Socioeconomic inequalities in double burden of malnutrition in three South Asian countries: A Decomposion Analysis

Background: The double burden of malnutrition at household level (DBMHL) underscores the

complex and multifaceted nature of malnutrition. DBMHL is a critical issue in South Asia (SA)

and mostly influenced by dietary transitions, healthcare access disparities as well as intricately

linked to socioeconomic inequality. The study aims to assess the associated determinants and

socioeconomic inequalities of DBMHL in SA countries, particularly Bangladesh, Pakistan, and

India.

Methods: Participants (26,731) were taken from the most recent Demographic and Health

Survey (DHS) datasets for the analysis. We applied bivariate statistics, binary logistic regression,

concentration curve, and decomposition analysis to determine the factors and socioeconomic

inequalities related to DBMHL in the selected SA countries.

Results: The overall prevalence of DBMHL was 7.8% in the selected SA countries, and the

extent of disparity exists much among affluent groups (CIX: 0.1927; p<0.001). Maternal

education, wealth index, pregnancy termination, iron supplement during pregnancy, and mode of

delivery are the most concerning factors influencing DBMHL. Mothers who opted for elective

(AOR: 1.49; 95% CI: 1.31-1.68) and emergency (AOR: 1.31; 95% CI: 1.13-1.52) C-sections

were more likely to report DBMHL than mothers who opted for normal delivery. Place of

residence, wealth index, media access, mode of delivery, age of household head, and number of

living children were the major contributors to socioeconomic disparities in DBMHL.

Conclusion: DBMHL must be controlled strategically in order to prevent child mortality and

promote overall well-being among mother-child pairs. As maternal health during pregnancy

affects a child’s overall well-being, our study recommends public health practitioners and

policymakers to encourage women in reproductive age to opt for healthy diet and normal mode

of delivery during pregnancy for the overall well-being of mother-child dyads. 

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