School-Based Nutrition Programs for Adolescents in Dodoma, Tanzania: A Situation Analysis.

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.

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

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.

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

Background: The double burden of malnutrition (DBM), the simultaneous existence of both underweight and overweight sequelae, is an emerging public health concern in low- and middle-income countries (LMICs). Women of child-bearing age (15-49 years) and preschool children (under 5 years) are among the most vulnerable groups to be affected by the DBM. However, the DBM phenomenon among these population subgroups is understudied. Objectives: We explored the following objectives: 1) To determine which nutrition indicators have been used to define the DBM among women of child-bearing age and preschool children; 2) To establish the plausible explanations for the identified DBM phenotypes women of child-bearing age and preschool children; and 3) To identify the risk factors for the DBM women of child-bearing age and preschool children. Methods: We systematically searched for literature from the following databases: EMBASE, CINAHL, MEDLINE, LILACS, Scopus and ProQuest Dissertations &amp; Thesis Global. Studies discussing the DBM phenomenon in LMICs were included. Thematic analysis was conducted on extracted information from the literature to reveal emerging themes from included studies. The findings were reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Results: Preliminary findings indicate that frequently used indicators for defining DBM across all levels of operationalization were anthropometric indices and micronutrients measurements (e.g., overweight/obesity and anemia) for women and anthropometric indices (e.g., overweight/obesity and stunting) for preschool children. The following themes emerged as plausible explanations for the DBM phenotypes: Food insecurity; diet behavior; breastfeeding; illness and metabolic programming. Age, child sex, household wealth, women’s education, occupation and urbanization were frequently occurring DBM risk factors. Of note was the use of the term ‘double burden’ as a buzz word in substantial number of studies without a proper definition or discussion of the DBM concept. Conclusion: The DBM phenomenon is loosely understood due to the varying operational definitions of the DBM construct. Emerging themes and common risk factors may provide target areas for public health interventions. Studies with robust designs are needed to succinctly understand the DBM phenomenon.

This scoping review synthesized the evidence on double-duty actions targeted at adolescents to address the double burden of malnutrition (DBM). Adolescents face unique challenges related to the DBM, including both undernutrition and overweight, obesity, or diet-related noncommunicable diseases (NCDs). Understanding effective strategies for addressing these issues is critical. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. We examined studies from MEDLINE, Embase, CENTRAL, CINAHL, and Google Scholar on double-duty actions, defined as an array of interventions, programs, and policies that aim to simultaneously reduce the risk or burden of both undernutrition (including wasting, stunting and micronutrient deficiency) and overweight, obesity or diet-related NCDs. The evidence was analyzed through narrative synthesis. Our comprehensive search of the published and gray literature identified 17 publications representing 16 studies. These included 5 cluster randomized controlled trials, 2 evaluation studies, and 10 quasi-experimental studies conducted across 10 countries, mainly in sub-Saharan Africa and Asia. The interventions varied in duration from 1 month to 5 years and incorporated multi-component approaches, such as physical activity promotion, school feeding programs, nutrition education, and water, sanitation, and hygiene (WASH) activities. While 2 studies effectively reduced both undernutrition and overweight, 9 were DBM-neutral, 4 were potentially beneficial, and 2 had potential DBM-harmful outcomes. Thirteen multi-component interventions showed improved nutritional indicators, particularly in anemia and dietary diversity, with strong engagement from the school community contributing to successful outcomes. This review emphasizes the need for multifaceted interventions to address the DBM among adolescents. The included studies showed that school-based, multi-component strategies, including physical activity promotion and nutrition education, can improve nutritional outcomes. However, variations in effectiveness highlighted the complexity of the DBM, requiring re-design of strategies to address common drivers of multiple forms of malnutrition through context-specific approaches that engage multiple sectors and local communities. Ongoing evaluation and adaptation of strategies to attain optimal nutritional status are key to success.

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.

Nutrition transition is characterized by shifts in dietary patterns (DPs) and is one of the factors associated with the double burden of malnutrition (DBM). Evidence indicates correlations between DPs and obesity, diabetes, and cardiovascular diseases. However, little is known on how DP influences DBM. This mini-review examined DP-DBM relationship among adults along with different DP approaches and DBM definitions. A structured search of peer-reviewed articles was performed from Web of Science. Keywords related to "dietary patterns," "double burden of malnutrition," and "adults" were used. A total of 133 studies were included. Results showed that factor analysis was the predominant DP analysis method. DBM was frequently assessed at the national level and defined as the coexistence of overweight/obesity and underweight. From the 133 studies, only four articles investigated DP-DBM association and suggested that healthier DPs positively improved DBM. Significant knowledge gaps remain, including (1) application of a combination of DP approaches, (2) evaluation of individual-level and household-level DBM, and (3) inconsistency of micronutrient deficiencies and non-communicable disease indicators in DBM definition. This review revealed paucity of studies on the nexus of DPs and DBM. Future research is imperative to establish evidence on the link between food patterns and multiple burdens of malnutrition.

BackgroundThe double burden of malnutrition (DBM), characterized by concurrent undernutrition and overnutrition, is a growing global concern. Families share resources and eating behaviors and programs often target households, yet evidence of the DBM at the family level is scarce. ObjectivesThis study examined trends and inequality in the intrahousehold DBM in India between 2006 and 2021. MethodsData were from 3 waves of India’s National Family Health Survey (NFHS 2006, 2016, and 2021). We examined 3 types of household member (with children aged <5 y) combinations: mother–child (N = 328,039 across 3 waves), father–child, and parent (mother and father)–child (N = 47,139 for each pair). The DBM was defined as one or more individuals with undernutrition (either wasting or stunting in children or underweight in adults) and one or more overweight individuals within the same household. DBM was examined over time, at national and subnational levels, and by residence and wealth. ResultsNearly all DBM was in the form of an overweight parent and an undernourished weight or stunted child. The prevalence of parent–child DBM increased from 15% in 2006 to 26% in 2021. Father–child pairs experienced the most rapid DBM increase, from 12% in 2006 to 22% in 2021, an 83% increase, driven by increasing overweight among men. In 2021, the DBM was highest in North-Eastern and Southern states, and among relatively rich households from urban areas. The increase in the DBM was faster in rural areas and among poor households compared with that in urban areas and rich households. Urban–rural and rich–poor inequalities in the DBM have decreased over time. ConclusionsThe intrahousehold DBM has increased over time, affecting 1 in 4 households in India in 2021. Family-based interventions that can simultaneously address child underweight and parent overweight are required to address India’s increasing intrahousehold DBM.

Child malnutrition and maternal obesity are serious public health issues in Sri Lanka. This study explores the associations between socioeconomic status and the double burden of malnutrition among school-aged children and within their household. A total of 543 primary school children aged 5–10 years (204 boys and 339 girls) in Gampaha District, Sri Lanka, were included in the analysis. The nutritional statuses of thinness, normal, overweight, and obesity for children and mothers were defined according to WHO growth references and body mass index. Maternal education, household equivalent income, and maternal employment were used as socioeconomic status indicators. The proportion of child thinness and overweight was 19.3% and 13.4%, respectively, and that of maternal overweight (body mass index ≥ 25 kg/m2) was 36.5%. A positive correlation was found between maternal body mass index and the child’s body mass index for age z-score in older boys and younger girls. A multivariate stepwise logistic regression analysis showed that lower education of mothers posed a higher association with child thinness (adjusted odds ratio = 2.33, 95% confidence interval: 1.08–5.00). Mothers with overweight and obesity were less likely to have a child with thinness (adjusted odds ratio = 0.30, 95% confidence interval: 0.16–0.58). Maternal employment status and household equivalent income were not significantly, but marginally, associated with child overweight and obesity. Socioeconomic inequality combined with maternal nutritional status affected child malnutrition. These findings suggest that the underlying circumstances within households should be considered to improve child malnutrition.

Differences in food intake among children under five years in urban and rural areas in provinces with the double burden of malnutritionBackground: The double burden of malnutrition is one of the nutritional problems in children at national and global levels. Food intake is the main cause of the double burden of malnutrition. Differences in residence in urban and rural areas will affect food access which will have an impact on different food intake. Objective: To analyze the differences in energy, protein, fat, and carbohydrate intake of children under-fives in urban and rural areas in provinces with the double burden of malnutrition. Methods: This research used secondary data analysis using the Total Diet Study (TDS) 2014. The subjects of this study were 813 children in provinces with a dual burden of malnutrition that fulfilled the inclusion and exclusion criteria. Provinces with the double burden of malnutrition are provinces with a prevalence of underweight children aged ≥24-59 months at &gt;22.36% and a prevalence of overweight children age ≥24-59 months at &gt;1.23%. Total Diet Study (TDS) data will provide information on food intake of children through recall results, differences in residence obtained from district classification data, the double burden of malnutrition data obtained from children nutritional status is overweight and underweight based on weight and age data of children processed using WHO-ANTRO software. Results: The average intake of energy, protein, and fat in the urban area are higher than in a rural area, but the average carbohydrate intake in an urban area is lower than in a rural area. The average intake of energy in urban was 1300.01 kcal, in rural areas was 1223.23 kcal (p=0.0008). The average intake of protein in urban was 55.03 g, in rural areas was 47.67 g (p&lt;0.0001). The average intake of fat in urban was 47.99 g, in rural areas was 37.12 g (p&lt;0.0001). The average intakes of carbohydrate in urban were 163.61 g, in rural areas was 178.88 g (p=0.0042).Conclusions: There are differences in energy, protein, fat, and carbohydrate intake of children under five years in urban and rural areas in provinces with the double burden of malnutrition.

On the eve of independence in 1962, malnutrition was the largest single cause of death in Jamaica for children under one. Although child malnutrition rates have rapidly declined since 1962, today Jamaica experiences a double burden of malnutrition: the coexistence of pockets of high child malnutrition with rising levels of childhood obesity. Based on a wide range of sources, including public documents, newspaper reports, scientific studies and reports by international agencies, this article examines a gradual decline in child malnutrition and the rise of the double burden of malnutrition in Jamaica from independence to the present. It will first of all show that changes in the global economy and overseas loans and aid both aided and limited the ability of the Jamaican government to lower child malnutrition levels and also contributed to a rise in childhood obesity. Second, it will illustrate that a traditional deficit-led approach to child malnutrition was followed in post-independent Jamaica, focussing on the public and individuals as targets for intervention and using quantitative measures to trace progress. And third, it will question whether the double burden of child malnutrition will give rise to ‘healthy publics’—‘dynamic collectives of people, ideas and environments that can enable health and well-being’.

ABSTRACTBackgroundChild overweight prevalence is increasing globally, but micronutrient deficiencies persist.ObjectivesWe aimed to 1) describe the prevalence and distribution of intraindividual double burden of malnutrition (DBM), defined as coexistence of overweight or obesity (OWOB) and either micronutrient deficiencies or anemia, among preschool children; 2) assess the independence of DBM components, e.g., whether the prevalence of DBM is greater than what would be expected by chance; and 3) identify predictors of intraindividual DBM, to guide intervention targeting.MethodsWe analyzed data from 24 population-based surveys from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project (separately by survey; n = 226 to n = 7166). We defined intraindividual DBM as coexisting OWOB and ≥1 micronutrient deficiency [e.g., Micronutrient Deficiency Index (MDI) > 0; DBM-MDI] or anemia (DBM-Anemia). We assessed independence of DBM components with the Rao–Scott chi-square test and examined predictors of DBM and its components with logistic regression.ResultsDBM prevalence ranged from 0% to 9.7% (median: 2.5%, DBM-MDI; 1.4%, DBM-Anemia), reflecting a lower prevalence of OWOB (range: 0%–19.5%) than of micronutrient deficiencies and anemia, which exceeded 20% in most surveys. OWOB was generally not significantly associated with micronutrient deficiencies or anemia. In more than half of surveys, children 6–23 mo of age, compared with ≥24 mo, had greater adjusted odds of DBM-Anemia, anemia, and micronutrient deficiencies. Child sex and household socioeconomic status, urban location, and caregiver education did not consistently predict DBM or its components.ConclusionsIntraindividual DBM among preschool children was low but might increase as child OWOB increases. The analysis does not support the hypothesis that DBM components cluster within individuals, suggesting that population-level DBM may be addressed by programs to reduce DBM components without targeting individuals with DBM.

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.

ObjectiveTo assess whether the observed prevalence of the double burden of malnutrition (DBM) would be higher than expected on the basis of chance, through analyses at national, wealth quintile and individual child levels.DesignWe selected nationally representative surveys from low- and middle-income countries (LMIC) carried out since 2005 with anthropometric measures on children under 5 years of age. Household wealth was assessed through asset indices. The expected prevalence of DBM was estimated by multiplying the prevalence of stunting (low height/length for age) and overweight (high weight for height/length). The WHO recommended cut-offs (20% for stunting and 10% for overweight) that were used to define DBM at national level. DBM at individual level was defined as co-occurrence of stunting and overweight in the same child.SettingNationally representative surveys from ninety-three LMIC.ParticipantsA total of 825 633 children were studied.ResultsDBM at national level was observed in five countries, whereas it would be expected to occur in eleven countries. Six countries did not present evidence of DBM at national level but did so in at least one wealth quintile. At individual level, thirty countries (32·3%) showed higher prevalence of DBM than would be expected, but most differences were small except for Syria, Azerbaijan, Albania and Egypt.ConclusionsThe observed number of countries or socio-economic subgroups within countries with the DBM using recommended thresholds was below what would be expected by chance. However, individual-level analyses showed that one-third of countries presented higher prevalence of DBM than would be expected.