A structural equation modeling approach to examine determinants of nutritional status in Palestinian children 6–59 months

Abstract

Background Undernutrition remains a persistent public health concern among young children in Palestine, shaped by a range of socioeconomic and dietary factors. This study applies a Structural Equation Modeling (SEM) approach to explore both direct and indirect determinants of child growth among children aged 6–59 months in the West Bank. Methods Data were drawn from a 2022 cross-sectional survey involving 300 children selected from 1,400 households. Child growth was assessed using anthropometric indicators (HAZ, WAZ, MUAC) and dietary adequacy via the Mean Nutrient Inadequacy Ratio (MNIR). Latent constructs were developed for socioeconomic status, food insecurity, dietary intake (macro- and micronutrients), feeding practices, neonatal health, and food availability. SEM was used to examine interrelationships and the pathways influencing child nutritional status. Results Descriptive analysis showed substantial variation in undernutrition and nutrient intake across regions, family size, and parental education. SEM results showed that macronutrient intake had the strongest direct effect on child growth, followed by socioeconomic status and neonatal health. Infant feeding practices and micronutrient intake also contributed positively, though their effects were primarily indirect. Food availability acted as a significant mediator, linking structural access issues to poor dietary diversity and feeding behavior. The model demonstrated good fit across multiple indices. Conclusion Child nutrition in Palestine is shaped by interrelated determinants of dietary intake, caregiver practices, food access, and early-life health conditions. Effective interventions must target both nutritional quality and the broader social and environmental context to improve growth outcomes. SEM offers a powerful framework to understand these pathways and guide evidence-based policy design.