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Armed conflict and nutritional vulnerability: A cross-sectional analysis of child wasting and stunting in conflict-affected regions of northern Ethiopia
*Corresponding author: Zerai Gebrehiwot, Faculty of Science, Research and Public Health, The Euler-Franeker Memorial University, Willemstad, Curaçao, Netherlands. drzeraih@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Gebrehiwot Z. Armed conflict and nutritional vulnerability: A cross-sectional analysis of child wasting and stunting in conflict-affected regions of northern Ethiopia. Sri Ramachandra J Health Sci. 2026;6:34-40. doi: 10.25259/SRJHS_8_2026
Abstract
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.
Keywords
Armed conflict
Child malnutrition
Ethiopia
Stunting
Survey methods
Tigray
Wasting
INTRODUCTION
Ethiopia’s public health landscape is strained by climate variability, economic challenges, and armed conflicts, severely impacting nutritional security.[1] The 2020–2022 Tigray conflict displaced approximately 2 million people, damaged healthcare infrastructure, and restricted humanitarian aid, exacerbating food insecurity.[2] Nationally, child stunting affects 39% and wasting 11% of under-fives, with conflict zones showing higher burdens.[3] In Tigray, pre-conflict global acute malnutrition (GAM) was approximately 9%, but post-conflict estimates have ranged from 28% to 44% in various assessments.[4]
Globally, conflicts contribute substantially to childhood stunting by disrupting food systems, water and sanitation services, and healthcare delivery.[5] In Ethiopia, post-conflict areas like North Wollo report stunting at 46% and thinness at 33% among school-aged children, indicating broader undernutrition.[6] In Tigray specifically, 87% of war-affected households face food insecurity, resorting to coping strategies such as meal skipping and reduced dietary diversity.[7] A study conducted immediately post-conflict in 2021 reported GAM rates of 28.4% among children in Tigray’s urban communities, highlighting the immediate nutritional crisis.[4]Despite national efforts, such as Ethiopia’s Food and Nutrition Strategy (2021–2030), data gaps in active and post-conflict zones hinder targeted interventions.[8] This study quantifies wasting and stunting in selected zones of post-conflict Tigray and identifies determinants to inform Ethiopia’s National Nutrition Program and global initiatives.[9]
MATERIAL AND METHODS
Study design and setting
We conducted a community-based cross-sectional study from March 1 to 31, 2025, in Tigray Region, northern Ethiopia. Before the 2020 conflict, the region’s population was approximately 7 million; post-conflict estimates indicate approximately 1.5 million internally displaced persons (IDPs) residing in the central and eastern zones.[2] The study was conducted in ten woredas (districts) across central and eastern Tigray, selected to represent varying levels of conflict intensity and agro-ecological conditions.
Target population and sampling frame
The target population comprised all children aged 6–59 months residing in the ten selected woredas of central and eastern Tigray. These zones were selected because they experienced varying degrees of conflict intensity and hosted substantial IDP populations, while maintaining sufficient security for field data collection. The ten woredas were drawn from the approximately 35 woredas comprising central and eastern Tigray (total woredas in the Tigray region: approximately 52 across all zones).
Sampling strategy
Sample size calculation
Assuming 20% wasting prevalence,[4] 5% margin of error, 95% confidence level, and design effect (DEFF) of 1.5, we calculated a required sample of 1,056 children. This was inflated to 1,200 to account for 10% anticipated non-response.
Sampling procedure
We employed multistage cluster sampling with probability proportional to size (PPS):
Stage 1 (Woreda selection): Ten woredas were purposively selected from central and eastern Tigray zones based on the following criteria: (a) variation in conflict intensity during 2020–2022 (classified as high, moderate, or low based on documented clashes and displacement data from humanitarian reports); (b) representation of different agro-ecological zones (highland, midland, lowland); (c) inclusion of both IDP-hosting and non-hosting communities; and (d) accessibility and security for field teams. While purposely, this selection aimed to capture the diversity of post-conflict conditions rather than achieve statistical representation of the entire Tigray region.
Stage 2 (Kebele selection): Within each selected woreda, six kebeles (the smallest administrative units) were selected using PPS based on 2024 population estimates from the Tigray Regional Health Bureau.
Stage 3 (Household selection): From each selected kebele, 20 households were selected through systematic random sampling using updated household lists obtained from kebele administrations and IDP camp registrations.
Stage 4 (Child selection): In households with multiple eligible children aged 6–59 months, one child was randomly selected using a Kish grid.
Sampling weights
Sampling weights were calculated as the inverse of the selection probability at each stage:
Weight = 1/(P(woreda) × P(kebele|woreda) × P(household|kebele) × P(child|household))
For the purposive woreda selection, we assigned selection probabilities proportional to the estimated number of woredas in the sampling frame (i.e., P(woreda) = number of selected woredas/total woredas in central and eastern Tigray [approximately 35]). Final weights were normalized to sum to the sample size. The observed DEFF were 1.42 for wasting and 1.38 for stunting.
Participants
Eligible children were aged 6–59 months and resided in selected households. Exclusion criteria were (a) congenital anomalies affecting anthropometric measurements (e.g., limb deformities, spinal abnormalities); (b) acute illness requiring immediate medical referral at the time of measurement; and (c) absence of a primary caregiver capable of providing informed consent and household information.
Data collection
Twenty enumerators with prior health survey experience underwent 5 days of intensive training, including standardization of anthropometric measurements. Inter-observer technical error of measurement (TEM) was maintained below 1.5% for all anthropometric indicators.
Anthropometric measurements
Weight was measured using Seca 374 electronic scales (precision 0.01 kg), calibrated daily. Length (for children <24 months) and height (for children ≥24 months) were measured using Shorr boards (precision 0.1 cm). Bilateral pitting edema was assessed by applying thumb pressure for three seconds on the dorsum of both feet; edema was considered present if a visible pit persisted after release. All edema assessments were conducted by trained personnel following World Health Organization (WHO) guidelines.[10]Z-scores were computed using WHO Antho v3.2.2, applying the WHO 2006 growth standards.
Questionnaire data
Structured questionnaires were administered to primary caregivers using KoboToolbox on mobile devices. Data collected included:
Sociodemographics: Child age, sex, household composition, maternal education (categorized as none/primary incomplete vs. primary complete or higher)
Displacement status: Households were classified as displaced if they had been forced to leave their original residence due to the 2020–2022 conflict and had not permanently returned
Food security: Measured using the household food insecurity access scale (HFIAS); severe food insecurity was defined as HFIAS category 3 (severe)
Sanitation: Assessed using the joint monitoring programme ladder; poor sanitation was defined as the use of unimproved or limited sanitation facilities
Immunization status: Based on vaccination cards when available (68% of participants) or maternal recall when cards were unavailable or destroyed during displacement. “No recent immunization” was defined as no vaccination received in the 6 months preceding the survey, a proxy for disruption in routine immunization services during the post-conflict period rather than a measure of complete vaccination history.
Quality control
Supervisors conducted 10% re-measurements of randomly selected children; inter-observer reliability exceeded 0.95 for all anthropometric indicators. Daily field checks identified and corrected data entry errors.
Ethical considerations
The study protocol was approved by the Institutional Review Board of Mekelle University (MU-IRB/2025/001). Before data collection, we consulted community leaders in all selected kebeles, including IDP camp leaders, to explain study objectives and address concerns. Written informed consent was obtained from all primary caregivers after full explanation of study procedures, risks, and benefits. For caregivers with limited literacy, consent information was read aloud in Tigrigna, and consent was documented through a thumbprint with a literate witness signature.
Referral pathways
Children identified with severe acute malnutrition (weight-for-height z-score [WHZ] < -3 or edema) or moderate acute malnutrition (WHZ -3 to <-2) were referred to the nearest outpatient therapeutic program (OTP) or targeted supplementary feeding program (TSFP) site. Study teams provided caregivers with written referral notes and, where possible, accompanied families to health facilities. All OTP/TSFP sites had been previously mapped and contact information verified before fieldwork.
Field safety protocols
Given the post-conflict setting, we implemented comprehensive safety measures: (a) daily security briefings with local authorities; (b) restriction of data collection to daylight hours; (c) teams of at least four members including at least one female enumerator; (d) satellite phones and GPS trackers for each team; (e) daily check-in protocols with the field coordinator; and (f) immediate cessation of activities in any location with security concerns. No security incidents occurred during data collection.
Data were de-identified, stored on encrypted servers with access restricted to the principal investigator and will be retained for 5-year post-publication in accordance with ICMJE guidelines.
Statistical analysis
Primary analyses
Survey-weighted prevalence estimates with 95% confidence intervals (CI) were calculated for wasting and stunting using STATA v17 svy: Proportion commands, accounting for sampling weights, clustering at kebele level, and stratification by woreda.
Bivariate analyses
Associations between covariates and nutritional outcomes were assessed using Rao-Scott Chi-square tests, which adjust for complex survey design. Bivariate analysis revealed significant associations (Rao-Scott p < 0.05) between both nutritional outcomes and displacement, food insecurity, maternal education, sanitation, and immunization status [Supplementary Table S1].
Multivariable logistic regression
We developed separate models for wasting and stunting using a priori confounder selection based on a literature review and directed acyclic graphs. Covariates included displacement status, severe food insecurity, maternal education, sanitation, immunization status, child age (6–23 vs. 24–59 months), and child sex. Results are presented as adjusted odds ratios (aOR) with 95% CI.
Sensitivity analyses
We conducted three sensitivity analyses: (a) backward elimination with p < 0.1 retention criterion; (b) unweighted logistic regression; and (c) multiple imputation by chained equations for missing data (10 imputed datasets). Primary results are presented from the complete case-weighted analysis.
Model diagnostics
Collinearity was assessed using variance inflation factors (VIF), with all predictors having VIF <2.1. Model fit was evaluated using Hosmer-Lemeshow goodness-of-fit tests (p > 0.3 for both models) and area under receiver operating characteristic curves (>0.78 for both models). Robust standard errors accounted for clustering at the kebele level.
RESULTS
Participant flow and characteristics
Of 1,200 households approached, 1,152 children were included (96% response rate). Forty-eight households were excluded due to child age outside the eligible range (n = 23), congenital anomalies (n = 8), acute illness requiring immediate referral (n = 5), and caregiver absence after three visits (n = 12). Figure 1 presents the participant flow diagram. Among included children, mean age was 28.4 ± 14.2 months; 588 (51.0%) were male and 564 (49.0%) female [Table 1]. Displacement affected 519 households (45.1%), and severe food insecurity was reported by 749 households (65.0%). No cases of bilateral pitting edema were detected. Missing data were minimal (4.7% overall, primarily for immunization recall); imputed results were consistent with complete-case analyses.
| Characteristic | n (%) | Wasting % (95% CI) | Stunting % (95% CI) |
|---|---|---|---|
| Total | 1,152 (100) | 25.8 (23.1–28.5) | 48.5 (45.5–51.5) |
| Age (months) | |||
| 6–23 | 512 (44.4) | 29.8 (25.8–33.8) | 44.3 (40.0–48.6) |
| 24–59 | 640 (55.6) | 22.9 (19.7–26.1) | 51.6 (47.7–55.5) |
| Sex | |||
| Male | 588 (51.0) | 27.3 (23.6–31.0) | 47.5 (43.4–51.6) |
| Female | 564 (49.0) | 24.3 (20.7–27.9) | 49.5 (45.3–53.7) |
| Displacement | |||
| Yes | 519 (45.1) | 35.2 (31.0–39.4) | 52.8 (48.4–57.2) |
| No | 633 (54.9) | 18.2 (15.1–21.3) | 44.9 (40.9–48.9) |
| Severe food insecurity | |||
| Yes | 749 (65.0) | 32.7 (29.3–36.1) | 54.4 (50.8–58.0) |
| No | 403 (35.0) | 14.1 (10.7–17.5) | 37.9 (33.0–42.8) |
| Maternal education | |||
| <Primary | 681 (59.1) | 28.4 (25.0–31.8) | 53.2 (49.5–56.9) |
| ≥Primary | 471 (40.9) | 22.3 (18.4–26.2) | 41.6 (37.0–46.2) |
| Sanitation | |||
| Poor | 543 (47.1) | 29.9 (25.9–33.9) | 52.1 (47.8–56.4) |
| Improved | 609 (52.9) | 22.4 (19.0–25.8) | 45.2 (41.2–49.2) |
| Recent immunization | |||
| No (past 6 months) | 468 (40.6) | 31.8 (27.5–36.1) | 56.0 (51.5–60.5) |
| Yes | 684 (59.4) | 22.0 (18.9–25.1) | 43.2 (39.4–47.0) |
CI: Confidence interval
Survey-weighted prevalence of wasting and stunting
Survey-weighted wasting prevalence was 25.8% (95% CI: 23.1–28.5), with severe wasting affecting 7.9% (95% CI: 6.3–9.5). Survey-weighted stunting prevalence was 48.5% (95% CI: 45.5–51.5), with severe stunting affecting 20.7% (95% CI: 18.3–23.1). Unweighted prevalence estimates were similar (wasting: 25.6%; stunting: 48.3%), reflecting balanced sampling across strata.
Factors associated with wasting and stunting
Bivariate analysis revealed significant associations (Rao-Scott p < 0.05) between both nutritional outcomes and displacement, food insecurity, maternal education, sanitation, and immunization status. Child age was associated with wasting (p = 0.008) but not stunting (p = 0.064); sex was not associated with either outcome.
In the primary multivariable model, displacement and severe food insecurity showed strong independent associations with wasting, while low maternal education and no recent immunization were strongly associated with stunting. Poor sanitation was associated with wasting but not stunting. The association between displacement and stunting was borderline (p = 0.054). Younger children (6–23 months) had higher odds of wasting but lower odds of stunting compared to older children, though the latter did not reach statistical significance.
Sensitivity analyses
All sensitivity analyses produced estimates within ±5% of the primary model, indicating robustness of findings [Supplementary Table S2]. The backward elimination model retained all predictors except child sex. Multiple imputation
Comparison with regional data
Our finding of 25.8% wasting exceeds the 11% national average from the 2016 EDHS[3] and the 28.4% reported in a 2021 study of urban Tigray communities immediately post-conflict.[4] The 48.5% stunting prevalence substantially exceeds the 39% national average[3] and is comparable to the 46% reported among school-aged children in post-conflict North Wollo.[6] A 2024 study in conflict-affected communities reported HFIAS at 87%, consistent with our finding of 65% severe food insecurity.[7] In the primary multivariable model [Table 2], displacement and severe food insecurity showed strong independent associations with wasting, while low maternal education and no recent immunization were strongly associated with stunting.
| Predictor | Wasting aOR (95% CI) | p-value | Stunting aOR (95% CI) | p-value |
|---|---|---|---|---|
| Displacement (Yes vs. No) | 2.81 (2.03–3.89) | <0.001 | 1.37 (0.99–1.87) | 0.054 |
| Severe food insecurity (Yes vs. No) | 3.48 (2.58–4.70) | <0.001 | 1.97 (1.48–2.62) | <0.001 |
| Maternal education (<Primary vs. ≥Primary) | 1.48 (1.07–2.04) | 0.018 | 2.15 (1.60–2.89) | <0.001 |
| Poor sanitation (Yes vs. No) | 1.69 (1.22–2.35) | 0.002 | 1.30 (0.94–1.79) | 0.113 |
| No recent immunization (Yes vs. No) | 1.61 (1.14–2.27) | 0.007 | 1.85 (1.36–2.51) | <0.001 |
| Age (6–23 vs. 24–59 months) | 1.42 (1.05–1.92) | 0.023 | 0.77 (0.59–1.01) | 0.059 |
| Male sex (vs. Female) | 1.15 (0.87–1.52) | 0.324 | 0.93 (0.72–1.20) | 0.571 |
P < 0.05 was considered statistically significant. P-values in column 3 (wasting) and column 5 (stunting) indicate the statistical significance of the adjusted associations. Exact p-values between 0.05 and <0.10 are reported for transparency. CI: Confidence interval; aOR: Adjusted odds ratio.
DISCUSSION
This study documents a critically high prevalence of wasting (25.8%) and stunting (48.5%) among children under five in selected zones of post-conflict Tigray, Ethiopia. These rates substantially exceed national averages[3] and persist 3 years after the November 2022 ceasefire, suggesting that conflict-related disruptions to food systems, healthcare, and livelihoods have not been adequately addressed by post-conflict recovery efforts.
Comparison with previous studies
Our wasting estimate of 25.8% is comparable to the 28.4% GAM reported in a 2021 study conducted immediately after active hostilities in urban Tigray communities.[4] The similarity between these estimates – despite the 3-year interval – is concerning and suggests that acute nutritional deficits have not resolved with the cessation of active conflict. This contrasts with typical post-conflict patterns where acute malnutrition often declines relatively quickly once humanitarian access is restored.[11] The persistence of emergency-level wasting (defined by WHO as GAM >15%) indicates ongoing systemic failures in food security and health service delivery.
Our stunting prevalence of 48.5% exceeds the 39% national average[3] and aligns with the 46% reported among school-aged children in post-conflict North Wollo.[6] Stunting reflects chronic deprivation and accumulates over time; the high prevalence we observed likely represents both pre-conflict vulnerabilities and the cumulative impact of 2 years of active conflict followed by incomplete recovery. This interpretation is supported by the strong association between low maternal education and stunting, which reflects longer-term structural factors that predate the conflict but were likely exacerbated by it.[12]
Mechanisms linking conflict and malnutrition
The strong association between displacement and wasting (aOR 2.81) likely operates through multiple mechanisms. Displaced households in our study were predominantly residing in IDP camps or host communities with limited access to cultivable land, livestock, and livelihoods. Displacement disrupts not only food access but also care practices, as caregivers may lack cooking facilities, safe water, and storage for food and supplies.[13] The association between severe food insecurity and both wasting (aOR 3.48) and stunting (aOR 1.97) underscores the central role of inadequate dietary intake in driving malnutrition. Qualitative studies in Tigray have documented that conflict-affected households employ severe coping strategies, including skipping meals for entire days and consuming seed stock intended for future planting.[7]
The association between no recent immunization and stunting (aOR 1.85) likely reflects both direct and indirect pathways. Directly, vaccine-preventable illnesses (particularly measles and diarrheal diseases) can precipitate or exacerbate undernutrition through increased metabolic demands, nutrient malabsorption, and reduced appetite.[14] Indirectly, immunization coverage serves as a tracer indicator of health system functionality; children missing recent vaccinations are likely also missing other preventive and curative health services essential for nutritional well-being.[15] During the Tigray conflict, systematic destruction of health facilities and looting of medical supplies disrupted routine immunization services; our findings suggest incomplete restoration of these services 3-year post-conflict.
The borderline association between displacement and stunting (aOR 1.37, p = 0.054) may reflect the longer time horizon required for stunting to manifest in response to environmental insults. Alternatively, it may indicate that displaced children in our sample experienced displacement relatively recently, with insufficient time for linear growth faltering to become fully apparent. Longitudinal studies tracking displaced children over extended periods would clarify this relationship.
Public health implications
Our findings carry several implications for policy and programming in post-conflict settings:
Integration of nutrition screening into immunization services
The strong association between immunization status and stunting, combined with the high prevalence of both conditions, supports integrating nutrition screening into routine immunization contacts. Immunization sessions reach a substantial proportion of young children and provide an opportunity for early identification of growth faltering before severe malnutrition develops. Ethiopia’s Health Extension Program provides a platform for such integration, but our findings suggest implementation gaps in conflict-affected areas.
Targeted assistance for displaced households
Displaced children had nearly 3 times the odds of wasting compared to non-displaced children, indicating that humanitarian assistance must prioritize IDP populations. However, assistance should extend beyond food provision to include support for livelihoods restoration, access to clean water and sanitation, and psychosocial support for caregivers.
Addressing structural determinants
The strong association between low maternal education and stunting highlights the need for interventions that extend beyond the health sector. Girls’ education, women’s literacy programs, and economic empowerment initiatives should be integral components of post-conflict recovery strategies, recognizing that maternal education influences child nutrition through multiple pathways, including health literacy, care practices, and household resource allocation.
Health system strengthening
The association between immunization status and both wasting and stunting underscores the importance of restoring routine health services as a nutrition-sensitive intervention. Reconstruction of damaged health facilities, resupply of vaccines and essential medicines, and re-establishment of the cold chain are urgent priorities.
Strengths and limitations
Strengths
This study has several important strengths, including a large sample size (n = 1,152) with high response rate (96%), use of standardized anthropometric protocols with rigorous quality control (inter-observer TEM <1.5%, 10% re-measurement), inclusion of bilateral pitting edema assessment, application of survey weights accounting for complex sampling design, comprehensive sensitivity analyses confirming robustness of findings, and dual ethical approval with established referral pathways for malnourished children.
Limitations
Several limitations warrant consideration:
First, the cross-sectional design precludes causal inference. While we identify associations between risk factors and nutritional outcomes, we cannot determine temporal sequence or rule out reverse causality. For example, households with malnourished children may be more likely to report food insecurity, creating potential for recall bias. Second, the purposive selection of woredas limits generalizability. Our ten woredas were drawn from central and eastern Tigray (approximately 35 woredas) rather than from all 52 woredas across the region. We intentionally selected woredas representing varying conflict intensity, agro-ecological conditions, and displacement status to capture the diversity of post-conflict experiences. However, findings may not be representative of western Tigray (where access remained restricted) or areas with different conflict histories. We acknowledge this as a limitation and frame our inferences accordingly – our findings apply to the studied populations in accessible zones of central and eastern Tigray rather than the entire region.
Third, security constraints prevented inclusion of some conflict-affected areas, potentially excluding the most severely affected populations. If excluded areas have higher malnutrition prevalence, our estimates may underestimate the true burden.
Fourth, immunization status relied partly on maternal recall (32% of participants), introducing potential recall bias. However, the direction of association (no recent immunization associated with higher malnutrition) is biologically plausible and consistent with established literature. The 6-month recall period was chosen specifically to capture disruptions during the post-conflict period rather than lifetime vaccination history.
Fifth, HFIAS was measured using HFIAS, a subjective measure that may be influenced by respondents’ perceptions and expectations. However, HFIAS is widely validated and correlates well with objective measures of food access.
Sixth, the absence of bilateral pitting edema in our sample may reflect true absence or challenges in detecting mild cases. All enumerators received standardized training in edema assessment, and we consider the findings reliable.
CONCLUSION
Malnutrition remains at critical levels in post-conflict Tigray, with wasting prevalence (25.8%) exceeding emergency thresholds and stunting affecting nearly half of children under five. The persistence of acute malnutrition 3 years after the ceasefire signals incomplete recovery and ongoing systemic disruptions. Displacement and food insecurity are strongly associated with wasting, while low maternal education and disrupted immunization services are associated with stunting. These findings support integrated interventions combining nutrition-specific approaches (screening, therapeutic feeding) with nutrition-sensitive strategies (health system strengthening, education, livelihood support) targeting the most vulnerable populations. Longitudinal studies are needed to track recovery trajectories and identify effective interventions in post-conflict settings.
Acknowledgment:
The author thanks the study participants and their families for their time and cooperation. Field enumerators and supervisors are acknowledged for their dedication under challenging conditions. Community leaders in all selected kebeles facilitated community engagement and supported fieldwork. Mekelle University provided ethical oversight. No specific funding was received for this study.
Ethical approval:
The research/study approved by the Institutional Review Board of Regional Health Bureau, number THBIRB/2025/001, dated 12th January 2025.
Declaration of patient consent:
Patient’s consent is not required as there are no patients in this study.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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