BACKGROUND: Malnutrition is the global health issue, affecting many countries mostly developing countries. Risk factors for malnutrition differ geographically. It differs between countries and between regions of the same countries. OBJECTIVES: This study aimed to determine the prevalence, risk factors and care givers’ knowledge of malnutrition in children under five in Kilimanjaro region. METHODOLOGY: This was a cross-sectional study conducted from 24th May to 24th June 2016, involving malnourished children under the age of five years with their caregivers in three hospitals in Kilimanjaro region; Mawenzi Regional Hospital, Hai District Hospital and KCMC. Questionnaire was used to collect data via face to face interview followed by taking anthropometric measurements. Data was analyzed using Statistical Package for Social Science (SPSS) version 22. Continuous variables were summarized using mean and median with their respective measures of dispersion. Categorical data was summarized using percentages. Odds ratio was used to assess strength of association and a p-value of <0.05 was considered statistically significant. RESULTS: A total of 52 children were enrolled in the study. The prevalence of wasting, underweight and stunting was 34 (70.8%), 40 (83.3%) and 35 (72.9%) respectively. after controlling for confounders, no factors were found to be associated with wasting, underweight or stunting. Majority of the caregivers 24(46.2%) had an average knowledge of malnutrition. CONCLUSION AND RECOMMENDATION: Malnutrition exists in Kilimanjaro region and it is high. Most of caregivers lack knowledge on causes of malnutrition and how to prevent their children from malnutrition. Nutritional knowledge and awareness programs may play a role in combating malnutrition.