Background Undernutrition is an important public health indicator for monitoring nutritional status and survival. In spite of its importance, undernutrition is a significant problem health problem in many East African communities. The aim of this study was to identify factors associated with childhood undernutrition in three disadvantaged East African Districts. Methods We examined data for 9270 children aged 0–59 months using cross-sectional survey from Gicumbi District in Rwanda, Kitgum District in Uganda and Kilindi District in Tanzania. We considered the level of undernutrition (stunting, wasting and underweight) as the outcome variables with four ordinal categories (severely undernourished, moderately undernourished, mildly undernourished, and nourished). Generalized linear latent and mixed models (GLLAMM) with the mlogit link and binomial family that adjusted for clustering and sampling weights were used to identify factors associated with undernutrition among children aged 0–59 months in three disadvantaged East African Districts. Results After adjusting for potential confounding factors, the odds of a child being stunted were higher in Gicumbi District in Rwanda while the odds of a child being wasted and underweight were higher in Kitgum District in Uganda. Having diarrhoea two weeks prior to the survey was significantly associated with severe undernutrition. Wealth index (least poor household), increasing child’s age, sex of the child (male) and unavailability of water all year were reported to be associated with moderate or severe stunting/wasting. Children of women who did not attend monthly child growth monitoring sessions and children who had Acute Respiratory Infection (ARI) symptoms were significantly associated with moderate or severe underweight. Conclusions Findings from our study indicated that having diarrhoea, having ARI, not having water availability all year and not attending monthly child growth monitoring sessions were associated with undernutrition among children aged 0–59 months. Interventions aimed at improving undernutrition in these disadvantaged communities should target all children especially those children from households with poor sanitation practices. Electronic supplementary material The online version of this article (10.1186/s12887-019-1482-y) contains supplementary material, which is available to authorized users.

Background The high rate of avoidable child mortality in disadvantaged communities in Africa is an important health problem. This article examines factors associated with mortality in children <5 y of age in three disadvantaged East African districts. Methods Pooled cross-sectional data on 9270 live singleton births from rural districts in Rwanda (Gicumbi), Uganda (Kitgum) and Tanzania (Kilindi) were analysed using logistic regression generalized linear latent and mixed models to adjust for clustering and sampling weights. Mortality outcomes were neonatal (0–30 d), post-neonatal (1–11 months), infant (0–11 months), child (1–4 y) and under-5 y (0–4 y). Results The odds of post-neonatal and infant mortality were lower among children delivered by a health professional (adjusted odds ratio [AOR] 0.62 [95% confidence interval {CI} 0.47–0.81] for post-neonatal; AOR 0.60 [95% CI 0.46–0.79] for infant), mothers who had four or more antenatal care (ANC) visits during pregnancy (AOR 0.66 [95% CI 0.51–0.85]) and mothers who initiated breastfeeding within 1 h after birth (AOR 0.60 [95% CI 0.47–0.78]). Neonates not exclusively breastfed had higher mortality (AOR 3.88 [95% CI 1.58–9.52]). Children who lived >6 h away from the nearest health centre (6–23 h: AOR 1.66 [95% CI 1.4–2.0] and ≥24 h: AOR 1.43 [95% CI 1.26–1.72]) reported higher mortality rates in children <5 y of age. Conclusions Interventions for reducing deaths in children ≤5 y of age in disadvantaged East African communities should be strengthened to target communities >6 h away from health centres and mothers who received inadequate ANC visits during pregnancy.