Double burden of malnutrition among under-five children in Eastern and Southern African countries

There is limited evidence on the burden and drivers of the co-occurrence of overweight/obesity and undernutrition at the individual level in low- and middle-income countries. This gap hinders the design of double-duty actions (DDAs) that can effectively address all forms of malnutrition. This multi-country study aimed to determine the magnitude of double burden of malnutrition (DBM) among under five children and identify household and individual level determinants in Eastern and Southern Africa (ESA) countries. We pooled data of 79,394 children aged 6-59 months, collected from Demographic and Health Surveys (DHS) conducted in 12 ESA countries between 2013 and 2016. We identified confounders a priori. A random effect logistic regression was performed to identify factors associated with the co-occurrence of Stunting and Overweight (StOw), Overweight and Anemia (OwA), and Stunting Overweight and Anemia (StOwA). The study revealed that the burden of co-occurrence of StOwA, StOw, and OwA among under-five children were 5.38%; 95% confidence interval (CI) (5.00-5.79), 4.04 (95% CI: 3.86-4.23), and 5.72% (95% CI: 5.40-6.04), respectively. South Africa had the highest burden of co-occurrence of StOwA (15.58%) and OwA (22.30%), while Namibia and Burundi had the lowest StOwA (2.19%) and OwA (2.78%), respectively. Male children were more likely than female children to experience co-occurrence of StOwA [adjusted odds ratio (AOR) (95% CI): 1.96 (1.49-2.57)], OwA [AOR = 1.51: (95% CI) (1.22, 1.86)], and StOw [AOR = 1.59: (95% CI) (1.36, 1.87)]. Children from the poorest and poorer households had higher odds of co-occurrence of StOwA, OwA, and StOw compared to those from the richest households. Compared to children born to mothers with normal body mass index, those born to mothers with overweight/obese had 60% and 39% higher risk, whereas those born to mothers who were underweight had 49% and 36% lower risk of StOw and OwA, respectively. The DBM among children poses a significant public health and economic problem in ESA countries. The DDAs approach should be strengthened in the ESA region to address all forms of malnutrition.