Abstract
Globally, overweight/obesity is rising rapidly while anaemia persists. Nevertheless, evidence on their coexistence at the household level remains limited. Using data from the Demographic and Health Surveys, we quantified the magnitude, distribution and inequalities (i.e., estimates by wealth, education level and residence) in the intra‐household double burden (DBM) of overweight/obesity and anaemia among mothers and their children living in 49 low‐ and middle‐income countries (LMICs). The pooled prevalence of total intra‐household DBM was 17.2% (95% confidence interval [CI]: 15.6, 18.8); 16.2% (95% CI: 14.6, 17.9) for mothers with overweight/obesity and children with anaemia; and 2.8% (95% CI: 2.5, 3.1) for mothers with anaemia and children with overweight/obesity. South Africa had the highest prevalence of total DBM at the household level, affecting almost one in three households. Households with mothers with overweight/obesity and children with anaemia followed an inverse social gradient, with higher estimates found in the richest quintile, highest maternal education level and in urban areas; although with some variation across regions. The opposite was observed for mothers with anaemia and children with overweight/obesity. The largest inequality gaps were found for mothers with overweight/obesity and children with anaemia in Togo by household wealth (29.3%‐points; p < 0.001), in Ghana by maternal education level (28.0%‐points; p = 0.001) and in Niger by area of residence (25.2%‐points; p < 0.001). Although double‐duty actions might help accelerate action towards reducing malnutrition in all its forms, a comprehensive assessment of the causes of anaemia is first warranted to design effective country‐specific programmes.
Highlights
In low‐and middle‐income countries (LMICs) women and children are disproportionally affected by malnutrition, where forms of undernutrition coexist with overweight/obesity within individuals, households and populations across the life‐course (Development Initiatives, 2020; Popkin et al, 2020)
Studies from individual countries point to a high prevalence of intra‐household co‐occurrence of overweight/obesity among mothers and anaemia in children (Sassi et al, 2018; Varghese & Stein, 2019). To address these gaps in knowledge, we aimed to examine the magnitude, distribution and inequalities in the intra‐ household double burden of overweight/obesity and anaemia by household wealth, education level and area of residence, among mothers and their children under‐5 living in LMICs
To the best of our knowledge, no previous studies have comprehensively explored the prevalence of overweight/obesity and anaemia among mothers and their children under‐5 at the household level across LMICs, as well as its distribution and inequalities by socioeconomic measures
Summary
In low‐and middle‐income countries (LMICs) women and children are disproportionally affected by malnutrition, where forms of undernutrition coexist with overweight/obesity within individuals, households and populations across the life‐course (Development Initiatives, 2020; Popkin et al, 2020). Overlapping forms of malnutrition referred as the double burden of malnutrition (DBM), are the direct consequence of increases in the prevalence of overweight/obesity over the last decades, as a result of the ongoing nutrition transition and food system transformations in LMICs, coupled up with persistent forms of undernutrition (including micronutrient deficiencies; Popkin et al, 2020; WHO, 2017). Anaemia currently affects 32.8% of women of reproductive age (15–49 years old) and 43.0% of children under‐5 (Balarajan et al, 2011; Development Initiatives, 2020), causing physical and cognitive impairments, fatigue and low productivity (Haas & Brownlie, 2001; WHO, 2014). Other identified risk factors for anaemia include infectious diseases, inflammation, haemoglobinopathies or parasitic infections (Chaparro & Suchdev, 2019)
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