This paper emphasises that malnutrition cannot be tackled without understanding its causes. Child malnutrition remains a major public health problem in Ethiopia, yet the government has no specific nutrition policy. Levels of wasting (acute malnutrition) and stunting (chronic malnutrition) in children aged 6 to 59 months are among the world's highest. As long as so many children remain malnourished, Ethiopia will not achieve the first Millennium Development Goal – eradication of extreme poverty and hunger.

Drawing on a sample of 1,999 one-year-olds across 20 sites, Young Lives has sought to better understand the child, household, community and policy level determinants of malnutrition and the ways in which they differ across different regions of Ethiopia. The paper quantifies the impact of poverty, health-care and caring practices, and challenges the World Bank belief that investment in growth monitoring to promote change in caregivers' behaviour will, by itself, significantly improve nutritional status.

Coverage of health services may have expanded, but limited and costly services discourage users. Quality services are lacking. Respondents complained about inadequate equipment, poorly trained and/or insensitive medical staff, and expensive medication.

The key findings of this paper are grouped under three headings: child, family/household, and community characteristics. Policy implications are discussed with reference to UNICEF's three-part conceptual framework on child malnutrition. The paper suggests that tackling child malnutrition requires training programmes for nutritionists; sensitivity training for health professionals; availability of essential quality drugs and health personnel who know how to administer these appropriately; health fee waiver systems for poor households; and the inclusion of specific nutritional indicators in the new Poverty Reduction Strategy Paper.

Keywords: Ethiopia, health, nutrition, health service provision, child outcomes