Child sensitive WASH composite score and children nutritional status in an urban-rural setting in the DRC: the case of Mont Ngafula II health zone

Background Limited access to safe drinking water, adequate sanitation, and appropriate hygiene practices (WASH) remains a key determinant of child malnutrition in the Democratic Republic of Congo (DRC). This study assessed the association between a child-sensitive composite WASH score and wasting among children aged 6–59 months in Mont Ngafula II, DRC. Methods A community-based cross-sectional survey was conducted among 415 households. Children aged 6–59 months were a target population. A child-sensitive WASH composite score (0 11), constructed from 11 indicators, was developed to assess household WASH conditions. Receiver Operating Characteristic (ROC) analysis (AUC=0.62) determined a cut-off (≥6 = improved). Logistic regression model was used to examine associations between WASH practices and wasting (weight-for-height < -2 zscore). A sensitivity analysis treated the WASH score as a continuous variable. Results Wasting prevalence was 11.6% (95% CI: 8.6-14.6). Children in unimproved WASH score had higher odds of wasting (AOR=2.01; 95% CI: 1.08-3.75). Sensitive analysis showed that children in good status had, on average, higher WASH score (β=0.175; 95% CI: 0.119-0.320). Conclusions Poor sanitation and hygiene practices were significantly associated with wasting. Although the predictive performance of the composite score was modest, it provides a useful operational indicator for identifying at risk households. Integrated WASH and nutrition strategies are needed to reduce wasting in peri-urban settings.