{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:50:19Z","timestamp":1789487419776,"version":"build-2803163510"},"reference-count":53,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2026,8,23]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Child 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We utilised the Young Lives Cohort Survey (YLCS), collecting data from ~1997 Ethiopian children across five time points (2002\u20132016). 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 (&lt;\u22122 SD=undernutrition; \u2265\u22122 SD=normal). Covariate effects were estimated with ORs and 95% CIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Undernutrition 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%\u2009CI: 0.02 to 0.11), stunting (OR=0.20, 95%\u2009CI 0.10 to 0.38) and wasting (OR=0.17, 95%\u2009CI 0.07 to 0.41). Females had lower odds (eg, underweight OR=0.61, 95%\u2009CI 0.53 to 0.70), while lack of safe water was associated with higher wasting odds (OR=1.40, 95%\u2009CI 1.16 to 1.69). Wasting odds surged by age 12 (OR=3.65, 95%\u2009CI 3.19 to 4.19).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Undernutrition 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2025-020133","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T14:00:36Z","timestamp":1789480836000},"page":"e020133","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Trajectories of child undernutrition in Ethiopia: a multivariate GEE approach"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7107-8388","authenticated-orcid":false,"given":"Getnet Bogale","family":"Begashaw","sequence":"first","affiliation":[{"name":"Statistics, Bahir Dar University College of Science, Bahir Dar, Amhara Region, Ethiopia"},{"name":"Data Science, Debre Berhan University, Debre Birhan, Amhara Region, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Temesgen","family":"Zewotir","sequence":"additional","affiliation":[{"name":"Statistics, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haile Mekonnen","family":"Fenta","sequence":"additional","affiliation":[{"name":"Statistics, Bahir Dar University, Bahir Dar, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"2026091507002658000_11.9.e020133.1","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2019.01728","article-title":"Current Understanding of Innate Immune Cell Dysfunction in Childhood Undernutrition","volume":"10","author":"Bourke","year":"2019","journal-title":"Front Immunol"},{"key":"2026091507002658000_11.9.e020133.2","doi-asserted-by":"crossref","DOI":"10.3390\/nu16010001","article-title":"Effects of Malnutrition on the Immune System and Infection and the Role of Nutritional Strategies Regarding Improvements in Children\u2019s Health Status: A Literature Review","volume":"16","author":"Morales","year":"2023","journal-title":"Nutrients"},{"key":"2026091507002658000_11.9.e020133.3","doi-asserted-by":"publisher","DOI":"10.1079\/095442200108728981"},{"key":"2026091507002658000_11.9.e020133.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-019-6688-2","article-title":"Determinants of stunting, underweight and wasting among children <\u20095\u2009years of age: evidence from 2012-2013 Pakistan demographic and health survey","volume":"19","author":"Khan","year":"2019","journal-title":"BMC Public Health"},{"key":"2026091507002658000_11.9.e020133.5","doi-asserted-by":"crossref","first-page":"68","DOI":"10.4103\/0019-557X.177319","article-title":"Exploring the multidimensional nature of anthropometric indicators for under-five children in India","volume":"60","author":"Gupta","year":"2016","journal-title":"Indian J Public Health"},{"key":"2026091507002658000_11.9.e020133.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-019-7121-6","article-title":"Exploring the association of anthropometric indicators for under-five children in Ethiopia","volume":"19","author":"Kassie","year":"2019","journal-title":"BMC Public Health"},{"key":"2026091507002658000_11.9.e020133.7","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-052267","article-title":"Risk factors associated with the coexistence of stunting, underweight, and wasting in children under 5 from 31 sub-Saharan African countries","volume":"11","author":"Amadu","year":"2021","journal-title":"BMJ Open"},{"key":"2026091507002658000_11.9.e020133.8","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/jir.12698","article-title":"Prevalence of underweight, wasting and stunting among young children with a significant cognitive delay in 47 low-income and middle-income countries","volume":"64","author":"Emerson","year":"2020","journal-title":"J Intellect Disabil Res"},{"key":"2026091507002658000_11.9.e020133.9","first-page":"39","article-title":"Prevalence of underweight, stunting and wasting among urban poor children aged 1-5 years of West Bengal, India","volume":"6","author":"Bisai","year":"2010","journal-title":"Int J Curr Res"},{"key":"2026091507002658000_11.9.e020133.10","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s12937-019-0477-8","article-title":"Association of low birth weight with undernutrition in preschool-aged children in Malawi","volume":"18","author":"Ntenda","year":"2019","journal-title":"Nutr J"},{"key":"2026091507002658000_11.9.e020133.11","doi-asserted-by":"crossref","DOI":"10.1186\/s40795-023-00683-3","article-title":"Factors associated with wasting and stunting among children aged 06-59 months in South Ari District, Southern Ethiopia: a community-based cross-sectional study","volume":"9","author":"Toma","year":"2023","journal-title":"BMC Nutr"},{"key":"2026091507002658000_11.9.e020133.12","unstructured":"WHO . 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