Documented Readmission for Undernutrition and Associated Factors Among Children Under Five Years of Age at a Rural District Hospital in South Africa

Background/Objectives: Undernutrition remains an important contributor to morbidity and mortality among children under five years of age, particularly in rural and low-resource settings. This study determined the proportion of children with documented readmission for undernutrition and identified associated factors at Bela-Bela District Hospital, Limpopo Province, South Africa. Methods: A retrospective analytical hospital record review covering January 2018 to December 2025 was conducted. Of 538 medical records identified, 94 were excluded, 444 remained eligible, and 222 were selected through systematic random sampling. Clinical, caregiver/household conditions, healthcare-related and post-discharge data were extracted. The primary outcome was documented readmission for undernutrition at Bela-Bela District Hospital following discharge. Multivariable logistic regression was used to identify independently associated factors. Results: Of 222 children, 54 (24.3%) had documented readmission. Previous admission for undernutrition was strongly associated with documented readmission (AOR = 4.12; 95% CI: 2.00–8.50; p < 0.001). Lack of documented caregiver nutrition education (AOR = 3.10; 95% CI: 1.40–6.90; p = 0.005), absence of a documented follow-up date (AOR = 2.20; 95% CI: 1.05–4.60; p = 0.036), and failure to attend follow-up according to schedule (AOR = 1.95; 95% CI: 1.05–3.60; p = 0.030) were also associated with documented readmission. Conclusions: Documented readmission was associated with previous admission for undernutrition and gaps in documented post-discharge care. These findings highlight the importance of strengthening post-discharge planning, documentation of caregiver nutrition education, documentation of follow-up appointments, and continuity of nutritional support.