National Prevalence and Determinants of Concurrent Wasting and Stunting among Under-Five Children in Yemen: Evidence from the 2022-2023 Multiple Indicator Cluster Survey

In the earliest years of life, a child's body is a construction site where the foundation is being poured. When that foundation is built correctly, the child grows tall and strong, ready to learn and explore. When it is not, the structure suffers. Two common ways this foundation fails are known as stunting and wasting. Stunting is a sign that a child has not grown tall enough for their age, a slow and steady result of long-term hunger or repeated sickness. Wasting is different; it is a sudden drop in weight, often caused by a recent shortage of food or a severe illness that strips the body of its strength. While these conditions are often studied separately, they can happen at the same time in the same child. This double burden, where a child is both too short and too thin, is particularly dangerous. It signals that the child is fighting a losing battle on two fronts, facing a much higher risk of death and long-term health problems than a child suffering from just one of these issues.

For years, Yemen has been a place where this double burden has been a silent crisis. Decades of conflict, economic collapse, and a shattered health system have left millions of families struggling to find enough food to survive. While aid workers and health officials have long known that malnutrition is widespread there, they lacked a clear, national picture of how many children were suffering from both stunting and wasting simultaneously, and exactly which factors were driving this tragedy. Without this specific map of the problem, it is difficult to know where to send help or how to design programs that will actually work. A new study, drawing on a massive survey of families across the entire country, has finally provided that clarity. By looking at nearly 18,000 children under the age of five, researchers have uncovered the true scale of the crisis and identified the specific conditions that make some children far more vulnerable than others.

The researchers turned to data collected in 2022 and 2023 by the United Nations Children's Fund, known as UNICEF, as part of a standard global survey called the Multiple Indicator Cluster Survey. This survey is designed to give a representative snapshot of a country's health and well-being. The team analyzed information from 17,734 children from all 22 governorates of Yemen, ensuring that the findings reflected the reality of the whole nation, not just a single city or region. They looked for children who were both too short for their age and too thin for their height, a condition the study calls concurrent wasting and stunting. Once they identified these children, they examined the circumstances of their lives, looking at everything from their age and gender to their family's wealth, the food available in their home, and the quality of their water and sanitation.

The results revealed a stark reality: one in every twelve children under five in Yemen is living with this double burden of malnutrition. This translates to a national prevalence of 8.4 percent, a figure that confirms the problem is not isolated to a few marginalized communities but is a widespread national emergency. The study found that the risk is not evenly distributed. It is highest among boys, who are significantly more likely to be affected than girls. It is also most severe for children between the ages of one and two years, a critical window when they are transitioning from breast milk to solid foods. If the food they receive during this time is insufficient or unsafe, their growth can falter rapidly, locking them into a cycle of poor health.

Geography plays a massive role in who suffers. The study mapped the problem across the country and found that the western coastal regions, along with the eastern and southern areas, carry the heaviest burden. In these specific zones, the odds of a child being both wasted and stunted are roughly double what they are in the northern regions. The central region, which includes the capital city, showed the lowest rates, but the disparity between the rich and the poor within the country is even more telling. Children from the poorest households are nearly twice as likely to suffer from this condition compared to children from the wealthiest families. This gap highlights that poverty is a primary driver, but it is not the only one.

Food insecurity emerged as a powerful predictor of this double burden. The study showed a clear, step-by-step relationship: as a household's access to food becomes more uncertain, the risk to children rises. In homes where food is secure, the rate of concurrent wasting and stunting is very low. However, in households facing severe food insecurity, where families go entire days without eating, the rate jumps dramatically. Children in these severely food-insecure homes are nearly twice as likely to be affected as those in homes with only mild food worries. This suggests that the lack of reliable food is a direct pathway to this severe form of malnutrition.

Beyond the food on the table, the study also looked at the environment in which these children live. It found that recent illness, particularly diarrhea, is a significant factor. Children who had diarrhea within the two weeks before the survey were more likely to be suffering from concurrent wasting and stunting. This connection makes sense, as diarrhea prevents the body from absorbing nutrients and can lead to rapid weight loss. The study also pointed to the importance of basic hygiene. Children living in homes with improved sanitation facilities and designated places for handwashing were less likely to be affected. While having access to safe drinking water was important, the presence of a toilet and a place to wash hands showed a stronger protective effect in the analysis.

Interestingly, the study challenged some common assumptions about where malnutrition is found. While rural areas generally had higher rates of malnutrition than cities in the initial comparisons, this difference disappeared once the researchers accounted for poverty, region, and food security. This suggests that living in a city does not automatically protect a child if the household is poor or food-insecure. In Yemen, the lines between urban and rural deprivation are blurred, and the risk is determined more by the specific conditions of the home and the local environment than by the type of settlement.

The researchers also looked at the role of the mother. Children whose mothers had at least a primary education were less likely to be affected than those whose mothers had no formal schooling. This protective effect held true even after adjusting for other factors, suggesting that a mother's education provides a buffer against malnutrition, perhaps through better knowledge of feeding practices or health care. However, the study noted that for mothers with higher levels of education, this protective effect was less clear, likely because the overwhelming pressure of poverty and food scarcity in the country can override the benefits of education.

This research does not claim to have solved the problem, nor does it offer a simple fix. Instead, it provides a precise map of where the problem is worst and what is driving it. The authors emphasize that treating this issue requires more than just giving food or medicine in isolation. Because the causes are so deeply intertwined—spanning poverty, conflict, lack of clean water, and illness—the solutions must be just as connected. They suggest that interventions need to target the most vulnerable groups: the poorest families, those in the western coastal and eastern regions, and children in the critical one-to-two-year age range. The study also highlights the need to address the cycle of infection and malnutrition by improving sanitation and preventing diarrhea.

Ultimately, the study paints a picture of a nation where a significant portion of its youngest generation is fighting a battle on multiple fronts. The 8.4 percent of children affected are not just statistics; they represent a future that is being compromised by a lack of resources and stability. By identifying the specific factors that lead to this double burden, the research offers a way forward for policymakers and aid organizations. It shows that to protect these children, efforts must be multi-layered, addressing the immediate need for food while simultaneously building stronger health systems, improving sanitation, and supporting the families who are struggling to survive in one of the world's most difficult humanitarian crises.