**Background:** Stunting (height-for-age Z-score ≤ -2) affects one in five children globally and is particularly prevalent in low-income countries (34.6%) and Africa (30.7% in 2020). In Angola, prior estimates suggested 37.7% prevalence but were not nationally representative. Stunting has lifelong consequences for cognition, health, and productivity, and is driven by multifactorial causes operating at proximal, intermediate, and distal levels. The Angola 2015–2016 DHS was the first nationally representative survey to collect child anthropometry, enabling this analysis.
**Methods:** This cross-sectional study used data from the Angola 2015–2016 DHS, a population-based, nationally representative survey of 16,244 households across all 18 provinces. Sampling was multi-stage, stratified, and clustered. Anthropometric data were available for 6,359 children (weighted n = 5,905). Stunting was defined as HAZ ≤ -2 SD below the WHO 2006 median. Exposures included child characteristics (sex, age, birth order, birthweight, diarrhea), maternal/paternal characteristics (age, education, reproductive health), household infrastructure (water source, sanitation, flooring, refrigerator, electricity), and socioeconomic/geographic variables (wealth index, urban/rural, province). Prevalence ratios (PR) were estimated using Poisson regression with sampling weights. Three hierarchical multivariable models were built: Model 1 (distal/non-modifiable), Model 2 (intermediate), and Model 3 (proximal/modifiable). Stratified analysis by child age-group (0–5, 6–23, ≥24 months) and multilevel mixed-effects models were also performed.
**Key Results:** Overall stunting prevalence was 37.4% (95% CI: 35.3%–39.6%). In the fully adjusted model (Model 3), significant associations included: male sex (aPR = 1.21; 95% CI: 1.12–1.30; p<0.001); child age 12–23 months (aPR = 2.14; 95% CI: 1.82–2.53; p<0.001) and 24–35 months (aPR = 2.46; 95% CI: 1.99–3.04; p<0.001); birth order fifth or above (aPR = 1.36; 95% CI: 1.11–1.68; p=0.004); low birthweight <2,500 g (aPR = 1.35; 95% CI: 1.13–1.60; p=0.001); recent diarrhea (aPR = 1.24; 95% CI: 1.11–1.37; p<0.001); maternal age 15–19 years (aPR = 1.38; 95% CI: 1.08–1.75; p=0.009); maternal secondary education (aPR = 0.80; 95% CI: 0.67–0.95; p=0.011) and higher education (aPR = 0.36; 95% CI: 0.19–0.68; p=0.002); paternal higher education (aPR = 0.61; 95% CI: 0.39–0.97; p=0.036); water from fountain/well (aPR = 1.30; 95% CI: 1.07–1.57; p=0.008) or spring/surface/rain (aPR = 1.30; 95% CI: 1.06–1.60; p=0.012); open-pit sanitation (aPR = 1.22; 95% CI: 1.06–1.40; p=0.005); and no refrigerator (aPR = 1.47; 95% CI: 1.19–1.83; p<0.001). Wealth index and urban/rural residence were not associated after full adjustment. Provincial-level variation persisted, with Cabinda (aPR = 0.57; 95% CI: 0.43–0.76; p<0.001) and Zaire (aPR = 0.63; 95% CI: 0.47–0.84; p=0.002) showing lower risk relative to Luanda. Stratified analysis revealed effect modification by age: low birthweight had a stronger effect in infants 0–5 months (aPR = 3.54; 95% CI: 1.93–6.49; p<0.001), while maternal age <20 years was only significant for children ≥24 months (aPR = 2.11; 95% CI: 1.56–2.86; p<0.001). Multilevel mixed-effects models yielded similar results.
**Clinical Implications:** Stunting affects over one-third of Angolan children under five. Interventions should target multiple levels: delaying childbearing, reducing high parity, improving maternal education (especially secondary and higher), preventing low birthweight, managing diarrhea, ensuring clean water and safe sanitation, and promoting food preservation (refrigeration). The rapid increase in stunting during the first two years of life underscores the need for early-life interventions. Provincial-level variation suggests that context-specific strategies may be needed. Limitations include potential survival bias (under-five mortality rate 75/1,000 child-years), residual confounding (especially lack of maternal height data), and the cross-sectional design precluding causal inference.