Childhood malnutrition is known as a public health concern globally. The present study aims to assess the anthropometry and blood biochemical status of rural primary school children in Malaysia. A total of 776 children (7-11 years old) from 10 rural primary schools from 5 states were included in this study. Nutritional outcomes were assessed based on gender, age group and school categories among the children (median age: 9 years [P25:8, P75:10]). The overall prevalence of malnutrition was 53.4%. Vitamin A deficiency (VAD) was recorded at 20.6% and 39.8% based on retinol and retinol-binding protein (RBP) levels, respectively. Anaemia, iron deficiency (ID), iron-deficiency anaemia (IDA) and elevated inflammation were found at 14.9%, 17.9%, 9.1% and 11.5%, respectively. Malnutrition, VAD, anaemia, ID, IDA, and elevated inflammation were more prevalent among Orang Asli (OA) school children compared to Non-Orang Asli (NOA) school children. Higher occurrence of VAD and anaemia were also found among children aged <10 years. Retinol, RBP, alpha-carotene, ferritin, and haemoglobin levels were lower among undernourished children. Besides, overweight/obese children exhibited a higher level of high-sensitivity C-reactive protein. Multivariate analysis demonstrated that children from OA schools (AOR:6.1; 95% CI: 4.1-9.0) and iron-deficiency anaemia (AOR:3.6; 95% CI:1.9-6.6) were associated to stunting among this population. The present study revealed that malnutrition, micronutrient deficiencies, and anaemia are prevalent among rural primary school children in Malaysia, especially those from OA schools and younger age children (<10 years). Hence, more appropriate and targeted measures are needed to improve the nutritional status of these children.

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