Introduction: In the Democratic Republic of Congo, particularly in remote areas such as the Sankuru health zones, malnutrition in children aged 0 to 5 years is a significant public health issue. It stems from a combination of factors (dietary, health-related, biological, socioeconomic, and environmental). Methods: A cross-sectional analytical study was conducted on 614 children aged 0 to 5 years, from May to October 2025. Multivariate logistic regression facilitated data analysis, leading to the identification of key predictors of malnutrition in Sankuru. The adjusted odds ratio (ORa) > 1, the 95% confidence interval (95% CI), and the significance threshold (p < 0.05) indicate a significant association. Results: The results of this study show a prevalence of malnutrition of all forms among children aged 0 to 5 years of approximately 52.1%. The presence of edema was significantly associated with malnutrition (ORa = 1.45; 95% CI: 1.18 - 1.78; p = 0.001). Socioeconomic factors such as lack of maternal education (ORa = 1.32; p = 0.018) and being a homemaker (ORa = 1.29; p = 0.009) were also significant. Environmental factors such as the use of river water (ORa = 1.33; p = 0.007), poor water storage (ORa = 1.41; p = 0.005), and lack of handwashing (ORa = 1.28; p = 0.022) were also significant. From a nutritional standpoint, non-consumption of fruit was a highly associated factor (ORa = 1.72; 95% CI: 1.58 - 1.91; p = 0.008). Non-use of preventive health services was a significant variable (ORa = 1.27; p = 0.025). Conclusion: Multifactorial causes such as diet, access to healthcare, parental education (especially maternal), and environmental factors constitute the fundamentals of malnutrition in children under 5 years of age. Combined, appropriate, and efficient interventions can reduce the prevalence over time.
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