Socioeconomic Inequalities and Environmental Determinants of Child Undernutrition in Cambodia: An Analysis of the 2021-22 Demographic and Health Survey

Childhood undernutrition remains a major public health problem in low- and middle-income countries, including Cambodia, despite improvements in economic development and health services. To better understand child undernutrition in Cambodia, we examined the prevalence, socio-economic and environmental determinants, and associated factors of stunting, wasting, and underweight among children aged 0-59 months using the 2021-22 Cambodia Demographic and Health Survey (CDHS). This study included 3,821 weighted children aged 0-59 months. The prevalence of stunting, wasting, and underweight was 20.4%, 9.4%, and 15.9%, respectively. The highest burden of stunting was observed among children aged 12-23 months. Children from the poorest households consistently contributed the largest proportion of undernutrition cases across all three outcomes. After adjusting for other variables, children aged 12-23 months had higher odds of stunting compared with infants (AOR = 2.64; 95% CI: 1.87-3.74). Male children had increased odds of stunting (AOR = 1.33; 95% CI: 1.10-1.61), wasting (AOR = 1.35; 95% CI: 1.01-1.82), and underweight (AOR = 1.28; 95% CI: 1.02-1.59). Children from richer (AOR = 0.55; 95% CI: 0.31-0.95) and richest households (AOR = 0.33; 95% CI: 0.16-0.68) had lower odds of stunting. Maternal secondary or higher education was associated with lower odds of wasting (AOR = 0.49; 95% CI: 0.28-0.84) and underweight (AOR = 0.51; 95% CI: 0.32-0.79). Access to bottled water and digital connectivity were also protective against undernutrition. Conversely, poor household environmental conditions were associated with increased odds of undernutrition. Interaction analysis showed a stronger protective effect of maternal education among wealthier households, indicating a synergistic effect of socioeconomic advantage. Childhood undernutrition remains highly prevalent in Cambodia. Public health interventions and policies should prioritize improving complementary feeding practices, reducing socioeconomic inequalities, and strengthening multisectoral actions across nutrition, education, WASH, and social protection systems.