Burden and trends of protein-energy malnutrition among children under 5 years in WHO South-East Asia Region Countries: an ecological study using the Global Burden of Disease data, 1990-2023.

Malnutrition in its various forms remains a serious public health concern worldwide. This ecological study, based on a secondary analysis of Global Burden of Disease (GBD) 2023 data, examines prevalence trends of protein-energy malnutrition (PEM) among children under 5 years of age in the WHO South-East Asia Region (SEAR) from 1990 to 2023. We utilised Joinpoint regression analysis to identify temporal shifts and calculated the average annual percentage change (AAPC) to summarise overall trends. Regional results show the number of prevalent cases declined from 32·4 million (95 % uncertainty intervals (UI): 32·2-32·7) in 1990 to 18·9 million (95 % UI: 18·7-19·1) in 2023. The prevalence rate per 100 000 population declined from 22 141 to 13 463 over the same period. India maintained the highest prevalence in 2023 at 14·8 % (95 % UI: 14·6-15·0). Joinpoint analysis indicated a significant overall reduction across all countries (p < 0·05), with the most substantial decline in the Democratic People's Republic of Korea (AAPC: -4·05 % (95 % CI -4·08 to -4·01)) and the most modest in Timor-Leste (AAPC: -0·66 % (95 % CI -0·67 to -0·65)). Sex-stratified analysis revealed higher prevalence rates in males than females across the study period. Age-specific findings identified children aged 6-23 months as the most vulnerable group. Furthermore, prevalence was negatively associated with the Socio-demographic Index (SDI), though country-specific trajectories remained heterogeneous. Despite progress, PEM remains a major public health burden in SEAR. These findings highlight the need for targeted, age-specific nutrition strategies and continued socio-economic investment to accelerate progress.