Patterns and determinants of the double burden of malnutrition at the household level in South and Southeast Asia

Objectives: Many developing countries currently face a double burden of malnutrition (DBM) at the household level, defined by the World Health Organization, as when a mother may be overweight or anemic, and a child or grandparent is underweight, in the same household. For the present study, we defined it as the coexistence of overweight or obesity in the mother, and at least one child under the age of 5 undernourished, within the same household. Although underweight has long been considered a major issue in South and Southeast Asia, overweight and obesity have also been identified as a growing problem. The main aim of this study was to assess the DBM at the household level and its major determinants in South and Southeast Asia. Methods: We used population-representative cross-sectional data from the Demographic and Health Survey, conducted between 2007 and 2017, for eight South and Southeast Asian countries: Bangladesh, India, Nepal, Pakistan, Myanmar, Timor, Maldives, and Cambodia. Multivariate logistic regression was performed to identify the sociodemographic factors associated with DBM. Results: A total of 798,961 households were included in this study. The pooled prevalence of overweight or obesity for the mother and stunted child was 10.0% (95% CI: 8.0.0–12.0), for OBM and wasted child, it was 7.0% (95% confidence interval (CI): 6.0–8.0), and for overweight or obese mother (OBM) and underweight child, it was 7.0% (95% CI: 6.0–8.0). The prevalence of any of these DBM coexistences was 12.0% (95% CI: 10.0–13.0) in all households. Statistically significant positive associations (p < 0.05) were found for each of these coexistences, and a higher age of the mother, mothers with a lower education, the richest household quintile, and households with more than four members. Conclusion: It is imperative that “double duty” action policies are developed that tackle the DBM, rather than targeting undernutrition or overnutrition separately. The findings from this study suggest that the promotion of education for women may aid in tackling the double burden on a household level.