ABSTRACT
The double burden of malnutrition (DBM) – the coexistence of child undernutrition and maternal overweight/obesity – within the same household is a growing public health challenge in sub-Saharan Africa (SSA). This study assessed the prevalence and determinants of DBM at the household level across 22 SSA countries using recent nationally representative Demographic and Health Survey (DHS) data from 103,497 mother–child under-five pairs. Outcomes included child stunting, maternal overweight/obesity, and DBM, defined as the concurrent occurrence of child stunting and maternal overweight/obesity in the same household. Descriptive statistics, binary logistic regression, and complementary log-log models were applied, accounting for complex survey designs. Across SSA, 28.34% of children were stunted, 29.59% of mothers were overweight/obese, and 6.09% of households experienced DBM. Child stunting was associated with maternal short stature (AOR = 3.00; 95% CI: 2.61–3.46 for those with height below 145 cm vs. the above), low maternal education (AOR = 0.44; 95% CI: 0.38–0.51 for higher vs. no education) and poverty (AOR = 0.43; 95% CI: 0.39–0.47 for richest vs. poorest). Maternal overweight/obesity was associated with higher maternal age (AOR = 4.52; 95% CI: 3.75–5.44 for 45–49 vs. 15–19 years), higher education (AOR = 1.54; 95% CI: 1.35–1.76 for higher vs. no education), wealthier households (AOR = 4.91; 95% CI: 4.37–5.51 for richest vs. poorest), and urban residence. The likelihood of DBM was higher in wealthier (AOR = 1.51; 95% CI: 1.28–1.79), urban households (AOR = 0.90; 95% CI: 0.82–0.99 for rural vs. urban), among older mothers (AOR = 1.92; 95% CI: 1.43–2.58 for 45–49 vs. 15–19 years), and children aged 2 years or more (AOR = 2.12; 95% CI: 1.91–2.37 for 2 vs. < 1 year). These findings highlight that the DBM in SSA reflects overlapping yet contrasting drivers of undernutrition and overnutrition. Urgent, integrated interventions, focusing on maternal education, early childhood nutrition, and the reduction of socioeconomic disparities, are needed to simultaneously curb child stunting and address the rising tide of maternal overweight and obesity.
Maternal &Child Nutrition, Volume 22, Issue 1, March 2026. Read More