Background: Malnutrition remains a major public health problem among children under five years of age in conflict-affected regions of Sudan. Tawila locality in North Darfur is characterized by displacement, poverty, and limited infrastructure, which increase children’s vulnerability to undernutrition. This study aimed to determine the prevalence of malnutrition and identify its associated risk factors among children under five in Tawila to inform targeted interventions.

Methods: A community-based cross-sectional study was conducted among 597 children aged 6–59 months and their caregivers using a two-stage cluster sampling technique. Data were collected using a structured questionnaire that covered household socioeconomic characteristics, child feeding practices, recent illnesses, and access to water, sanitation, and hygiene (WASH) services. Anthropometric measurements (weight, height/length, and mid-upper arm circumference) were taken and analyzed using ENA software to determine wasting, stunting, and underweight according to WHO standards. Non-anthropometric variables were analyzed using SPSS version 27. Descriptive statistics and inferential tests (independent t-tests and chi-square tests) were applied to assess associations.

Results: The prevalence of wasting, stunting, and underweight was 14.7%, 48.9%, and 35.6%, respectively. Children aged 12–35 months were at significantly higher risk of acute malnutrition. Significant determinants included use of unprotected water sources (P < 0.01), recent episodes of diarrhea, respiratory infections, malaria, and measles (P < 0.05), and lack of ROTA2 vaccination.

Conclusion: Malnutrition in Tawila is alarmingly high and strongly associated with poor WASH conditions, infectious diseases, and inadequate immunization coverage. Integrated, multi-sectoral interventions addressing water safety, disease prevention, and socioeconomic vulnerability are urgently needed in this conflict-affected setting.

Keywords: Children (6–59 months), Hygiene, Internally Displaced Persons (IDPs), Malnutrition, Risk Factors, Sanitation, Water

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