each category (row percentages).
Figure 1
Proportion of CISAF and CIAF among under‑five children in Benin.
Table 3
Prevalence of CISAF and its subgroups among children under five in Benin (N = 11,568).
| GROUP | CISAF | STUNTING | WASTING | UNDERWEIGHT | (%) |
|---|---|---|---|---|---|
| A | No severe failure | No | No | No | 87.98 |
| B | Severe wasting only | No | Yes | No | 0.48 |
| C | Severe wasting and underweight | No | Yes | Yes | 0.37 |
| D | Severe stunting, wasting, and underweight | Yes | Yes | Yes | 0.24 |
| E | Severe stunting and underweight | Yes | No | Yes | 2.52 |
| F | Severe stunting only | Yes | No | No | 7.78 |
| G | Severe underweight only | No | No | Yes | 0.00 |
| H | Severe stunting and wasting | Yes | Yes | No | 0.62 |
| 100 | |||||
| CISAF | B+C+D+E+F+G+H | 12.02% | |||
Table 4
Random effects and model fit statistics for predictors of CISAF among children under five in Benin.
| PARAMETER | NULL (MODEL I) | MODEL II | MODEL III | MODEL IV |
|---|---|---|---|---|
| Community‑level variance | 0.3437 | 0.1712 | 0.1883 | 0.1345 |
| ICC | 0.0946 | 0.0494 | 0.0541 | 0.03928 |
| PCV | reference | 50.1803 | 45.1814 | 60.8646 |
| MOR | 1.9703 | 1.6069 | 1.6446 | 1.5523 |
| AIC | 8396.15 | 7887.34 | 8300.11 | 7885.58 |
| Model fitness | ||||
| Log‑likelihood | −4198.07 | −3914.67 | −4144.05 | −3898.79 |
| Deviance (−2LL) | 8396.14 | 7829.34 | 8288.10 | 7797.58 |
Table 5
Predictors of the severe composite index of anthropometric failure among children under five in Benin.
| VARIABLES | MODEL II AOR (95% OF CI) | MODEL III AOR (95% OF CI) | MODEL IV AOR (95% OF CI) |
|---|---|---|---|
| Sex of child | |||
| Male | Ref | Ref | |
| Female | 0.66 (0.59, 0.75)* | 0.66 (0.59, 0.75)* | |
| Age of child (months) | |||
| 0–11 | Ref | Ref | |
| 12–23 | 1.64 (1.35, 1.98)* | 1.62 (1.34, 1.96)* | |
| 24–35 | 2.21 (1.83, 2.66)* | 2.20 (1.83, 2.65)* | |
| 36–47 | 1.86 (1.53, 2.26)* | 1.85 (1.53, 2.25)* | |
| 48–59 | 1.40 (1.13, 1.71)* | 1.39 (1.13, 1.70)* | |
| Wealth quintile | |||
| Poorest | Ref | Ref | |
| Poorer | 1.07 (0.90, 1.27) | 1.07 (0.90, 1.28) | |
| Middle | 0.81 (0.66, 0.98)* | 0.82 (0.67, 1.00) | |
| Richer | 0.81 (0.64. 1.01) | 0.84 (0.66, 1.09) | |
| Richest | 0.49 (0.35, 0.67)* | 0.52 (0.36, 0.74)* | |
| Source of water | |||
| Improved | Ref | Ref | |
| Unimproved | 1.24 (1.09, 1.40)* | 1.21 (1.06, 1.37)* | |
| Electricity | |||
| No | Ref | Ref | |
| Yes | 1.02 (0.84, 1.23) | 1.04 (0.85, 1.26) | |
| Access to mobile phone | |||
| No | Ref | Ref | |
| Yes | 0.82 (0.71, 0.95)* | 0.85 (0.73, 0.97)* | |
| Recent diarrhea prevalence | |||
| No | Ref | Ref | |
| Yes | 1.26 (1.05, 1.5)* | 1.25 (1.05, 1.50)* | |
| Birth type | |||
| Single | Ref | Ref | |
| Multiple | 3.57 (2.84, 4.49)* | 3.60 (2.86, 4.52)* | |
| Birth order | |||
| First | Ref | Ref | |
| 2nd–3rd | 0.89 (0.75, 1.05) | 0.89 (0.76, 1.06) | |
| 4th–5th | 0.84 (0.70, 1.02) | 0.85 (0.71, 1.03) | |
| 6th and above | 0.76 (0.62. 0.93)* | 0.77 (0.63, 0.94)* | |
| Delivery place | |||
| Home | Ref | Ref | |
| Health institution | 0.59 (0.51, 0.70)* | 0.61 (0.51, 0.72)* | |
| Mother’s education | |||
| No education | Ref | Ref | |
| Primary | 0.98 (0.83, 1.17) | 1.05 (0.88, 1.25) | |
| Secondary and higher | 0.74 (0.59, 0.92)* | 0.80 (0.63, 1.00) | |
| Healthcare access | |||
| Not a big problem | Ref | Ref | |
| Big problem | 1.17 (1.03, 1.34)* | 1.16 (1.01, 1.33)* | |
| Mother’s age at first birth | |||
| ≤17 | Ref | Ref | |
| 18–24 | 0.83 (0.72, 0.95)* | 0.83 (0.72, 0.95)* | |
| 25+ | 0.84 (0.67, 1.06) | 0.83 (0.66, 1.04) | |
| Birth size | |||
| Large | Ref | Ref | |
| Average | 1.25 (1.08, 1.45)* | 1.27 (1.09, 1.48)* | |
| Small | 2.12 (1.76, 2.54)* | 2.11 (1.75, 2.54)* | |
| ANC level | |||
| Not adequate | Ref | Ref | |
| Adequate | 0.89 (0.77, 1.03) | 0.87 (0.75, 1.01) | |
| Media exposure | |||
| No | Ref | Ref | |
| Yes | 0.86 (0.75, 0.98)* | 0.83 (0.72, 0.95)* | |
| Residence | |||
| Rural | Ref | Ref | |
| Urban | 0.77 (0.66, 0.91)* | 0.85 (0.72, 1.00) | |
| Community literacy level | |||
| Low | Ref | Ref | |
| High | 0.70 (0.59, 0.83)* | 0.79 (0.66, 0.95)* | |
| Community poverty level | |||
| Low | Ref | Ref | |
| High | 1.28 (1.07, 1.54)* | 0.96 (0.79, 1.17) | |
| Community media exposure | |||
| Low | Ref | Ref | |
| High | 0.85 (0.71, 1.00) | 1.00 (0.84, 1.20) | |
| Region | |||
| Alibori | Ref | Ref | |
| Atacora | 0.95 (0.71, 1.00) | 0.91 (0.68, 1.22) | |
| Atlantic | 1.02 (0.74, 1.40) | 1.07 (0.77, 1.49) | |
| Borgou | 0.88 (0.67, 1.16) | 0.82 (0.62, 1.09) | |
| Collines | 0.46 (0.32, 0.66)* | 0.55 (0.38, 0.79)* | |
| Couffo | 0.93 (0.67, 1.29) | 1.04 (0.74, 1.45) | |
| Donga | 0.78 (0.56, 1.10) | 0.80 (0.56, 1.12) | |
| Littoral | 0.81 (0.54, 1.21) | 1.11 (0.72, 1.71) | |
| Mono | 0.95 (0.66, 1.38) | 0.97 (0.66, 1.42) | |
| Ouémé | 0.85 (0.61, 1.19) | 0.95 (0.67, 1.35) | |
| Plateau | 1.04 (0.75, 1.44) | 1.14 (0.81, 1.59) | |
| Zou | 0.77 (0.56, 1.04) | 1.01 (0.74, 1.40) |
[i] Note: AOR = adjusted odds ratio; CI = confidence interval; *p < 0.05 indicates statistical significance.
| AIC | Akaike Information Criteria |
| ANC | Antenatal care |
| AOR | Adjusted Odds Ratio |
| BDHS | Benin Demography and Health Survey |
| BIC | Bayesian Information Criteria |
| CI | Confidence Interval |
| CIAF | Composite Index of Anthropometric Failure |
| CISAF | Composite Index of Severe Anthropometric Failure |
| EA | Enumeration area |
| HAZ | Height for age standardized score |
| MOR | Median odds ratio |
| PCV | Proportional Change in Variance |
| SD | Standard deviation |
| UNICEF | United Nations Population Fund |
| WAZ | Weight for age standardized score |
| WHZ | Weight for height standardized score |