Food Inflation, Institutional Support, and Household Coping Strategies: Implications for Child Nutritional Resilience in Urban Ethiopia

Background : Food inflation is a critical determinant of household welfare in market-dependent urban centers. In Addis Ababa, Ethiopia, rising food prices have eroded purchasing power, but the specific pathways through which institutional support and household coping strategies translate into child nutritional outcomes, measured through a multidimensional lens, remain under-researched. Objective : This study examined the impact of food inflation on the nutritional status of children aged 6-59 months in Addis Ababa, focusing on the mediating roles of institutional interventions and adaptive household behaviors. Methods : A cross-sectional mixed-methods study was conducted from October to December 2024. Quantitative data from 624 households were analyzed using a stratified two-stage cluster sampling design. Nutritional status was assessed using the Composite Index of Anthropometric Failure (CIAF). Econometric modeling included Seemingly Unrelated Regression (SUR) for continuous Z-scores and Binary/Multinomial Logit models for binary and categorical growth failure. Qualitative interviews provided context for household coping mechanisms. Results : The prevalence of anthropometric failure among children aged 6-59 months in Addis Ababa was 21.8%, with wasting (18.8%) and underweight (42.1%) exceeding stunting (6.1%). Infants aged 7-11 months were most vulnerable, with wasting (41.2%) and underweight (83.3%) peaking during the transition to complementary feeding. Boys were disproportionately affected by severe wasting (76.5%) and underweight (85.0%), while girls were more represented in severe stunting (62.5%). Overall, boys accounted for 55.8% of failures, compared to 44.2% among girls. Sustained breastfeeding reduced the odds of anthropometric failure by 33% (OR 0.67, p 0.008). Participation in the Urban Productive Safety Net Programme improved WHZ (β 1.100, p<0.05). Informal safety nets (Idir) buffered both WHZ (β 0.630, p<0.05) and WAZ (β 0.384, p<0.10). House ownership and equitable intra‑household food distribution lowered the risk of overlapping failures (“Wasting + Underweight”; p <0.10). Health insurance and school feeding showed marginal or negative associations, likely reflecting adverse selection. Multinomial logit models (Pseudo R² 0.492) highlighted the combined role of biological, behavioral, and institutional factors in shaping child nutritional resilience under inflation. Conclusion : Urban nutritional resilience in Addis Ababa is shaped less by household wealth and more by the interaction of biological practices, informal social capital, and targeted institutional support. Acute anthropometric failures proved highly sensitive to food inflation, underscoring the fragility of urban households under market shocks. Sustained breastfeeding emerged as a critical biological buffer, reducing vulnerability and reinforcing resilience. Informal safety nets such as Idir provided effective community‑based protection against acute nutritional stress. Engagement in the Urban Productive Safety Net Programme (UPSNP) strengthened child growth outcomes, highlighting the role of formal social protection. Conversely, negative associations with health insurance and school feeding suggest adverse selection, as these programs disproportionately reach already vulnerable households. The findings emphasize that resilience is built through adaptive behaviors and social capital rather than wealth alone. Integrated approaches that link formal and informal systems are essential to buffer children against inflationary shocks. Nutrition‑sensitive social protection must prioritize the critical 6-23-month window, where growth faltering is most acute. Finally, adopting the Composite Index of Anthropometric Failure (CIAF) offers a multidimensional lens to identify overlapping deficits and guide comprehensive interventions.