While child anemia remains an uncontrolled health issue in developing and underdeveloped countries, the public health burden of child anemia is high in Madagascar. Using cross-sectional data from Madagascar Demographic and Health Survey 2021 (Madagascar DHS 2021), this study aims to examine the prevalence and risk factors of child anemia by region and socioeconomic status in the country. A total of 5,048 children aged 6-59 months with hemoglobin (Hb) concentration data were used for the study. First, the associations between child anemia (Hb< 11.0g/dl) and the household, parental, and child characteristics were tested by univariate logistic regression analysis. Variables with a p-value <0.05 in the univariate were included in the multivariate regression analysis, and sub-group analysis was conducted for six provinces. A heatmap was provided to visualize the distribution of common risk factors for the child anemia across six provinces. The prevalence of child anemia was 47 %. Child anemia was negatively associated with older age, and positively associated with maternal anemia in a dose-response manner, maternal younger age (<25 years old), underweight (BMI<18.5), low education level, history of fever or diarrhea in the past two weeks and high birth order (5th or higher, compared to the 1st). There was a regional variation in anemia (3.8% to 56.3%) with a higher prevalence in the Southern provinces compared to Antananarivo province, the capital area. The age of the child and the maternal anemia status consistently determined child anemia status in all six provinces, with certain region-specific factors such as female child, poor wealth, maternal obesity, women’s empowerment, and iron supplementation. The prevalence of child anemia across Madagascar was found to be closely linked to both the age of the child and the maternal status, including health related, and socioeconomic conditions, which need to be more comprehensively examined. Further research is required to explore the pathways by which child anemia is related to maternal anemia and varies by regional location is required. Interventions targeting both anemic mother-child pairs, vulnerable populations, and young children are recommended to strengthen national nutrition programs in the country.