Mapping transitions and inequalities in the burden of malnutrition among Chinese children and adolescents: a dual-level analysis of 6 nationwide surveys, 1995 to 2019.

Prevalence and Correlates of Double and Triple Burden of Malnutrition Among Children and Adolescents in India: The Comprehensive National Nutrition Survey

BackgroundEvidence on double and triple burdens of malnutrition at household level among child-mother pairs is a key towards addressing the problem of malnutrition. In Ethiopia, studies on double and triple burdens of malnutrition are scarce. Even though there is a study on double burden of malnutrition at national level in Ethiopia, it doesn’t assess the triple burdens at all and a few forms of double burden of malnutrition. Therefore, this study aimed to determine the prevalence and associated factors of double and triple burdens of malnutrition among child-mother pairs in Ethiopia.MethodsA total sample of 7,624 child-mother pairs from Ethiopian Demographic and Health Survey (EDHS) 2016 were included in the study. All analysis were performed considering complex sampling design. Anthropometric measures and hemoglobin levels of children, as well as anthropometric measurements of their mothers, were used to calculate double burden of malnutrition (DBM) and triple burden of malnutrition (TBM). Spatial analysis was applied to detect geographic variation of prevalence of double and triple burdens of malnutrition among EDHS 2016 clusters. Bivariable and multivariable binary survey logistic regression models were used to assess the factors associated with DBM and TBM.ResultsThe overall weighted prevalence of DBM and TBM respectively were 1.8% (95%CI: 1.38–2.24) and 1.2% (95%CI: 0.83–1.57) among child-mother pairs in Ethiopia. Significant clusters of high prevalence of DBM and TBM were identified. In the adjusted multivariable binary survey logistic regression models, middle household economic status [AOR = 0.23, 95%CI: 0.06, 0.89] as compared to the poor, average birth weight [AOR = 0.26, 95%CI: 0.09, 0.80] as compared to large birth weight and children aged 24–35 months [AOR = 0.19, 95%CI: 0.04,0.95] as compared to 6–12 months were less likely to experience DBM. Average birth weight [AOR = 0.20, 95%CI: 0.05, 0.91] as compared to large birth weight and time to water source <=30 min [AOR = 0.41, 95%CI: 0.19,0.89] as compared to on premise were less likely to experience TBM.ConclusionThere is low prevalence of DBM and TBM among child-mother pairs in Ethiopia. Interventions tailored on geographic areas, wealth index, birth weight and child birth could help to control the emerging DBM and TBM at household level among child-mother pairs in Ethiopia.

Objective:To establish the prevalence of double burden of malnutrition (DBM) and triple burden of malnutrition (TBM) among mother–child pairs in Malawi and explore their geographical distribution and associated multilevel factors.Design:Cross-sectional study using secondary data from the 2015–2016 Malawi Demographic and Health Survey using a mixed effects binomial model to identify multilevel factors associated with DBM and TBM. Georeferenced covariates were used to map the predicted prevalence of DBM and TBM.Setting:All twenty-eight districts in Malawi.Participants:Mother–child pairs with mothers aged 15–49 years and children aged below 60 months (n 4618 pairs) for DBM and between 6 and 59 months (n 4209 pairs) for TBM.Results:Approximately 5·5 % (95% confidence interval (CI): 4·7 %, 6·4 %) of mother–child pairs had DBM, and 3·1 % (95 % CI: 2·5 %, 4·0 %) had TBM. The subnational-level prevalence of DBM and TBM was highest in cities. The adjusted odds of DBM were threefold higher (adjusted Odds Ratio, AOR: 2·8, 95 % CI: 1·1, 7·3) with a higher proportion of wealthy households in a community. The adjusted odds of TBM were 60 % lower (AOR: 0·4; 95 % CI: 0·2, 0·8) among pairs where the women had some education compared with women with no education.Conclusions:Although the prevalence of DBM and TBM is currently low in Malawi, it is more prevalent in pairs with women with no education and in relatively wealthier communities. Targeted interventions should address both maternal overnutrition and child undernutrition in cities and these demographics.

The double burden of malnutrition (DBM) and triple burden of malnutrition (TBM) remain a public health challenge in developing countries. This study examines the prevalence and factors associated with DBM and TBM in mother-child pairs in Guinea. A sample of 2605 mother-child pairs drawn from the fifth Guinea Demographic and Health Survey conducted in 2018 was selected for this study. Anthropometric measurements of children and their mothers and children's hemoglobin levels were collected. Univariate and multivariate regression analyses were performed to identify factors associated with DBM and TBM. The prevalence of DBM and TBM in mother-child pairs in households in Guinea were 9.6% (95% CI: 8.3-11.2) and 7.3% (95% CI: 6.1-8.6) respectively. Mothers who delivered by caesarean section (AOR = 2.63; 95% CI: 1.06-6.58), wealthy households (AOR = 2.17; 95% CI: 1.15-4.09) and mothers with 4 or more children (AOR = 2.18; 95% CI: 1.08-4.38) were factors significantly associated with the double burden of malnutrition. Wealthy households (AOR = 2.11; 95% CI: 1.04-4.29) and Caesarean delivery (AOR = 2.40; 95% CI: 1.06-5.42) were factors significantly associated with the triple burden of malnutrition. Multiparity was associated with DBM and wealthier households and caesarean section were positively associated with DBM and TBM. Public health actions focused on women of childbearing age should be undertaken to curb the development of this scourge.

BackgroundMalnutrition in mothers and children is a significant public health challenge in developing countries such as Nepal. Although undernutrition in children has been gradually decreasing, the coexistence of various forms of malnutrition in mothers and children has continued to rise globally. There is a gap in knowledge of the coexistence of such multiple burdens of malnutrition in the Nepalese context. The aims of this study were to explore the coexistence of various forms of malnutrition and associated factors among mother-child pairs residing in the same household.MethodsA total sample of 2261 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 were included in the study. Anthropometric measurements and hemoglobin levels of children and anthropometric measurements of their mothers were collected. Bivariate and multivariable logistic regression models were used to assess the factors associated with the double burden of malnutrition (DBM) and the triple burden of malnutrition (TBM).ResultsPrevalence of DBM and TBM was 6.60% (95% CI: 5.13–8.84) and 7.00% (95% CI: 5.42–8.99) respectively in the same households. In the adjusted multivariable logistic regression models, mothers with short stature (AOR = 4.18, 95% CI: 2.04–8.52), from the richest wealth quintile (AOR = 2.46, 95% CI: 1.17–5.15), aged over 35 years (AOR = 3.08, 95% CI: 1.20–7.86), and those who had achieved at least secondary level education (AOR = 2.05, 95% CI: 1.03–4.07) were more likely to suffer from the DBM. Similarly, mothers with short stature (AOR = 5.01, 95% CI: 2.45–10.24), from the richest wealth quintile (AOR = 2.66, 95% CI: 1.28–5.54), aged over 35 years (AOR = 3.41, 95% CI: 1.26–9.17), and those who had achieved at least secondary level education (AOR = 2.05, 95% CI: 1.00–4.18) were more likely to suffer from the TBM.ConclusionsOverall, there is a low prevalence of double and triple burden of malnutrition among mother-child pairs in Nepal. Older mothers with short stature and those from richer wealth quintiles were more likely to suffer from double and triple burden of malnutrition.

Background and Aims: In recent decades, lifestyle patterns have undergone significant transformations, particularly in low- and middle-income countries (LMICs). These changes have contributed to a dual nutritional crisis characterized by the coexistence of undernutrition and overweight/obesity, commonly referred to as the Double Burden of Malnutrition (DBM). Compounding this issue is the persistent prevalence of parasitic infections, due to poor personal hygiene and sanitation practices which further exacerbate nutritional imbalances, creating what is now recognized as the Triple Burden of Malnutrition (TBM). This review aims to explore the evolving lifestyle factors that have contributed to the emergence of the DBM and to examine its intersection with parasitic infections. The focus is particularly on South Asian low- and middle-income countries, where these overlapping burdens present a significant public health challenge. By highlighting the interconnectedness of malnutrition, obesity, and parasitic diseases, this study seeks to provide a comprehensive understanding of the current nutritional landscape in South Asian LMICs and to inform future health interventions and policies. Methods: This study was conducted using published and unpublished secondary data that are available on websites and other printed materials. One of the main requirements is date, with 2013 being regarded as the initiative’s landmark. Another crucial factor is the availability of the entire article. For this study, only research publications published in English were taken into consideration. Zotero was used for compilation. The majority of the analysis was performed using percentages and ratios. A thorough evaluation of all the studies’ methodology, design, execution, and reporting was performed in order to spot any systematic flaws in this study. Results: Only 45 of the 105 full-text papers that were screened met the requirements for inclusion. Of these studies, 15 satisfied the inclusion and exclusion requirements. The results show that China, with a comparatively higher income level status, has more prevalence of overweight and obesity among children (11.5%) and women (34.6%) than India (2.1% of OWOB among children and 20.6% among women). Nepal stands behind China and India with 1.2% of OWOB among children and between them with 22.2% OWOB among women. Interestingly, among the three South Asian nations, India has the highest stunting, wasting, and underweight among children (38.4%, 21%, and 35.7%, respectively) followed by Nepal (35.8%, 9.7%, and 27%) and China (8.1%, 2%, and 2.5%). This study finds no significant difference in the prevalence of intestinal parasitic infections among OWOB and underweight populations. This review finds that the DBM along with parasitic infections has resulted in a Triple Burden of Malnutrition, which is currently a major public health issue in low- and middle-income countries in South Asia. Discussion: The various types of malnutrition were once thought of and treated as distinct public health problems, but the new understanding is that undernutrition and overnutrition are linked, and that in order for policy solutions to be successful, double-duty measures that simultaneously address multiple dimensions must be put in place. When the DBM is combined with parasite illnesses, it becomes the Triple Burden of Malnutrition, which is the primary cause of the financial burden in LMICs. China has the worst obesity problem, yet it also has more obesity-related laws and intervention programs than India and Nepal combined. All three nations, however, have failed to stop or deal with the dramatic increase in OWOB over the last 20 years. For effective implementation and results, genetic and psychological factors must also be taken into account when developing policies and programs to tackle the obesity epidemic, undernutrition, and parasite diseases. Conclusions: The prevalence of the DBM has been rising globally, with South Asia seeing a faster rate of increase. A growing DBM is favorably correlated with national economic development. In South Asian LMICs, the DBM combined with parasite diseases has resulted in a Triple Burden of Malnutrition, a debilitating illness.

Patterns of the triple burden of childhood malnutrition in Ecuador by age, sex, ethnicity, and poverty: a cross-sectional population survey

BackgroundThe Caribbean faces a growing nutrition crisis marked by the double burden of malnutrition — the simultaneous presence of childhood undernutrition and rising obesity. Despite policy progress, malnutrition persists across socioeconomic lines, threatening long-term public health and development outcomes.ObjectiveThis narrative review explores the epidemiological trends, biochemical consequences, social determinants, and policy responses to childhood malnutrition in the Caribbean. It highlights barriers and opportunities for public health action, with a focus on equity and sustainability.MethodsThis narrative review was informed by a structured bibliographic search conducted between January and June 2025. Sources were identified through PubMed, Scopus, Web of Science, and Google Scholar using combinations of terms such as 'childhood malnutrition', 'double burden’, ‘nutrition policy', 'obesity', 'stunting', 'food security', and 'micronutrient deficiencies', each linked to 'Caribbean'. Grey literature was obtained from Food and Agriculture Organization of the United Nations (FAO), the Pan American Health Organization (PAHO), the Caribbean Public Health Agency (CARPHA), the Healthy Caribbean Coalition (HCC), and the Caribbean Food and Nutrition Institute (CFNI).ResultsUndernutrition remains significant in low-income populations, with stunting and micronutrient deficiencies such as anaemia persisting across several countries. Simultaneously, childhood overweight and obesity are increasing rapidly, especially in urban settings. Biochemical evidence reveals an early onset of metabolic dysfunction and hidden hunger (micronutrient deficiencies), both of which contribute to a higher burden of non-communicable diseases (NCDs). Structural drivers include poverty, food insecurity, and ultra-processed diets. Weak health systems exacerbate disparities. While national policies such as sugar-sweetened beverage (SSB) taxes, food fortification, and school-based nutrition programmes show promise, their implementation is often fragmented and under-resourced.ConclusionsAddressing the double burden of childhood malnutrition in the Caribbean will require multisectoral convergence, stronger data systems, targeted fiscal policies, and equity-driven interventions. Regional collaboration and investment in locally led research will be critical to designing sustainable solutions. The urgency of this crisis demands bold, coordinated action to protect the nutritional well-being of the Caribbean’s next generation.

Despite concerns about the coexistence of overnutrition, undernutrition and micronutrient deficiencies, which is compositely referred to as the triple burden of malnutrition (TBM), little is known about the phenomenon in sub-Saharan Africa (SSA). We, therefore, aimed to examine the prevalence and investigate the factors associated with TBM in SSA. This study uses cross-sectional survey data collected through the Demographic and Health Surveys (DHS) Program from 2010 to 2019. Data from 32 countries in SSA were used for the analysis. The prevalence of TBM were presented in tables and maps using percentages. The predictors of TBM were examined by fitting a negative log-log regression to the data. The results were then presented using adjusted odds ratios (aORs) at 95% Confidence Intervals (CIs). Out of the 169,394 children, 734 (1%) suffered from TBM. The highest proportion of children with TBM in the four geographic regions in SSA was found in western Africa (0.75%) and the lowest in central Africa (0.21%). Children aged 1 [aOR = 1.283; 95% CI = 1.215–1.355] and those aged 2 [aOR = 1.133; 95% CI = 1.067–1.204] were more likely to experience TBM compared to those aged 0. TBM was less likely to occur among female children compared to males [aOR = 0.859; 95% CI = 0.824–0.896]. Children whose perceived size at birth was average [aOR = 1.133; 95% CI = 1.076–1.193] and smaller than average [aOR = 1.278; 95% CI = 1.204–1.356] were more likely to suffer from TBM compared to those who were larger than average at birth. Children born to mothers with primary [aOR = 0.922; 95% CI = 0.865–0.984] and secondary [aOR = 0.829; 95% CI = 0.777–0.885] education were less likely to suffer from TBM compared to those born to mothers with no formal education. Children born to mothers who attended antenatal care (ANC) had lower odds of experiencing TBM compared to those born to mothers who did not attend ANC [aOR = 0.969; 95% CI = 0.887–0.998]. Children born to mothers who use clean household cooking fuel were less likely to experience TBM compared to children born to mothers who use unclean household cooking fuel [aOR = 0.724; 95% CI = 0.612–0.857]. Essentially, higher maternal education, ANC attendance and use of clean cooking fuel were protective factors against TBM, whereas higher child age, low size at birth and being a male child increased the risk of TBM. Given the regional variations in the prevalence and risk of TBM, region-specific interventions must be initiated to ensure the likelihood of those interventions being successful at reducing the risk of TBM. Countries in Western Africa in particular would have to strengthen their current policies and programmes on malnutrition to enhance their attainment of the SDGs.

The triple burden of malnutrition (TBM) is increasing globally, but significant evidence gaps exist regarding its burden and drivers among children in Southeast Asian (SEA) countries. We systematically searched four databases (PROSPERO-CRD42023420129) and Google Scholar through February 2024. We assessed stunting and overweight prevalence among children aged 0–18 years old across four SEA countries (Indonesia, Malaysia, Thailand, and Vietnam) from recent national surveys. We conducted random-effect meta-analyses to estimate the pooled prevalence of micronutrient deficiencies, and the pooled odds ratio for TBM-associated determinants using an adapted socio-ecological framework. 176 studies were included for systematic review, with 132 studies eligible for meta-analysis. Our findings illustrate significant variation in TBM across countries, dependent on region, age, and sex. Pooled prevalence [95% CI] of anemia, iron, vitamin A, and D deficiencies were 25% [22, 29], 14% [10, 18], 6% [4, 8], and 40% [32, 48], respectively (I2>90%). Determinants of the TBM included child-individual factors, poor early-life nutrition, and family household characteristics including maternal nutrition and education, socioeconomic, family size, sanitation, and food security. However, macro-level environmental impacts were less documented. Our findings emphasize the need for robust, timely monitoring of TBM data, including micronutrient biomarkers, and targeted policy intervention in SEA countries.

Identifying territorial inequalities in the population-level double burden of child malnutrition in Argentina: A joint spatial modeling approach.

Prevalence and socio-demographic factors associated with double and triple burden of malnutrition among mother-child pairs in India: Findings from a nationally representative survey (NFHS-5)

Background: There is a high prevalence of the double burden of malnutrition (DBM) in children and adolescents in South Asia. This research aims to explore which sociodemographic factors are attributed to DBM in urban Bangladesh, a South Asian country. Methods: We conducted secondary analyses of data obtained from the national survey of childhood obesity among school-age children in Bangladesh (2012–2013). The sample includes 4140 children (aged 5–9 years) and adolescents (10–19 years) randomly recruited from the city corporation (urban) areas in all administrative divisions. At the population level, DBM was defined as the coexistence of underweight and overweight/obesity among children and adolescents. At the household level, DBM was defined as maternal underweight co-occurring with child overweight/obesity within the same mother-child dyad. A multivariable logistic regression model was fitted to estimate odds ratios and 95% confidence intervals. A rapid policy review was conducted to understand the implication of the results obtained from the analysis. Results: The prevalence of DBM at the population level was 45.2% (95% CI: 42.5–45.5%), ranging between 40.0% and 47.6% across seven divisions (p < 0.001). At the household level, DBM prevalence was 16.6% (95% CI: 14.7–18.7%), ranging between 14.0% and 19.0% across seven divisions (p = 0.015). At the population level, DBM odds were 56% higher among younger children (5–9 years) than adolescents (10–19 years) (OR: 1.56; 95% CI: 1.37–1.78), and this association was found in four divisions. At the household level (mother-child pairs), DBM odds were 64% higher in younger children than adolescents (OR: 1.64; 95% CI:1.38–1.95); and higher in children living at a lower-middle socioeconomic status (SES) and middle SES, than upper SES. The policy review revealed that Bangladesh has made substantial commitments to improve nutrition; however, reference to DBM is absent from policy documents. Conclusions: The prevalence of DBM is high among children in urban areas in Bangladesh, disproportionately affecting younger children and households with low SES. In the current policy space, Bangladesh should revise national nutrition frameworks to recognize DBM as a public health priority and implement region-sensitive strategies for preventing and reducing malnutrition among school-aged children.

In spite of the implementation of several nutrition specifc initiatives in the country, India is still struggling to limit burden of malnutrition among preschool children. The aim of this study was to identify the correlates of the Double (DBM) and Triple (TBM) Burden of Malnutrition among children in India. Information about 1,99,534 children in the age group 6-59 months was obtained from the fourth round of the National Family Health Survey (NFHS - 4). For age stratifed analysis, age groups were created as 6-23 months, 24-35 months and 35+ months. The prevalence of DBM and TBM was found to be 40% and 16% respectively. All children who belonged to Scheduled Caste (SC) or Scheduled Tribe (ST) and to poorest household and born at higher birth orders, etc were found to be signifcantly affected with DBM and TBM. The study recommends that government policies need to specifcally address nutritional needs of socially disadvantaged children. Also, policies should acknowledge the importance of women’s education and awareness about family planning practices to control its effect on child malnutrition.

BackgroundIndia is strongly committed to reducing the burden of child malnutrition, which has remained a persistent concern. Findings from recent surveys indicate co-existence of child undernutrition, micronutrient deficiency and overweight/obesity, i.e. the triple burden of malnutrition among children below 5 years. While considerable efforts are being made to address this challenge, and several composite indices are being explored to inform policy actions, the methodology used for creating such indices, i.e., linear averaging, has its limitations. Briefly put, it could mask the uneven improvement across different indicators by discounting the ‘lagging’ indicators, and hence not incentivising a balanced improvement. Signifying negative implications on policy discourse for improved nutrition. To address this gap, we attempt to develop a composite index for estimating the triple burden of malnutrition in India, using a more sensitive measure, MANUSH.MethodologyData from publicly available nation-wide surveys - National Family Health Survey (NFHS) and Comprehensive National Nutrition Survey (CNNS), was used for this study. First, we addressed the robustness of MANUSH method of composite indexing over conventional aggregation methods. Second, using MANUSH scores, we assessed the triple burden of malnutrition at the subnational level over different periods NHFS- 3(2005–06), NFHS-4 (2015–16) and CNNS (2106–18). Using mapping and spatial analysis tools, we assessed neighbourhood dependency and formation of clusters, within and across states.ResultMANUSH method scores over other aggregation measures that use linear aggregation or geometric mean. It does so by fulfilling additional conditions of Shortfall and Hiatus Sensitivity, implicitly penalising cases where the improvement in worst-off dimension is lesser than the improvement in best-off dimension, or where, even with an overall improvement in the composite index, the gap between different dimensions does not reduce. MANUSH scores helped in revealing the gaps in the improvement of nutrition outcomes among different indicators and, the rising inequalities within and across states and districts in India. Significant clusters (p < 0.05) of high burden and low burden districts were found, revealing geographical heterogeneities and sharp regional disparities. A MANUSH based index is useful in context-specific planning and prioritising different interventions, an approach advocated by the newly launched National Nutrition Mission in India.ConclusionMANUSH based index emphasises balanced development in nutritional outcomes and is hence relevant for diverse and unevenly developing economy like India.