Abstract: The current study investigated the prevalence and risk factors for poor nutritional status among children less than 36 months of age in the Kilimanjaro region of Tanzania. Using a cross sectional study design, children and their caregivers were recruited into the study. Anthropometric measures were taken based on established protocol while a standard questionnaire was utilized to collect socio-demographic data. A finger-prick blood sample was collected from all the children and haemoglobin (Hb) concentration analyzed using a HemoCue photometer (HemoCue AB, Angelholm, Sweden). Four hundred and twenty three (423) children (214 females) took part in this study. Participating children were aged between 1–35 months (mean = 13.04, SD = 7.70). We observed high rates of stunting (44.2%) and underweight (19.1%). Nearly 70% (n = 295) of the sample was anaemic (Hb < 11 g/dL). In a multivariate logistic regression model concerns on child growth, maternal education, and child’s age were found to independently predict stunting; whereas concerns over child’s growth and development, and distance to water source were found to uniquely predict being underweight. Maternal education was the only factor related to the child’s anaemia. The current study further emphasizes the need to implement OPEN ACCESS Int. J. Environ. Res. Public Health 2012, 9 3507 context relevant interventions to combat malnutrition in this region of Tanzania and other similar settings.