Prevalence of undernutrition and associated factors among orphan and vulnerable children in East Africa: a systematic review and meta-analysis

Abstract

Undernutrition is a state in which nutritional intake does not meet the body’s physiological needs. It was more common among Orphan and vulnerable children (OVC) compared to the general population. Uncovering the burden and its main factors could help relevant stakeholders to plan and implement appropriate interventions. Therefore, this study was aimed to assess the prevalence and associated factors of undernutrition among OVC in East Africa. The Preferred Reporting Items for Systematic Reviews and Meta-analysis reporting guideline were used to report this systematic review and meta analysis. The observational studies conducted in East Africa among OVC published until February 2026 were included. Pubmed, Science direct, AJol, Google scholar and Cochrane library databases were used to access studies. The quality of the articles was assessed using the Joanna Briggs Institute (JBI) tool for observational studies in meta-analyses. The pooled prevalence and odds ratio of the associated factors with their 95% confidence interval was computed using STATA version 18.1 software. A total of twenty seven (27) eligible studies were included in the meta-analysis. The pooled prevalence of stunting, wasting, and underweight was 27.66% (95% confidence interval[CI]: 23.94, 31.39), 12.91% (95% CI: 10.39, 15.43), and 19.95% (95% CI: 16.60, 23.30) among OVC in East Africa respectively using the random-effects model analysis. Both graphical and Egger’s test showed no publication bias of studies. Signficant heterogeneity of studies were found. Vitamin A supplementation, household food security (HHFS), orphan status, and caregiver educational level were significantly associated with stunting. A history of recent illness, household wealth status, and child´s age were significantly associated with wasting. Furthermore, HHFS was again significantly associated with underweight. Undernutrition among OVC remains one of the most important public health problems in East Africa. Over a quarter of these children suffer from stunting, while nearly one in five is underweight. Furthermore, wasting affects approximately one in every eight children, underscoring a significant and persistent burden of malnutrition across the region. Integrated intervention combining targeted nutritional and health support with household-level economic strengthening and food security programs should be implemented to address identified significant factors and effectively mitigate this overlooked public health problem.