Undernutrition in children under five years of age is a critical public health issue, contributing significantly to morbidity and mortality in developing countries. This study aimed to determine the prevalence of undernutrition and its associated factors among children aged 6-59 months in the Ablekuma West District, Accra, Ghana. An institution-based descriptive cross-sectional study design was employed, involving 419 mother-child pairs. Data were collected using a structured questionnaire and anthropometric measurements, with analysis conducted through descriptive statistics, Chi-square tests, and logistic regression. The findings revealed a prevalence of 22% for stunting, 21% for wasting, and 21% for underweight among the children studied. These rates indicate a substantial burden of undernutrition within the district, aligning with broader trends in Sub-Saharan Africa. The high prevalence underscores the urgency for targeted nutritional interventions. The study identified significant associations between undernutrition and various maternal, childhood, and socio-demographic factors. Caregivers' knowledge about the causes of undernutrition was generally high, with 98.8% acknowledging the role of lack of access to nutritious food and 99.5% recognizing economic difficulties as contributory factors. Despite this awareness, there remains a gap between knowledge and practice, as evidenced by the persistent high rates of undernutrition. This gap highlights the need for effective strategies to translate knowledge into practice, ensuring that caregivers can implement proper feeding practices. Maternal factors such as education, age, and occupation were found to significantly influence the nutritional status of children. Children of mothers with lower educational levels, younger mothers, and those engaged in occupations limiting their caregiving ability were more likely to be undernourished. These findings emphasize the importance of maternal education and support systems in improving child nutrition. Childhood factors, including age, birth weight, and recent medical history, were also significantly associated with undernutrition. Preterm children and those with low birth weight were more prone to wasting and stunting. Additionally, recent episodes of malaria significantly increased the risk of stunting. These results indicate the necessity of addressing perinatal and postnatal health to prevent undernutrition and improve child health outcomes. The study recommends enhancing nutritional education, improving maternal support, addressing socioeconomic barriers, and implementing targeted health interventions. Formulating and implementing comprehensive nutritional policies at national and district levels is crucial. Future research should focus on longitudinal studies to understand the long-term impact of interventions and explore cultural influences on feeding practices. In conclusion, addressing undernutrition in the Ablekuma West District requires a multifaceted approach. By adopting the recommended strategies, it is possible to reduce the prevalence of undernutrition and improve the health and well-being of children in the district, contributing to the broader goal of achieving sustainable development and improving public health outcomes.