ArticleBMJ global health2026
Trajectories of child undernutrition in Ethiopia: a multivariate GEE approach.
Article in BMJ global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectivesChild undernutrition remains a significant public health issue in Ethiopia despite Millennium Development Goal efforts. Most prior Ethiopian studies have relied on cross-sectional designs or have modelled underweight, stunting and wasting as separate independent outcomes, limiting insight into their longitudinal interplay. This study employs a multivariate longitudinal framework to jointly examine trajectories, co-occurrence and shared determinants of all three anthropometric outcomes from infancy through adolescence.
methodsWe utilised the Young Lives Cohort Survey (YLCS), collecting data from ~1997 Ethiopian children across five time points (2002-2016). A multivariate generalised estimating equations (GEE) model with a logit link function and exchangeable working correlation structure assessed associations between covariates and three undernutrition outcomes (underweight, stunting and wasting) defined by WHO z-scores (<-2 SD=undernutrition; ≥-2 SD=normal). Covariate effects were estimated with ORs and 95% CIs.
resultsUndernutrition prevalence varied over time: underweight peaked at 52.1% at age 12, stunting was highest at 42.5% at age 1 (persisting at 25.6% by age 15), and wasting reached 41.2% at age 12. Overall, 37.2% of measurements showed underweight, 30.2% stunting and 24.7% wasting. The GEE model showed that higher wealth was associated with lower odds of underweight (OR=0.05, 95% CI: 0.02 to 0.11), stunting (OR=0.20, 95% CI 0.10 to 0.38) and wasting (OR=0.17, 95% CI 0.07 to 0.41). Females had lower odds (eg, underweight OR=0.61, 95% CI 0.53 to 0.70), while lack of safe water was associated with higher wasting odds (OR=1.40, 95% CI 1.16 to 1.69). Wasting odds surged by age 12 (OR=3.65, 95% CI 3.19 to 4.19).
conclusionUndernutrition burden shifted across childhood, with stunting predominating in early years, underweight peaking in preadolescence and wasting escalating in later childhood. Wealth-targeted economic support programmes, poverty reduction strategies and improved water purification may help to address these disparities.
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