Objective: Estimate levels of and identify factors contributing to child malnutrition in Tigray, Northern Ethiopia. Design: Cross-sectional survey. Setting: Rural communities from four zones of Tigray. Subjects: Three hundred and eighteen under five children representing 587 randomly selected households were included. Results: Among the children surveyed, 46.9%, 33.0% and 11.6% were stunted, underweight and wasted, respectively. Older children were more likely to be undernourished. Stunting increases from 16% in the second half of the first year to 53% in children 24 months and older. Similarly, underweight increases from 10% in the first six months to 36.5% in children aged 24 months and older. A very high proportion of the mothers (80%) initiated feeding of newborns with pre-lacteal feeds primarily butter or water. Family foods and cereal-based porridge were the main complementary foods after six months. Child age, maternal anthropometric characteristics, inadequate complementary foods, the use of prelacteal feeds and area of residence were the main contributing factors to child undernutrition. Conclusion: Undernutrition gets worse as the children grow older. The energy and nutrient density of the complementary foods are low as the foods were prepared from a limited number of local staple cereals without the addition of sugar, fat/oil or animal products. More importantly, these foods are diluted with water to reduce their viscosity. This makes the quality and quantity of the foods insufficient to prevent stunting and underweight. Promotion of traditional household technologies such as germination and fermentation may be affordable measures to improve the quality of the complementary foods. Thus, sustained nutrition education programmes focusing on appropriate complementary feeding practices are recommended.