Association Between Low Maternal Body Mass Index (BMI) and the Co-Occurrence of Multiple Forms of Childhood Undernutrition: A Systematic Review and Meta-Analysis Biniyam Sahiledengle, Paul Ward, Bereket Duko, Kingsley Agho, Lillian Mwanri Maternal and Child Nutrition, 2026 Low maternal Body Mass Index (BMI) is a critical risk factor for child undernutrition. While its association with single anthropometric deficits such as stunting or wasting is well documented, evidence on its relationship with the co‐occurrence of multiple forms of undernutrition remains scarce. The Composite Index of Anthropometric Failure (CIAF) is a summary measure that classifies children as having anthropometric failure if they are stunted, wasted, underweight, or any combination of these, thereby capturing both single and concurrent deficits. This systematic review and meta‐analysis explored the relationship between maternal underweight and CIAF in children under five, addressing a significant research gap. We systematically searched major databases, including MEDLINE (PubMed), Embase, Scopus, CINAHL, ProQuest (EBSCO), ScienceDirect, Global Index Medicus, and the Cochrane Library, without language or geographic restrictions, to identify relevant observational studies. We pooled extracted confounder‐adjusted odds ratios (ORs) and 95% confidence intervals (CIs) using an inverse‐variance weighted random‐effects meta‐analysis, with heterogeneity assessed using the I² statistic. Sensitivity analyses were conducted to evaluate the robustness of the results, and subgroup and meta‐regression analyses were performed to explore heterogeneity. Pooled prevalence ratios (PRs) and prevalence differences (PDs) were estimated to quantify the relative and absolute inequalities in CIAF prevalence between children of mothers with normal weight and those with underweight mothers, respectively. A total of 19 studies, comprising 536,840 mother‐child pairs, were included in the final analysis. Children of underweight mothers, compared with those of normal‐weight mothers, had 34% higher odds of CIAF (pooled OR: 1.34, 95% CI: 1.25–1.44, n = 375,248), with significant relative (pooled PR: 1.32, 95% CI: 1.06–1.64) and absolute inequalities (pooled PD: 0.13, 95% CI: 0.03–0.23). Subgroup analysis by geographic region showed a significant association between low maternal BMI and increased CIAF odds in children under five (pooled OR: 1.47, 95% CI: 1.39–1.56 in Asia; pooled OR: 1.16, 95% CI: 1.12–1.20 in Africa). No significant evidence of publication bias was detected. These findings indicate that low maternal BMI is significantly associated with an increased risk of CIAF in children under five. Substantial inequities in CIAF prevalence exist across maternal BMI groups, with children of underweight mothers disproportionately affected by higher burdens of CIAF. Prioritising nutritional interventions that address maternal underweight during preconception and pregnancy is essential to reduce multiple forms of undernutrition in children.
Cardiometabolic Outcomes among Adults with Abdominal Obesity and Normal Body Mass Index Kedir Y. Ahmed, Setognal B. Aychiluhm, Subash Thapa, Teketo Kassaw Tegegne, Daniel Bekele Ketema, et al. JAMA Network Open, 2025 ImportanceCardiometabolic disorders are the leading causes of death and disability worldwide, with abdominal obesity being a major contributor to these conditions. Data on normal-weight abdominal obesity and its association with cardiometabolic outcomes are limited.ObjectiveTo investigate the global prevalence of normal-weight abdominal obesity and its association with cardiometabolic outcomes.Design, Setting, and ParticipantsThis cross-sectional study used data from the World Health Organization Stepwise Approach to Surveillance of Noncommunicable Disease Risk Factors survey datasets between 2000 and 2020. The surveys were from 91 countries across Africa, the Americas, the Eastern Mediterranean region, Europe, Southeast Asia, and the Western Pacific region. Adults aged 15 to 69 years or 18 to 69 years (based on participating countries’ national definitions of adult) were included. The data were analyzed between April 2024 and January 2025.ExposureNormal-weight abdominal obesity, which is defined as a normal body mass index (BMI) of 18.5 to 24.9 (calculated as weight in kilograms divided by height in meters squared) but high waist circumference (female, ≥80 cm; male, ≥94 cm).Main Outcomes and MeasuresThe main outcomes were hypertension, diabetes, cholesterol, and triglycerides. Associations with these cardiometabolic outcomes were quantified using multivariable binary logistic regression models.ResultsThe study included 471 228 participants (mean [SD] age, 40.4 [15.9] years; 57.8% female). Globally, 21.7% (95% CI, 21.5%-21.8%) of participants with a normal BMI had abdominal obesity, ranging from 15.3% (95% CI, 15.0%-15.7%) in the Western Pacific region to 32.6% (95% CI, 31.9%-33.3%) in the Eastern Mediterranean region. Lebanon had the highest prevalence of normal-weight abdominal obesity (58.4%; 95% CI, 54.1%-62.6%), while Mozambique had the lowest (6.9%; 95% CI, 5.9%-8.1%). Factors associated with abdominal obesity included primary and secondary or higher education (odds ratio [OR], 1.53 [95% CI, 1.50-1.57] and 2.38 [95% CI, 2.33-2.43], respectively), unemployment (OR, 1.25 [95% CI, 1.23-1.27]), low fruits and vegetables intake (OR, 1.22 [95% CI, 1.20-1.24]), and physical inactivity (OR, 1.60 [95% CI, 1.57-1.63]). Additionally, having a normal BMI and abdominal obesity was consistently associated with hypertension (OR, 1.29 [95% CI, 1.25-1.33]), diabetes (OR, 1.81 [95% CI, 1.72-1.90]), high total cholesterol (OR, 1.39 [95% CI, 1.35-1.44]), and high triglycerides (OR, 1.56 [95% CI, 1.48-1.64]).Conclusions and RelevanceIn this cross-sectional study, more than 1 in 5 adults worldwide with a normal BMI had abdominal obesity. Relying solely on BMI may be insufficient to identify these high-risk individuals and provide timely interventions. The findings have implications for the United Nations’ Sustainable Development Goal targets 2.2 (ending all forms of malnutrition) and 3.4 (reducing premature mortality from noncommunicable diseases).
Cancer Burden Attributable to Potentially Modifiable Risk Factors in Australia Tenaw Tiruye, Bereket Duko, Laychiluh Mekonnen, Paul Ward, Trang H. H. D. Nguyen, et al. Cancers, 2025 Understanding the relative contribution of modifiable risk factors to cancer morbidity and mortality is crucial for designing effective cancer prevention and control strategies. Our study estimated cancer-related deaths and disability-adjusted life years (DALYs) lost attributable to potentially modifiable risk factors in Australia using data from the Global Burden of Diseases 2021 study. In 2021, an estimated 20,409 cancer deaths (37.5%) and 431,575 cancer DALYs lost (37.9%) in Australia were attributable to potentially modifiable risk factors. Males had higher modifiable risk attributed to cancer death and DALY rates than females. Behavioral risks accounted for 25.0% of cancer deaths and 26.5% of DALYs. Metabolic risks and environmental/occupational risks accounted for 9.4% and 9.3% of deaths, respectively. Smoking remained the leading attributable risk factor, accounting for 12.2% cancer deaths and 13.1% DALYs lost. Dietary risks accounted for 40.0% of colorectal cancer deaths and DALYs lost. Cervical, larynx, liver, lung, and colorectal cancers had a high proportion of deaths and DALYs lost attributed to modifiable risks. Liver and nasopharyngeal cancers had the highest burden attributed to alcohol use (39.1% and 39.0%, respectively), while 21.3% liver cancer deaths were attributed to drug use. Strengthening public health interventions, such as multi-disciplinary approaches to promote a healthy lifestyle, is required.
Perinatal and Childhood Risk Factors of Adverse Early Childhood Developmental Outcomes: A Systematic Review Using a Socioecological Model Kendalem Asmare Atalell, Gavin Pereira, Bereket Duko, Sylvester Dodzi Nyadanu, Gizachew A. Tessema Children, 2025 Background: Adverse early childhood developmental outcomes across physical, cognitive, language, communication, and socioemotional domains are major global health concerns. This systematic review aimed to synthesise perinatal and childhood risk factors using a socioecological model. Methods: We searched six databases for cohort, case–control, and cross-sectional studies published between January 2000 and January 2024. Studies reporting risk factors for adverse developmental outcomes were included. Findings were organised across individual, interpersonal, community, and societal levels using a socioecological model. The protocol was registered in PROSPERO (CRD42023447352). Results: A total of 175 studies were included. Individual-level risk factors, including preterm birth, low birth weight, male sex, chronic illness, undernutrition, and excessive screen use, were associated with adverse developmental outcomes, while exclusive breastfeeding, reading books, and storytelling were protective factors. Interpersonal risks included maternal age, education, mental health, and pregnancy complications. Community and societal risks include environmental pollution, access to education, conflict, and healthcare access. Conclusions: Improving early childhood developmental outcomes may require intervention at multiple levels. Future studies may need to focus on the influence of culturally and linguistically diverse backgrounds and environmental exposures on early childhood developmental outcomes.
Socio-ecological determinants of multiple anthropometric failures among under-five children: A systematic review and meta-analysis of observational studies Biniyam Sahiledengle, Paul Russell Ward, Bereket Duko, Kingsley Emwinyore Agho, Lillian Mwanri Plos Global Public Health, 2025 The composite index of anthropometric failure (CIAF) offers a comprehensive measure of the overall burden of undernutrition in children, extending beyond the traditional anthropometric indices to better capture the co-occurrence of multiple anthropometric deficits. Despite its growing use, evidence on the determinants of CIAF remains fragmented and inconclusive. This systematic review and meta-analysis aimed to identify and synthesize the determinants of CIAF among under five children. A comprehensive search of nine major databases was conducted, including MEDLINE (PubMed), Embase (Ovid), Scopus, CINAHL, ProQuest, ScienceDirect, Global Index Medicus, the Cochrane Library, and Google Scholar. Determinants were categorized using a socio-ecological model across intrapersonal, interpersonal, and community levels. Random-effects meta-analyses were conducted to generate pooled odds ratios (ORs), and heterogeneity was assessed using the I² statistic and Cochran’s Q test. Subgroup analyses, sensitivity testing, and publication bias assessment were also performed. Of 6,816 records identified, 56 studies met inclusion criteria (encompassing a total of 1,029,452 under five children). Intrapersonal factors significantly associated with higher odds of CIAF included male sex (OR: 1.17, 95% CI:1.04-1.30), older child age (OR: 1.50, 95% CI: 1.42-1.59), diarrhea (OR: 1.18, 95% CI: 1.08-1.29), fever (OR: 1.08, 95% CI: 1.04-1.13), anemia (OR: 1.22, 95% CI: 1.16-1.29), low birthweight (OR: 2.07, 95% CI: 1.51-2.83), and poor dietary diversity (OR: 1.11, 95% CI: 1.06-1.17). Interpersonal and community-level determinants significantly associated with increased odds of CIAF included low maternal education, maternal unemployment, household poverty, larger family size, food insecurity, and use of unimproved drinking water. We identified key modifiable risk factors associated with CIAF among under five children at different levels, including inadequate dietary intake, childhood morbidity, household food insecurity, limited maternal education, and poor access to safe water. These findings emphasize the need for comprehensive, multi-level interventions that address modifiable risk factors across individual, household, and community levels to reduce childhood multiple anthropometric failures.
Maternal prenatal anxiety and risk of preterm birth and low birthweight: Evidence from a cumulative meta-analysis with stability thresholds B Duko, F Desta, B Sahiledengle, YT Efa, T Tiruye, L Whitehead, ... Comprehensive Psychiatry, 152701 , 2026 2026
Association Between Low Maternal Body Mass Index (BMI) and the Co‐Occurrence of Multiple Forms of Childhood Undernutrition: A Systematic Review and Meta‐Analysis B Sahiledengle, P Ward, B Duko, K Agho, L Mwanri Maternal & Child Nutrition 22 (2), e70188 , 2026 2026
Over 30 years of HIV interventions in Indonesia: a bibliometric analysis and scoping review NK Fauk, CY Kustanti, B Duko, PR Ward AIDS care, 1-27 , 2026 2026 Citations: 1
Correction: Indirect evidence of sex-selective abortion practices to the imbalanced sex ratio at birth in Australian migrant populations AT Gebremedhin, GA Tessema, R Srinivasjois, JA Daire, KEK Chai, ... PLOS Global Public Health 5 (12), e0005747 , 2025 2025
Cardiometabolic outcomes among adults with abdominal obesity and normal body mass index KY Ahmed, SB Aychiluhm, S Thapa, TK Tegegne, DB Ketema, ZY Kassa, ... JAMA network open 8 (10), e2537942 , 2025 2025 Citations: 22
Cancer burden attributable to potentially modifiable risk factors in Australia T Tiruye, B Duko, L Mekonnen, P Ward, THHD Nguyen, S Byrne, D Roder, ... Cancers 17 (19), 3101 , 2025 2025 Citations: 2
Perinatal and Childhood Risk Factors of Adverse Early Childhood Developmental Outcomes: A Systematic Review Using a Socioecological Model KA Atalell, G Pereira, B Duko, SD Nyadanu, GA Tessema Children 12 (8), 1096 , 2025 2025 Citations: 3
Prenatal and early childhood exposure to biothermal stress and developmental vulnerability at school entry in Western Australia: A population-based cohort study KA Atalell, G Pereira, B Duko, SD Nyadanu, M O’Donnell, GA Tessema Environment International 202, 109642 , 2025 2025 Citations: 1
Socio-ecological determinants of multiple anthropometric failures among under-five children: A systematic review and meta-analysis of observational studies B Sahiledengle, PR Ward, B Duko, KE Agho, L Mwanri PLOS Global Public Health 5 (7), e0005008 , 2025 2025 Citations: 1
Developmental vulnerability in children from culturally and linguistically diverse backgrounds in Western Australia: A population-based study KA Atalell, G Pereira, B Duko, SD Nyadanu, V Skirbekk, GA Tessema World Journal of Pediatrics 21 (7), 744-754 , 2025 2025 Citations: 3
Indirect evidence of sex-selective abortion practices to the imbalanced sex ratio at birth in Australian migrant populations AT Gebremedhin, GA Tessema, R Srinivasjois, JA Daire, KA Chai, B Duko, ... PLOS Global Public Health 5 (5), e0004672 , 2025 2025 Citations: 2
Associations between maternal preconception and pregnancy adiposity and neuropsychiatric and behavioral outcomes in the offspring: A systematic review and meta-analysis B Duko, TS Mengistu, D Stacey, LJ Moran, G Tessema, G Pereira, ... Psychiatry research 342, 116149 , 2024 2024 Citations: 17
Perinatal and early life risk factors of adverse early childhood developmental outcomes: Protocol for systematic review using socioecological model KA Atalell, G Pereira, B Duko, SD Nyadanu, GA Tessema Plos one 19 (10), e0311500 , 2024 2024 Citations: 5
Prevalence of common mental disorder and its association with perceived stigma and social support among people living with HIV/AIDS in Ethiopia: a systematic review and meta … B Duko, Y Belayhun, A Bedaso International Journal of Mental Health Systems 18 (1), 25 , 2024 2024 Citations: 4
The effect of maternal prenatal tobacco smoking on offspring academic achievement: a systematic review and meta-analysis B Duko, A Bedaso, BA Dachew, E Newnham, AT Gebremedhin, ... Addictive Behaviors 153, 107985 , 2024 2024 Citations: 7
Diabetic and hypertensive disorders following early pregnancy loss: a systematic review and meta-analysis J Dunne, D Foo, BA Dachew, B Duko, AT Gebremedhin, SD Nyadanu, ... EClinicalMedicine 71 , 2024 2024 Citations: 12
The effects of pre-eclampsia on social and emotional developmental vulnerability in children at age five in Western Australia: a population data linkage study B Duko, AT Gebremedhin, GA Tessema, J Dunne, R Alati, G Pereira Journal of Affective Disorders 352, 349-356 , 2024 2024 Citations: 5
Associations between endometriosis and adverse pregnancy and perinatal outcomes: a population-based cohort study AT Gebremedhin, VR Mitter, B Duko, GA Tessema, GF Pereira Archives of gynecology and obstetrics 309 (4), 1323-1331 , 2024 2024 Citations: 19
Maternal exposure to ambient air temperature and adverse birth outcomes: an umbrella review of systematic reviews and meta-analyses SD Nyadanu, J Dunne, GA Tessema, B Mullins, B Kumi-Boateng, ML Bell, ... Science of the Total Environment 917, 170236 , 2024 2024 Citations: 64
Influence of preterm birth on the association between gestational diabetes mellitus and childhood developmental vulnerability: a causal mediation analysis B Duko, AT Gebremedhin, GA Tessema, G Pereira World Journal of Pediatrics 20 (1), 54-63 , 2024 2024 Citations: 8
MOST CITED SCHOLAR PUBLICATIONS
Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020 D Bryazka, MB Reitsma, MG Griswold, KH Abate, C Abbafati, ... The Lancet 400 (10347), 185-235 , 2022 2022 Citations: 658
Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the … TD Frank, A Carter, D Jahagirdar, MH Biehl, D Douwes-Schultz, ... The lancet HIV 6 (12), e831-e859 , 2019 2019 Citations: 613
Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017 SL James, CD Castle, ZV Dingels, JT Fox, EB Hamilton, Z Liu, ... Injury Prevention 26 (Suppl 2), i96-i114 , 2020 2020 Citations: 583
The COVID-19 pandemic and healthcare systems in Africa: a scoping review of preparedness, impact and response GA Tessema, Y Kinfu, BA Dachew, AG Tesema, Y Assefa, KA Alene, ... BMJ global health 6 (12) , 2021 2021 Citations: 350
Anemia prevalence in women of reproductive age in low-and middle-income countries between 2000 and 2018 D Kinyoki, AE Osgood-Zimmerman, NV Bhattacharjee, NJ Kassebaum, ... Nature medicine 27 (10), 1761-1782 , 2021 2021 Citations: 262
The prevalence of alcohol use disorders among people living with HIV/AIDS: a systematic review and meta-analysis B Duko, M Ayalew, G Ayano Substance abuse treatment, prevention, and policy 14 (1), 52 , 2019 2019 Citations: 247
Prevalence and correlates of depression and anxiety among patients with tuberculosis at WolaitaSodo University Hospital and Sodo Health Center, WolaitaSodo, South Ethiopia … B Duko, A Gebeyehu, G Ayano BMC psychiatry 15 (1), 214 , 2015 2015 Citations: 233
Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study SL James, CD Castle, ZV Dingels, JT Fox, EB Hamilton, Z Liu, ... Injury Prevention 26 (Suppl 2), i125-i153 , 2020 2020 Citations: 196
The prevalence of depression among patients with tuberculosis: a systematic review and meta-analysis B Duko, A Bedaso, G Ayano Annals of general psychiatry 19 (1), 30 , 2020 2020 Citations: 191
Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000–17: analysis for the Global Burden of Disease … RC Reiner, KE Wiens, A Deshpande, MM Baumann, PA Lindstedt, ... The Lancet 395 (10239), 1779-1801 , 2020 2020 Citations: 176
Prenatal exposure to ambient air pollution and adverse birth outcomes: an umbrella review of 36 systematic reviews and meta-analyses SD Nyadanu, J Dunne, GA Tessema, B Mullins, B Kumi-Boateng, ML Bell, ... Environmental pollution 306, 119465 , 2022 2022 Citations: 162
Prevalence and factors associated with preoperative anxiety among patients undergoing surgery in low-income and middle-income countries: a systematic review and meta-analysis A Bedaso, N Mekonnen, B Duko BMJ open 12 (3), e058187 , 2022 2022 Citations: 150
Author Correction: Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017 GBD collabortors Nature medicine , 2020 2020 Citations: 128
Depression among caregivers of cancer patients: Updated systematic review and meta‐analysis A Bedaso, G Dejenu, B Duko Psycho‐Oncology 31 (11), 1809-1820 , 2022 2022 Citations: 119
Triage knowledge and skills among nurses in emergency units of Specialized Hospital in Hawassa, Ethiopia: cross sectional study B Duko, E Geja, Z Oltaye, F Belayneh, A Kedir, M Gebire BMC research notes 12 (1), 21 , 2019 2019 Citations: 105
Mapping inequalities in exclusive breastfeeding in low-and middle-income countries, 2000–2018 NV Bhattacharjee, LE Schaeffer, SI Hay Nature Human Behaviour 5 (8), 1027-1045 , 2021 2021 Citations: 101
Perceived stigma and associated factors among patient with tuberculosis, Wolaita Sodo, Ethiopia: Cross‐sectional study B Duko, A Bedaso, G Ayano, Z Yohannis Tuberculosis research and treatment 2019 (1), 5917537 , 2019 2019 Citations: 100
Depression among pregnant women and associated factors in Hawassa city, Ethiopia: an institution-based cross-sectional study B Duko, G Ayano, A Bedaso Reproductive health 16 (1), 25 , 2019 2019 Citations: 96
Prevalence and associated factors of depression among patients with HIV/AIDS in Hawassa, Ethiopia, cross-sectional study B Duko, E Geja, M Zewude, S Mekonen Annals of general psychiatry 17 (1), 45 , 2018 2018 Citations: 96
Epidemiology of depression among displaced people: a systematic review and meta-analysis A Bedaso, B Duko Psychiatry research 311, 114493 , 2022 2022 Citations: 82
