Armed conflict and nutritional vulnerability: A cross-sectional analysis of child wasting and stunting in conflict-affected regions of northern Ethiopia

Objectives: The 2020–2022 Tigray war in northern Ethiopia disrupted food systems, healthcare, and livelihoods, heightening child malnutrition risks. Limited post-conflict data exist on the prevalence of wasting and stunting. The objectives of the study are to assess the prevalence of wasting and stunting among children under five in selected zones of Tigray and identify sociodemographic and environmental risk factors. Material and Methods: We conducted a community-based cross-sectional study from March 1 to 31, 2025, in ten woredas across central and eastern Tigray. Using multistage probability proportional to size (PPS) cluster sampling, we enrolled 1,152 children aged 6–59 months (96% response rate). Anthropometric measurements followed the World Health Organization (WHO) protocols, including assessment for bilateral pitting edema; z-scores were calculated using WHO Anthro v3.2.2. Wasting was defined as weight-for-height z-score < −2 or edema and stunting as height-for-age z-score < −2. Covariates included displacement, household food insecurity access scale, maternal education, sanitation (Joint monitoring programme unimproved/limited), and immunization status. Survey-weighted prevalence estimates and multivariable logistic regression were computed in STATA v17 using svy commands. Results: Among 1,152 children (mean age 28.4 ± 14.2 months; 51% male), survey-weighted wasting prevalence was 25.8% (95% confidence interval [CI]: 23.1–28.5; severe: 7.9%) and stunting prevalence was 48.5% (95% CI: 45.5–51.5; severe: 20.7%). Displacement affected 45.1% (519/1,152) of households; severe food insecurity affected 65.0% (749/1,152). In multivariable analysis, displacement (adjusted odds ratios [aOR] 2.81, 95% CI: 2.03–3.89) and severe food insecurity (aOR 3.48, 95% CI: 2.58–4.70) were associated with wasting; low maternal education (aOR 2.15, 95% CI: 1.60–2.89) and no recent immunization (aOR 1.85, 95% CI: 1.36–2.51) were associated with stunting. Conclusion: Malnutrition prevalence in post-conflict Tigray remains at emergency levels, exceeding national averages. Findings support integrating nutrition screening into routine immunization services and targeting food and health assistance to displaced households.