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.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The original data collection tools and study protocols for the 2021–22 Cambodia Demographic and Health Survey (CDHS) were reviewed and approved by the National Ethics Committee for Health Research (NECHR), Cambodia (Ref: 083 NECHR, approved on 10 May 2021) and the Institutional Review Board (IRB) of ICF International, Rockville, Maryland, USA. Written informed consent was obtained from all participants prior to data collection. For participants under 18 years of age, consent was obtained from parents or legal guardians. This study is a secondary analysis of the 2021–22 CDHS dataset. Access to the dataset was granted by the DHS Program upon formal request. The dataset is fully de-identified and publicly available therefore, additional ethical approval was not required for this secondary analysis. All data were used in accordance with DHS Program data use policies.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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The data used in this study are publicly available from the Demographic and Health Surveys (DHS) Program. The 2021–22 Cambodia Demographic and Health Survey (CDHS) dataset can be accessed upon reasonable request and approval from https://dhsprogram.com . The authors did not have any special access privileges to the data.

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