Coexisting maternal and child undernutrition in Ethiopia: Spatial modeling and multilevel analysis of consecutive EDHS data

Introduction Maternal and child undernutrition remains a major public health challenge globally, with the highest burdens observed in low- and middle-income countries. Coexisting maternal and child undernutrition has serious implications for survival, growth, and quality of life.Maternal and child undernutrition is a complex, multifactorial issue influenced by a web of interconnected determinants including health, socio-economic status, education and environmental conditions. Objectives To examine the spatial distribution and multilevel determinants of coexisting maternal and child undernutrition in Ethiopia using EDHS data from 2000–2016. Methods We analyzed a weighted sample of 33,445 participants from four consecutive EDHS surveys. Spatial autocorrelation, hotspot, and interpolation analyses were conducted using ArcMap 10.8. Multilevel logistic regression was performed in Stata 17. Cluster variability was assessed using ICC, MOR, and PCV. Variables with p < 0.05 were considered statistically significant. Result A total of 33,445 weighted sample was used for this study. The prevalence of coexisting maternal and child undernutrition was 22.87% (95% CI: 22.42, 23.32). Spatial analysis result showed that hot spot areas were concentrated in the northern regions especially Tigray, Amhara, and parts of Benishangul-Gumuz. Multilevel logistics regression analysis result revealed that maternal primary education (AOR = 0.88; 95% CI: 0.78, 0.98), secondary/higher education (AOR = 0.38; 95% CI: 0.29, 0.49), medium household wealth (AOR = 0.85; 95% CI: 0.75, 0.97), high household wealth (AOR = 0.78; 95% CI: 0.69, 0.89), child age 12–23 months (AOR = 2.77; 95% CI: 2.44, 3.16), ANC use (AOR = 0.83; 95% CI: 0.75, 0.92), improved toilet (AOR = 0.83; 95% CI: 0.71, 0.98) and regions. Conclusion and recommendations Coexisting maternal and child undernutrition shows marked geographic clustering in northern Ethiopia. Strengthening maternal education, improving household economic conditions, enhancing ANC use, and expanding sanitation services particularly in high-risk regions are essential to reduce the burden.