Coexisting burden of maternal and child undernutrition in Ethiopia: a systematic review and meta-analysis.

Coexisting burden of maternal and child undernutrition in Ethiopia: a systematic review and meta-analysis - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Syst Rev . 2026 Mar 7;15:135. doi: 10.1186/s13643-026-03131-y Search in PMC Search in PubMed View in NLM Catalog Add to search Coexisting burden of maternal and child undernutrition in Ethiopia: a systematic review and meta-analysis Getasew Daru Tariku Getasew Daru Tariku 1 Department of Rural Development and Agricultural Extension, College of Agriculture and Natural Resources, Mekdela Amba University, P.O. Box 32, Gimba, Ethiopia Find articles by Getasew Daru Tariku 1, ✉ , Senkie Alemu Kebede Senkie Alemu Kebede 1 Department of Rural Development and Agricultural Extension, College of Agriculture and Natural Resources, Mekdela Amba University, P.O. Box 32, Gimba, Ethiopia Find articles by Senkie Alemu Kebede 1 , Tadsual Asfaw Dessie Tadsual Asfaw Dessie 1 Department of Rural Development and Agricultural Extension, College of Agriculture and Natural Resources, Mekdela Amba University, P.O. Box 32, Gimba, Ethiopia Find articles by Tadsual Asfaw Dessie 1 , Abebaw Abebe Getahun Abebaw Abebe Getahun 1 Department of Rural Development and Agricultural Extension, College of Agriculture and Natural Resources, Mekdela Amba University, P.O. Box 32, Gimba, Ethiopia 2 College of Economics and Management, Northwest A & F University, Yangling, China Find articles by Abebaw Abebe Getahun 1, 2 Author information Article notes Copyright and License information 1 Department of Rural Development and Agricultural Extension, College of Agriculture and Natural Resources, Mekdela Amba University, P.O. Box 32, Gimba, Ethiopia 2 College of Economics and Management, Northwest A & F University, Yangling, China ✉ Corresponding author. Received 2025 Jun 10; Accepted 2026 Feb 15; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13081260  PMID: 41794724 Abstract Background Maternal and child undernutrition is one of the contemporary pervasive and pressing public health crises in developing country, like Ethiopia. It perpetuates a devastating intergenerational cycle that adversely impacts health, cognitive development, and socioeconomic well-being. Methods This systematic review analyzed maternal and child undernutrition in Ethiopia from 2015 to 2025. Studies were identified through PubMed, Scopus, Web of Science, and Google Scholar using predefined inclusion criteria. Methodological quality was assessed using the Newcastle–Ottawa Scale, and a random-effects meta-analysis was conducted to estimate prevalence and regional variations. Results According to meta-analysis result, maternal undernutrition was 29%, which exceeding national estimates. Among children under-five, stunting stands at 35%, wasting at 14%, and underweight at 24%, with marked disparities across regions. Subgroup analysis identified Tigray, Afar, Amhara, and Somali regions had the highest under-five undernutrition. Stunting was highest in Tigray (40%) and Amhara (38%), wasting in Somali (21%) and Afar (18%), and underweight in Afar (34%) and Tigray (30%). The review categorizes the most key drivers of undernutrition, including inadequate dietary intake, recurrent infections, food insecurity, suboptimal child feeding practices, and insufficient access to healthcare services, further exacerbated by poverty, low maternal education, and inadequate water, sanitation, and hygiene (WASH) conditions. Conclusions Multiple interconnected factors contribute to the high prevalences of maternal and child undernutrition in Ethiopia. This urgently calls for comprehensive, multi-sectorial intervention of undernutrition. Addressing these challenges is imperative to achieve Ethiopia’s progress toward its national health and national development goals. Keywords: Maternal, Child, Undernutrition, Stunting, Wasting, Underweight, Ethiopia Introduction Malnutrition is one of the complex global public health problems particularly prevalent in low‐and middle‐income countries [ 10 , 101 ]. Malnutrition refers to any discrepancy from the optimum body needs (it can be undernutrition or overnutrition). It can happen due to unbalanced, inadequate, or excessive intake of nutrients [ 103 ]. Undernutrition is a form of malnutrition occurred because of lack of appropriate nutrition, which is necessary for growth and health [ 112 ]. It is manifested in the form of wasting, stunting, and underweight [ 9 , 93 ]. In 2024, an estimated 150.2 million children under five (23.2%) were affected by stunting, and 42.8 million children (6.6%) were suffering from wasting globally [ 113 ]. Asia and Africa account for more than 90% children suffering from wasting and stunting, with Southern Asia alone contributing the largest share [ 113 ]. Nearly half of all deaths in children under five are attributable to undernutrition [ 113 ]. In addition, more than one billion adolescent girls and women globally suffer from undernutrition and micronutrient deficiencies, weakening immunity and increasing pregnancy risks [ 114 ]. Particularly in most food-insecure African countries, maternal malnutrition is a serious issue, with pregnant and breastfeeding women facing severe nutritional challenges due to inadequate access to food and healthcare [ 44 , 46 ]. Maternal and child undernutrition are intimately linked, perpetuating a detrimental cycle that undermines health, impairs physical and cognitive development, and diminishes socioeconomic potential for successive generations [ 60 , 115 ]. Children under five are more vulnerable to malnutrition than any other age group, and their nutritional status is a key determinant of their overall health [ 11 , 15 , 57 , 83 , 116 ]. The issue of undernutrition is a critical public health crisis in Sub‑Saharan Africa, with children facing prevalent stunting and wasting [ 6 , 45 ]. Particularly, in Ethiopia, 37%, 7%, and 21% of children under five were affected by stunting, wasting, and underweight respectively, at the national level, with notable regional differences [ 27 , 37 ]. Child undernutrition is the cause of several complications including increased morbidity, mortality risk, impaired cognitive development, reduced school performance, and decreased productivity in adult hood [ 65 , 75 , 105 , 106 ]. Maternal and childhood undernutrition is a persistent global health crisis that has drawn decades of research attention and remains a priority for international public health agendas [ 8 , 25 , 35 , 89 , 91 , 99 ]. Various stakeholders have implemented strategies to reduce child undernutrition worldwide [ 62 , 68 ]. Understanding the prevalence and key determinants of undernutrition among mothers and children is crucial to guide effective interventions, particularly in developing countries such as Ethiopia [ 43 , 63 , 98 , 102 ]. Various studies conducted across different regions of Ethiopia have identified key factors contributing to child wasting, stunting, and underweight including maternal education and employment [ 40 ], maternal nutritional status [ 67 ], age at first childbirth, birth spacing, place of delivery, household economic condition, residential location, the child's gender [ 120 ], number of children in the household [ 124 , 125 ], and access to clean water [ 47 ]. The prevalence of maternal and child undernutrition remains persistently high at the national level [ 93 , 96 ] and there are wide regional differences in maternal and child under nutrition [ 56 ],Ethiopian Public Health [ 64 , 70 , 79 ]. However, previous studies are often fragmented, region-specific, and focused on particular aspects of undernutrition, offering limited insight into the complex relationship between maternal and child nutritional status. This systematic review and meta-analysis aim to fill this scientific gap by conducting an integrated analysis that captures updated prevalence rates, regional disparities, and the interrelated factors influencing both maternal and child undernutrition. Such a comprehensive approach is crucial for developing targeted interventions and evidence-based policies to address the root causes and break the intergenerational cycle of malnutrition in Ethiopia. Methodology Search Strategy A systematic literature search was conducted to identify empirical studies on maternal and child undernutrition and its disparities across regions of Ethiopia, that covering the publications from January 2015 to March 2025. To collect relevant evidence, all reviewers were transparently searched four major databases including, PubMed, Scopus, Web of Science, and Google Scholar. The structured search strategies were developed using Boolean operators (AND, OR) to combine relevant terms, including "maternal undernutrition", "maternal malnutrition", "child undernutrition", "child malnutrition", stunting, wasting, underweight, "under-five children", "malnutrition prevalence", "child undernutrition prevalence", "undernutrition determinants in Ethiopia", and regional terms "Amhara", "Oromia", "Afar", "Tigray", "Somali", and "Southern". The search strategies were adapted for each database, using MeSH terms in PubMed, TITLE-ABS-KEY in Scopus, TS = in Web of Science, and exact phrase searches in Google Scholar (see Supplementary Table 1 for full search strings). After all search results were exported, the selection of included studies performed by following guidelines of PRISMA 2020 to ensure transparency and reproducibility (Fig. 1 ). Fig. 1. Open in a new tab Stages of the PRISMA protocol used to display the overall searching and screening process of this review Literature inclusion and exclusion criteria This systematic review employed eligibility criteria to identify relevant publications examining the prevalence and associated factors of undernutrition among mothers and children under five in Ethiopia. The selection criteria were designed to ensure methodological rigor while capturing the most relevant evidence, and included the following parameters: Inclusion Criteria Publication Date: studies published between 2015 and 2025 were only included to reflects up-to-date information about child undernutrition Study Area: Only studies conducted in Ethiopia or comprising Ethiopia were included to keep a specific geographical scope. Publication Language: Publications only written in English were selected Publication Topics: Publications focusing on maternal and child undernutrition (stunting, wasting, underweight) were included to align with the review's aim. Availability of papers: Only studies with accessible full texts were included; attempts were made to obtain unavailable articles by contacting authors and searching online and institutional repositories before exclusion. Study quality and nature: Study quality was evaluated using the Newcastle–Ottawa Scale (NOS), and studies with scoring ≥ 5 out of 9 NOS criteria were included. Exclusion Criteria Studies were excluded if they met any of the following conditions: Non-primary studies: Reviews, meta-analyses, systematic reviews, or another secondary research. Qualitative studies: Studies reporting without quantitative measures of undernutrition. Incomplete Studies: Studies without full text or insufficient data for extraction. Low-quality methodology: Studies with unclear sampling methods, incomplete reporting of outcomes, or inadequate statistical analysis and also studies scoring < 5/9 based on NOS quality appraisal were considered poor quality and excluded. Editorials, commentaries, letters, or conference abstracts lacking full data Study screening process To select relevant literatures all identified publications were cautiously checked and duplicates were removed. The two independent reviewers screened the titles and abstracts against the predefined inclusion and exclusion criteria. The discrepancies between reviewers were resolved through discussion. The full texts of potentially eligible studies were retrieved and independently assessed by the same reviewers for final inclusion. The study selection process is summarized in the PRISMA flow diagram (Fig. 1 ). Data Extraction The data were extracted using a standardized data extraction form. Two reviewers independently extracted data from all included studies to minimize bias. The discrepancies between reviewers were resolved through discussion and consensus, and when necessary, a third reviewer was consulted to solve the divergence. For this review the extracted variables included author name, year of publication, study design, study setting, sample size, study population, prevalence estimates of maternal and child undernutrition, and reported associated factors. Data Analysis For synthesizing the evidence, the review employed meta-analyses using Stata version 15. The random-effects model was used to estimates the pooled prevalence of maternal undernutrition and child undernutrition indicators (stunting, wasting, and underweight) and accounting for between-study variability. Prevalence estimates were reported with corresponding 95% confidence intervals (CIs) and presented using forest plots. Statistical heterogeneity among studies was assessed using the Cochran Q test (with a p-value < 0.05 indicating significant heterogeneity) and quantified using the I 2 statistic. I 2 values of approximately 25%, 50%, and 75% were considered to indicate low, moderate, and high heterogeneity, respectively. Subgroup analyses were performed based on geographical regions of Ethiopia to explore potential sources of heterogeneity in prevalence estimates. For regions with three or fewer studies, heterogeneity statistics were not calculated due to insufficient degrees of freedom. Moreover, the factors driving maternal and child undernutrition of children were organized into overarching categories using the preselected 2020 UNICEF conceptual framework on maternal and child nutrition [ 112 ]. Results Study Selection and Characteristics The literature search identified 2,324 records on maternal and under-five child undernutrition in Ethiopia. After removing 1,598 duplicates, 726 records were screened by title and abstract, narrowing to 173 based on study area and publication year. Of these, 69 full-text articles were assessed, and 58 studies met the inclusion criteria for the final systematic review and meta-analysis. Screening was conducted independently by two reviewers, with disagreements resolved through discussion or consultation with a third reviewer. The study selection process is summarized in the PRISMA flow diagram (Fig. 1 ). Quality Assessment of Included Studies The methodological quality assessment of included studies (n = 58) demonstrates substantial variability in research rigor (Table 1 ). The quality of included studies were assessed and categorized as high, medium, or low based on study design, sample size, outcome measurement, statistical analysis, and completeness of reporting. From the total studies, 20 studies were rated as high quality, characterized by robust study designs, representative sampling, validated outcome measures, appropriate statistical analyses, and complete reporting of results. The other 28 studies were rated as medium quality, showing adequate design but with some slight limitations such as smaller samples, minor gaps in measurement and way of reporting. Whereas 10 studies were rated as low quality, often descriptive in nature with incomplete data and inadequate measurements that imply potential for bias. Overall, the majority of studies were moderate to high quality, indicating generally reliable evidence for the prevalence and determinants of maternal and child undernutrition. Table 1. Risk of Bias / Quality Assessment of Included Studies (n = 58) Quality Level Frequency (n) Percentage (%) Typical Characteristics High 20 34.5% Robust study design (representative sampling, adequate sample size), validated outcome measurements, appropriate and transparent statistical analyses, complete reporting of key results, clear description of associated factors Medium 28 48.3% Adequate study design with slight limitations (smaller sample, minor gaps in outcome measurement or reporting), statistical analysis mostly appropriate, some missing details in methodology or results, moderate risk of bias Low 10 17.2% Descriptive or cross-sectional design with major limitations, incomplete or missing outcome data, inadequate measurements, inappropriate statistical analyses, high potential for bias Total 58 100% – Open in a new tab Results of Extracted Data on Maternal and Child Undernutrition in Ethiopia The synthesized result extracted from the included studies are presented in (Table 2 ) and (Table 3 ). The prevalence of maternal undernutrition across different regions of Ethiopia, along with the associated factors identified in each study (Table 2 ). The evidence shows that the prevalence of maternal undernutrition varied substantially across studies, ranging from 15.2% to 43.8%. This result reflecting considerable regional and contextual differences on maternal undernutrition in Ethiopia. Multiple included studies identified low dietary diversity, household food insecurity, low socioeconomic status, limited antenatal care utilization, substance use, and inadequate nutrition counseling as a commonly determinate factors associated with maternal undernutrition. Table 2. Extracted result that shows prevalence maternal undernutrition and associated factors Author (Year) Study Region in Ethiopia Sample size of study Prevalence of maternal Undernutrition Key drivers of maternal undernutrition Gebremichael et al. [ 48 ] Eastern (Kersa & Haramaya) 1015 43.8% Early marriage, no Antenatal Care (ANC) follow-up, inadequate dietary diversity, substance use, history of mental illness, common mental disorders Demisew et al. [ 33 ] North Shewa (Minjar Shenkora) 334 22.2% Low income, low education, poor nutritional attitude, inadequate dietary diversity Bekele et al. [ 21 ] Oromia Ethiopia 545 17.7% Dietary diversity, low monthly income, lack of extra meals, home delivery, household food insecurity Fekadu et al. [ 39 ] Chiro District, Eastern Ethiopia 629 26.9% Female-headed household, medium/rich wealth quintiles, lack of dietary advice, khat chewing, low dietary diversity, household food insecurity Wubetie & Mekonen [ 122 ] Northwest Ethiopia 428 22.6% Household income, food security, dietary diversity, meal frequency, lack of access to clean water, latrine access Hechera & Dona [ 59 ] Sidama Region 612 25.9% Polygamy, small household size, recent abortion, low wealth status Derseh et al. [ 34 ] Northwest Ethiopia 733 21.8% Unmarried status, early pregnancy (< 18yrs), high parity (> 5), poor dietary diversity, food insecurity Tafara et al. [ 104 ] Western Ethiopia 780 39.2% Low dietary diversity, mildly food insecure household, food insecure household Gebre et al. [ 46 ] Oromia Ethiopia 900 24% No Antenatal Care attendance, Pastoralist occupation Families receiving TSF Aychiluhm et al. [ 19 ] Afar Region Ethiopia 387 30.9% Illiteracy, Rural residence, Substance use during pregnancy, No balanced diet counseling, Chronic medical problems, Not taking extra meals and Food restrictions Muze et al. [ 84 ] Silte Zone, Ethiopia 422 21.8% Age, Birth intervals > 2, Good nutritional knowledge (protective, No dietary change due to pregnancy Abera et al. [ 4 ] Eastern Tigray 2,260 38.0% Household morbidity, Adult chronic disease mortality, Diverse food production Good health-seeking Berihun et al. [ 24 ] Northwest Ethiopia 668 25.4% Age at first pregnancy, Home delivery, No nutrition education Family size Gelebo et al. [ 51 ] Konso, Southern Ethiopia 501 43.1% Food insecurity, Low dietary diversity, No latrine, Male-dominated decision-making, Cultural food restrictions Fite et al. [ 42 ] Haramaya (Eastern Ethiopia) 448 15.2% Khat chewing, Food restrictions, Husband's education Belew et al. [ 22 ] North Gondar Ethiopia 1,560 34.3% Mother’s age, Family size Gizachew et al. [ 55 ] Siraro District, Southern Ethiopia 390 - Lack of Antenatal Care visits, Latrine availability, Poor food consumption score, Inadequate dietary diversity, Poor wealth index Chea et al. [ 28 ] Southern Ethiopia 550 38% Previous pregnancy, History of miscarriage, Food taboos, No nutritional counseling Ayele et al. [ 20 ] Tigray Region 840 40.6% Agricultural occupation, Coffee intake during pregnancy, Hemoglobin Mulaw et al. [ 82 ] Abala district, Afar Region 366 32.8% Inadequate dietary diversity Open in a new tab Table 3. Extracted result that shows Prevalence of Stunting, Wasting, Underweight and associated factors among under-five children Author name & publication Year Study area Data Collection Season Participants age and number Prevalence of Stunting Prevalence of Wasting Prevalence of Underweight Driving factors of undernutrition Lee et al. [ 71 ] Somali Region May–July 2018 Under 5 years (116) 11.21% 23.28% 23.28% Maternal self-employment, low dietary diversity, open defecation, Gebreayohanes & Dessie [ 47 ] Afar Region January 2018 6–59 months (554) 39.5% Not reported Not reported Delayed breastfeeding initiation, lack of exclusive breastfeeding, poor diet and water sources Gebru et al. [ 49 ] Tigray region not specified under 5 year (n = 394) Not reported 7.2% Not reported Family not living together, poor family planning Kebede & Aynalem [ 69 ] Somali Region January–June 2016 Under 5 years (1339) 27.4% 22.7% 28.7% Child age, multiple births, anemia, small birth size, maternal underweight, unimproved water Maalin et al. [ 72 ] Somali Region Feb–Mar 2014 6–59 months (694) 33.4% 20% 24.5% Family size, child’s sex, income, maternal education, breastfeeding duration Bogale et al. [ 26 ] Southern Ethiopia Mar–Apr 2019 6–59 months (654) 47.9% Not reported Not reported Exclusive breastfeeding, maternal decision-making, autonomy, freedom of mobility Yigezu et al. [ 124 , 125 ] South region June 2020 6–59 months (386) 49% 10% 19.7% Dietary diversity, meal frequency, family size, maternal BMI status Dake et al. [ 30 ] South Ethiopia Not specified 6–59 months (342) 24.9% Not reported Not reported Sex, age, non-use of family planning, diarrhea, low income Abeway et al. [ 5 ] Amhara region February–March 2017 6–59 months (410) 52.4% (18% severe) Not reported Not reported Age, low birth weight, lack of maternal ANC visits, mistimed feeding, low maternal education Moges et al. [ 80 ] South region April 2013 6–59 months (734) 35.4% Not reported Not reported Child’s age, low maternal education, low income, small birth size, lack of cup feeding Abera et al. [ 3 ] South Ethiopia Not specified 6–59 months (398) 41.7% Not reported Not reported Female sex, high birth order, low maternal education, lack of toilet facilities, poor handwashing Yisak et al. [ 127 ] Amhara region 2019 (cross-sectional) 6–12 years (314) 11% 6.3% 11.4% Rare breakfast consumption, lack of milk/milk products Woldeamanuel & Tesfaye [ 118 , 119 ] Tigray Region 2016 (EDHS data) Under-5 children (370) 30.8 17.3% 25.4% Household size, parental education, sanitation, child and maternal health Wasihun et al. [ 117 ] Tigray Region, August 2017 6–59 months (610) 36.1% 7.9% 37% Child age, small family size Tamiru et al. [ 107 ] Tigray Region Not specified 6–59 months (219) 57.1% 17.8% 37.4% Family size, low income, Low education, poor family planning Nigusu et al. [ 87 ] Oromia Region Not specified Children 6–59 (n = 997) 43.4% 14.8% 27.1% Breastfeeding, sex difference, safe water access Shifera et al. [ 100 ] Oromia Region July 2021 under 5 children (n = 422) Not reported 15.6% Not reported No antenatal care visits, maternal decision-making autonomy, poor feeding Roba et al. [ 94 ] Oromia Region Not specified under 5 children (1091) 5.8% 16.8% 53.9% Age, gender, water treatment and parents education Yeshaneh et al. [ 123 ] South region Not specified 6–59 months (n = 293) Not reported 14.7% Not reported Child age, caregiver illiteracy, poor maternal handwashing practices Tebeje et al. [ 108 ] Amhara region Jan–Apr 2020 under 5 children (364) 43.13% 35.44% 40.93% Child age, maternal knowledge, large family size, unprotected drinking water Tufa et al. [ 111 ] South region Not specified Children 6–59 months (375) Not reported 11.1% 14.0% Male gender, Recent diarrheal morbidity, Early complementary feeding, maternal illiteracy Gelu et al. [ 52 ] Amhara region 3–28 May 2017 6–59 months (593) 42.3% 7.3% Not reported Poor wealth status, child age, paternal control over resources, maternal lack of education Afework et al. [ 7 ] Oromia region Not specified Under-five (n = 767) 31.8% Not reported Not reported female sex (unvaccinated, poor wealth status, severe food insecurity Nigatu et al. [ 86 ] Amhara region January–February 2017 6–59 months (n = 645) Not reported Not reported 19.5% Rural residence, no ANC follow-up, maternal age Anato [ 15 ] Amhara region February–March 2020 6–59 months (384) Not reported 26% Not reported Large family size, younger age, recent diarrhea, household food insecurity Motbainor & Taye [ 81 ] Amhara region June–August 2017 6–59 months (876) Not reported 7.1% Not reported Low maternal decision-making power, maternal illiteracy, low income, recent diarrhea, early complementary feeding Getu et al. [ 53 ] Amhara region 2019 6–59 months (436) Not reported 6.2% Not reported Younger child age, poor household wealth, young maternal age Amare et al. [ 13 ] Amhara region 2016 Under-five (342) 24.9% 11.1% 14.3% Male sex, low maternal education, low income, preterm birth, lack of ANC Tilahun et al. [ 110 ] Oromia region August–September 2022 6–59 months (n = 422) Not reported 16.4% Not reported Maternal illiteracy, lack of latrine, food insecurity, lack of dietary diversity, no home visits Ararsa et al. [ 16 ] Oromia Region, February 2022 6–23 months (n = 580) 32.1% 7% 9% Male sex, lack of improved water, bottle-feeding, low knowledge, lack of improved water Yisak et al. [ 126 ] Oromia region Dec 2012-Jan 2013 6-59mo (791) 45.8% 10.7% 21% Rural residence, high birth order, diarrhea, maternal undernutrition, lack of ANC Asfaw et al. [ 17 ] Oromia region Not specified 6–59 months (796 children) 47.6% 13.4% 29.2% Diarrhea, male sex, pre-lacteal feeding, age, complementary feeding, no family planning Menalu et al. [ 77 ] Amhara region Oct 07, 2019 – Jan 24, 2020 Under-five (385 children) 41% 33% 26% Maternal illiteracy, inadequate breastfeeding, infectious diseases, diarrhea Darsene et al. [ 31 ] South region Not specified 6–59 months (811 children) 39.3% 6.3% 15.8% Male sex, mother age, low complementary feeding, Low maternal education, large family Sewenet et al. [ 97 ] Amhara region October, 2021 6–23 months (421) 36.8% 11.5% 27.6% Child sex, poor handwashing, poor family planning use Mekonen et al. [ 76 ] Oromia region Not specified Under five children (616) 44.4% Not reported Not reported Mother's education, number of under-five children, husband-decision, delayed complementary Fentahun et al. [ 41 ] Amhara region April–May 2014 6–59 months (633) 57.7% 16% Not reported Early maternal birth, improper feeding, Mengesha &Haile [ 78 ] Afar Region 2016 Under 5 years (937) 41.1% 17.7% 36.2% Age of child, wealth index, size at birth, number of living children, place of residence Open in a new tab The result in Table 3 presents the prevalence of stunting, wasting, and underweight among under-five children in Ethiopia, together with the associated factors reported by the included studies. The prevalence of child undernutrition indicators showed marked variation across study settings and populations. Stunting prevalence ranged from low to very high levels across regions, while wasting and underweight were also widely reported, indicating persistent nutritional challenges among young children. Frequently identified factors associated with child undernutrition included poor dietary diversity, inadequate infant and young child feeding practices, low maternal education, household poverty, food insecurity, poor sanitation and water access, limited maternal health service utilization, and childhood morbidity. The result revels a substantial heterogeneity in the prevalence and determinants of maternal and child undernutrition across Ethiopia, underscoring the influence of socioeconomic, environmental, and health-related factors. Number of included studies across region and publication years As presented in Fig. 2 the distribution of studies examining the prevalence of maternal and under-five child undernutrition in Ethiopia between 2015 and 2025 shows variable publication trends. Among the selected studies, the highest number of publications occurred in 2022 (12 studies), followed by 2018 and 2023 (7 studies each), and 2020–2021 (6 studies annually). In contrast, 2025 had the fewest publications. These findings suggest that research output on maternal and child undernutrition prevalence did not follow a consistent upward or downward trend, but rather fluctuated across the study period. Fig. 2. Open in a new tab Number of publications on the prevalence maternal and under-five children undernutrition (2015–2025) The result revealed in Fig. 3 , depict the distribution of included publications varied across Ethiopian regions. The highest number of studies originated from the Amhara region (18 studies), followed by the Oromia region (13 studies), South region (12 studies) and Tigray region (7 studies). In contrast, the fewest publications came from the Somali region (3 studies) and Afar (5 studies) regions. These findings suggest significant regional disparities in research representation, which may limit the generalizability of the review's conclusions, particularly for understudied regions. Fig. 3. Open in a new tab The number of included publications across Ethiopian regions Meta-analysis of the prevalence of maternal undernutrition in Ethiopia According to the World Health Organization (WHO) classification for adult maternal malnutrition, the prevalence is categorized as mild (10–19%), moderate (20–29%), and severe (≥ 30%) [ 121 ]. As the result display in Fig. 4 , the present systematic review and meta-analysis demonstrate the pooled prevalence of maternal undernutrition in Ethiopia was 29% (95% CI: 25%–33%). Based on the WHO classification, a prevalence of 20–29% falls within the moderate prevalence category, indicating a medium burden of maternal undernutrition among pregnant and lactating women in Ethiopia. The analysis revealed considerable variation in prevalence rates among studies, ranging from 15% (95% CI: 12%-19%) to 43% (95% CI: 39%-47%). The meta-analysis demonstrated significant heterogeneity across studies (χ 2 = 519.90, p < 0.001; I 2 = 96.54%), which may be attributed to regional disparities, socioeconomic factors, methodological variations, or between-study differences. The high I 2 value (96.54%) indicates that most observed variation reflects real differences rather than chance. Fig. 4. Open in a new tab The pooled prevalence maternal undernutrition (pregnancy and lactating) in Ethiopia Prevalence of stunting among under-five children across synthesized Studies In this systematic review, the random-effects meta-analysis estimated an overall stunting prevalence among under-five children of 35% (95% CI: 28–43%) (Fig. 5 ). According to the World Health Organization (WHO), child stunting is classified as low (< 20%), medium (20–29%), high (30–39%), and very high (≥ 40%) [ 121 ]. Based on this classification, the observed prevalence of 35% falls within the high category, indicating that stunting remains a significant public health problem among under-five children in Ethiopia. Fig. 5. Open in a new tab The pooled prevalence of stunting among under-five children in Ethiopia The result also confirms the existence of extreme heterogeneity among included studies ( I 2 = 99.45%, p < 0.001 ), indicating that the factual prevalence likely differs significantly by subpopulation, geographic region, or methodological factors. Prevalence of wasting among under-five children across synthesized Studies Based on the World Health Organization (WHO), prevalence of child wasting is classified as low (< 5%), medium (5–9%), high (10–14%), and very high (≥ 15%) [ 121 ]. The result of random-effects meta-analysis revales the overall prevalence of wasting among under-five children across the included studies at 14% (95% CI: 12–17%) (Fig. 6 ). Based on this classification, the observed prevalence of 14% falls within the high category, indicating that wasting remains a major public health concern among under-five children in Ethiopia. Fig. 6. Open in a new tab The pooled prevalence of wasting among under-five children in Ethiopia Moreover, the I 2 test result showed that there was heterogeneity among the included studies (I 2 = 98.22%, p < 0.001). Prevalence of underweight among under-five children across synthesized Studies The results of the random effects model revealed that the overall prevalence of underweight across the synthesized studies was 23% (95% CI: 19%–27%). This indicates that the accurate proportion of underweight children in the population is likely between 19 and 27% with 95% confidence. Furthermore, the I 2 statistic of 96.84% shows that most of the variability in the results is due to factual differences between studies rather than by probabilities (Fig. 7 ). Fig. 7. Open in a new tab The pooled prevalence of underweight among under-five children in Ethiopia Subgroup analysis of stunting, wasting and underweight across Ethiopian regions The random-effects meta-analysis revealed significant regional disparities in under-five malnutrition across Ethiopian regional administrations (Fig. 8 ). According to the result in Table 4 , Tigray region had the highest stunting prevalence (40%, 95% CI: 9–70%), followed by Amhara (38%, 27–50%) and the South Region (39%, 33–46%), while Afar and Oromia showed moderate stunting (31%) and Somali region had the lowest (29%, 27–31%). Wasting was most prevalent in Somali region (21%, 20–23%), followed by Afar (18%, 15–20%), Amhara (16%, 11–21%), Oromia (13%, 10–16%), and Tigray (12%, 7–17%), with the South Region having the lowest (10%, 6–14%). For underweight, Afar (34%, 31–37%) and Tigray (30%, 10–50%) had the highest rates, even though the South Region had the lowest (16%, 13–18%), and Somali (27%), Amhara (23%), and Oromia (26%) showed intermediate levels, with stunting findings largely aligning with the 2016 EDHS except for Somali, which had higher reported prevalence in the EDHS. Fig. 8. Open in a new tab Pooled prevalence of under-five stunting, wasting, and underweight by region in Ethiopia Table 4. Random-effects meta-analysis of under-five stunting, wasting and underweight prevalence by region Stunting Wasting Underweight Regions No. of Studies Prevalence Of Stunting (95% CI) I 2 (%) p-value No. of Studies Prevalence of wasting (95% CI) I 2 (%) p-value No. of Studies Prevalence of underweight (95% CI) I 2 (%) p-value Tigray 3 40% (9–70) NC 0.01 4 12% (7–17%) 99.59 0.01 3 30% (10–50) NC 0.003 Amhara 8 38% (27–50) 98.26 < 0.001 10 16% (11–21) 96.94 < 0.001 6 23% (15–30) 95.64 < 0.001 South Region 6 39% (33–46) 93.77 < 0.001 3 10% (6–14%) NC < 0.001 3 16% (13–18) NC < 0.001 Afar 3 31% (15–46) NC < 0.001 3 18% (15–20%) 96.82 < 0.001 2 34% (31–37) NC < 0.001 Oromia 7 31% (14–48) 99.69 < 0.001 6 13% (10–16%) 97.53 < 0.001 4 18% (9–26) 97.69 < 0.001 Somali 2 29% (27–31) NC < 0.001 2 21% (20–23%) NC < 0.001 2 27% (25–28) NC < 0.001 Overall 28 35% (28–43) 99.45 < 0.001 26 14% (12–17%) 98.22 < 0.001 19 24% (19–30) 96.84 < 0.001 Open in a new tab NB: Non-calculable (NC) h eterogeneity of p-values could not be computed due to insufficient degrees of freedom for regions with ≤ 3 studies Determinants of Undernutrition Among Under-Five Children and Mothers in Ethiopia The result in Fig. 9 highlights the key factors associated with undernutrition among under-five children and mothers in Ethiopia. Socioeconomic and demographic factors (70.4%), inadequate dietary intake (65%), and poor child feeding and care practices (56.7%) were the most frequently reported contributors. Other important determinants included inadequate maternal and child health services (40.3%), disease and infection (42%), household food insecurity (28.5%), poor water, sanitation, and hygiene (35.2%), and policy-related factors (9.2%). These findings underscore that undernutrition is a multifactorial problem, driven primarily by socio-economic conditions, dietary inadequacies, and suboptimal care practices, emphasizing the need for integrated interventions targeting both household and community-level determinants. Fig. 9. Open in a new tab The key factors associated with undernutrition among under-five children and mothers in Ethiopia The result from Table 5 further summarizes that maternal and under-five child undernutrition in Ethiopia is shaped by immediate factors (such as inadequate diet and infections), underlying factors (including food insecurity, suboptimal care practices, early marriage, limited healthcare access, and poor WASH conditions), and basic factors (like low household wealth, large family size, low maternal education, and limited decision-making autonomy). Table 5. The summary of the key factors associated with undernutrition among under-five children and mothers in Ethiopia Driving Factors Discussion Studies (1) Immediate Causes Inadequate Dietary Intake Inadequate dietary diversity, poor feeding behavior and practices, lack of exclusive breastfeeding, and delayed breastfeeding contribute to undernutrition Fentahun et al. [ 41 ],Gebreayohanes & Dessie [ 47 ],Bogale et al. [ 26 ],Yigezu et al. [ 124 , 125 ] ,Gizachew et al. [ 55 ], Mulaw et al. [ 82 ] Disease & Infection The incidence of diarrhea, infectious diseases, and anemia reduce appetite and alter metabolism, deteriorating undernutrition Gebremichael et al. [ 48 ], Gebre et al. [ 46 ]; Dake et al. [ 30 ],Kebede & Aynalem [ 69 ],Martial et al. [ 73 ] (2) Underlying Causes Household Food Insecurity Households with severe food insecurity increase the risk of child and maternal undernutrition Afework et al. [ 7 ],Anato [ 15 ],Rahi et al. [ 90 ] Hidruet al. [ 61 ] Poor Feeding Behavior & Care Practices Untimely feeding, unsuitable complementary feeding, and food restrictions/taboos limit nutrient intake of mothers and child Moges et al. [ 80 ],Abeway et al. [ 5 ],Yisak et al. [ 127 ],Aychiluhm et al. [ 19 ],Chea et al. [ 28 ] Dembedza et al. [ 32 ] Headey et al. [ 58 ] Early Marriage & Polygamy Early pregnancy (< 18 years) and polygamy increase susceptibility to undernutrition Derseh et al. [ 34 ],Hechera & Dona [ 59 ],Masse et al. [ 74 ] Inadequate Maternal & Child Healthcare Absence of antenatal care (ANC) and nutrition counseling deteriorates maternal and child undernutrition Abeway et al. [ 5 ],Shifera et al. [ 100 ],Endawkie et al. [ 36 ],Chileshe & Kamiya [ 29 ] Poor WASH (Water, Sanitation & Hygiene) Lack of safe water, open defecation, and poor handwashing increase infection risks and undernutrition Abera et al. [ 3 ],Yeshaneh et al. [ 123 ],Sewenet et al. [ 97 ],Sahiledengle et al. [ 96 ] (3) Basic Causes Low Household Wealth & Large Family Size Low-income household and larger family size have higher undernutrition rates due to limited resources Maalin et al. [ 72 ]; Gelu et al. [ 52 ]; Bogale et al. [ 26 ],Anato [ 15 ] Low Maternal Education & Decision-Making Autonomy Limited maternal education and male-dominated decisions diminish access to proper nutrition and healthcare Darsene et al. [ 31 ]; Amare et al. [ 13 ],Mekonen et al. [ 76 ] Poor Family Planning & Policy focus Inadequate access to contraceptives and weak policy enforcement worsens child undernutrition Gebru et al. [ 49 ],Tamiru et al. [ 107 ],Wubetie & Mekonen [ 122 ],Fekadu et al. [ 39 ] Assefa et al .[ 18 ] Open in a new tab Discussion Prevalence of maternal undernutrition in Ethiopia According to the results of this systematic review and meta-analysis, the pooled prevalence of maternal undernutrition in Ethiopia was recorded as 29%, indicating a moderate burden among pregnant and lactating women. This number exceeds the 21% national prevalence reported in the 2016 Ethiopian Demographic and Health Survey (EDHS) analysis [ 50 ]. Similarly, other evidence from the EDHS 2016 showed that the prevalence of maternal underweight was lower than the findings of this review [ 38 ]. Furthermore, the results confirmed wide regional variations in undernutrition, highlighting the influence of geographic and socioeconomic disparities on maternal health in Ethiopia. Comparatively, the evidence from Sub-Saharan Africa suggests that maternal undernutrition remains a widespread public health problem across the region, although the burden appears relatively higher in Ethiopia. The evidence confirm Ethiopia reflects broader regional challenges related to food insecurity, inadequate maternal nutrition services, and socioeconomic inequities [ 54 , 95 , 128 ]. Prevalence of stunting, wasting and underweight among under-five children in Ethiopia The synthesized result of meta-analysis demonstrates child stunting, wasting, and underweight remain serious public health concerns in Ethiopia. According to results of random-effects meta-analysis the overall prevalence of stunting among under-five children was 35% (Fig. 5 ). This finding reflects a high burden of stunting among the populations studied. However, the result also indicate relatively stunting shows significant variability in prevalence estimates across different populations or regions of Ethiopia. Consistent with these findings, other studies have also confirmed that stunting remains a widespread issue in developing countries, including Ethiopia [ 1 , 14 , 88 ]. Additionally, the meta-analysis revealed that the pooled prevalence of wasting among under-five children in Ethiopia was 14%. This indicates a moderate burden of wasting compared to the problems of stunting. Moreover, the result confirmed that wasting is relatively consistent estimates compared to stunting. Previous evidence reported a wasting prevalence of 10.91% among children under two in Ethiopia [ 66 ]. The estimate from this review is higher than that reported by Abdulahi et al. [ 2 ], which may indicate emerging nutritional challenges or broader inclusion of high-risk populations in recent studies. Furthermore, the synthesized result of meta-analysis shows an overall underweight prevalence among under-five children was 24% in Ethiopia (Fig. 7 ). For comparison, evidence from Nigeria reported a higher prevalence of 29% among under-five children [ 8 ]. Other studies confirm that child undernutrition varies widely across sub-Saharan African countries [ 12 , 92 , 105 , 106 , 109 ]. Coexistence of Maternal and under-five child undernutrition in Ethiopia Several studies conducted in Ethiopia have confirmed a strong association between maternal and under-five child undernutrition. Mothers with low body weight, short stature, low educational attainment, inadequate income, and short birth intervals were more likely to have children suffering from undernutrition [ 34 , 39 , 82 ]. According to findings by Farah et al. [ 38 ], children experiencing stunting, underweight, or wasting often had mothers with lower body mass index (BMI), highlighting a strong link between maternal and child nutritional status. A study conducted in the Tigray region also showed that maternal undernutrition significantly increases the risk of giving birth to low-birth-weight infants, compared to well-nourished mothers [ 23 ]. Similarly, evidence from Negash et al. [ 85 ] indicated that maternal BMI, height, and education are significantly associated with child nutritional outcomes. Collectively, these studies underscore the strong interconnection between maternal and child undernutrition, with overlapping contributing driving factors. Drivers of maternal and under-five child undernutrition in Ethiopia We applied UNICEF’s framework (2020), to identify and synthesis key drivers of undernutrition in Ethiopia. The results revealed immediate, underlying, and structural determinants, with most studies highlighting structural determinants as the most frequent contributors, followed by immediate and underlying factors. The synthesized result of this review indicate inadequate dietary intake and disease/infection most frequently reported by several studies as immediate determinant of undernutrition, with 65% of studies linking poor nutrition (low dietary diversity, suboptimal breastfeeding, and inadequate feeding practices) [ 41 , 47 , 55 ], while 42% of studies linking diseases like diarrhea, infections and anemia [ 48 ],Gebre et al., 2018) to worsened nutritional status, as these conditions impair appetite and metabolism [ 30 , 69 , 73 ] Moreover, multiples studies reported food insecurity, poor feeding behaviors, harmful cultural practices, inadequate healthcare access, and poor WASH conditions emerged as critical underlying determinants of maternal and child undernutrition in Ethiopia. Food insecurity [ 7 ] and suboptimal care practices [ 80 ] directly impacted nutritional status, while early marriage [ 34 ], food taboos [ 19 ], and limited healthcare access [ 5 ] exacerbated risks. Poor WASH conditions [ 3 ] further compounded these challenges more extreme. In addition to immediate and underlying drivers, several studies also identified diverse socioeconomic and policy factors that critically influence undernutrition in Ethiopia. Notably, as demonstrated in Fig. 8 , 70.4% of studies highlighting household wealth [ 26 , 52 , 72 ], family size/rural residence [ 15 , 117 ], maternal education [ 13 , 31 , 110 ], and decision-making autonomy [ 76 ] and poor family planning policy [ 49 , 97 ] as key structural determinants of undernutrition. The result of this review implies that the domination of structural factors and this suggests that long-term solutions must first address systemic inequities to sustainably eradicate malnutrition in Ethiopia. The result in Fig. 10 display socioeconomic and demographic factors underpin food insecurity, poor WASH, and weak health services, leading to inadequate diets, disease, and poor feeding practices creating a cyclical cause of undernutrition. The circle visualizes how these interdependent factors collectively perpetuate maternal and child undernutrition. This implies that interventions targeting only diet/disease will fail without dismantling deeper socioeconomic barriers. Fig. 10. Open in a new tab Cyclical drivers of maternal and child undernutrition Limitations of the review This systematic review and meta-analysis have limitations that should be considered when interpreting the findings. First, there is a potential regional imbalance in research representation, which may limit the generalizability of the results to underrepresented regions such as Afar, Tigray, and the Somali Region, as well as non-represented regions including Gambella and Benishangul, due to the absence of eligible studies from these areas during the review period. Second, although a methodological quality assessment was conducted, 10 of the 58 included studies were identified as having low quality, which may have influenced the overall estimates. This limited number of studies and the heterogeneity observed across studies may have contributed to variability in the results; however, a random-effects model was employed to account for between-study variability and minimize potential bias in the pooled estimates. Conclusion This systematic review and meta-analysis show the severe and persistent burden of maternal and child undernutrition across Ethiopia. The findings depict a maternal undernutrition rate of 29% , exceeding national estimates. Among under-five children, stunting was 35%, wasting 14% , and underweight 24%, with significant regional disparities. The review identified Tigray, Somali, Afar, and Amhara as the regions with the highest burdens of child undernutrition. Multiple interconnected factors drive maternal and child undernutrition, including limited access to essential healthcare services, recurrent infections, chronic food insecurity, and suboptimal feeding practices. These immediate causes are compounded by deeper structural challenges, such as persistent poverty, gender disparities in education, and inadequate water and sanitation infrastructure. Together, these factors perpetuate an intergenerational cycle of malnutrition, particularly in regions already facing environmental fragility and limited-service coverage. Based on the substantial regional variation identified, a uniform national nutrition strategy is unlikely to be sufficient. Instead, the evidence from this review supports the need for regionally targeted interventions that prioritize high-burden areas such as Afar, Somali, Tigray, and Amhara. In these regions, integrated actions should focus on strengthening maternal and child health services, improving food security in drought- and conflict-prone settings, expanding access to safe water and sanitation, and promoting context-specific infant and young child feeding practices. Aligning nutrition interventions with regional vulnerabilities and resource constraints will be essential to reducing undernutrition and accelerating progress toward Ethiopia’s health and development goals. Acknowledgements The authors sincerely appreciate the valuable support provided by Mekdela Amba University and the Department of Rural Development and Agricultural Extension throughout this review work. Their assistance and resources were instrumental in the successful completion of this study . Authors’ contribution Getasew Daru Tariku and Sinkie Alemu Kebede conceived the review topic, designed the framework, and defined the review scope. They conducted literature searches, screened publications using predefined criteria, developed the methodology, and performed the meta-analysis, interpreting the results. Both authors draft the original manuscript, ensuring rigor and coherence. Tadsual Asfaw Dessie and Abebaw Abebe Getahun contributed to data extraction, statistical analysis, and methodology refinement, enhancing robustness. All the authors confirmed the findings for accuracy and consistency, and critically revised the manuscript for clarity and academic quality. Funding The authors received no direct funding for this research. Data availability Not applicable. Declarations Ethics approval and consent to participate Not applicable. 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