Background

The double burden of malnutrition (DBM), which involves both undernutrition and overweight/obesity, has become a significant global health concern. Significant research gaps exist in understanding the prevalence and trends of DBM among mother–child pairs in South and Southeast Asia, as existing studies frequently concentrate on single countries or specific populations. Therefore, the objective of this study is to estimate the prevalence and trends of DBM by utilising the most updated nationally representative data from four selected countries in these regions.

Methods

We analyzed cross-sectional, nationally representative secondary data from the Demographic and Health Survey, conducted from 2004 to 2022. The survey included households with at least one mother–child pair for Bangladesh, Cambodia, Nepal, and Timor-Leste. Using survey weights, we calculated the weighted prevalence of household level DBM, underweight children (< 5 years old), and overweight mothers ($𝐵𝑀𝐼\ge 23𝑘𝑔/{𝑚}^2$) for each country. Using chi-square tests, we investigated associations between DBM prevalence and factors such as wealth index, place of residence, and child sex. We assessed socioeconomic disparities using odds ratios obtained from a multivariable logistic regression model.

Results

The prevalence of DBM at household level in Bangladesh rose from 4 in 2004 to 13.8% in 2018, with underweight children decreasing from 47.6 to 21.5% and overweight or obese mothers increasing from 11.6 to 42.3%. We observed similar trends in Cambodia (DBM prevalence: 7.4% in 2005 to 14.3% in 2022; underweight child: 28.3% in 2005 to 16.5% in 2022; overweight/obese mother: 18.6% in 2005 to 48.8% in 2022), Nepal (DBM prevalence: 5.6% in 2006 to 12.3% in 2022; underweight child: 38.6% in 2006 to 19% in 2022; overweight/obese mother: 14.4% in 2006 to 48.7% in 2022), and Timor-Leste (DBM prevalence: 9.4% in 2009 to 15.8% in 2016; underweight child: 44.1% in 2009 to 40.8% in 2016). In all four nations, households with a higher socioeconomic level (richest) consistently had a higher likelihood of developing DBM (odds ratio > 1) compared to households with a lower socioeconomic status (poorest). Furthermore, mother–child pairs living in rural regions had a lower likelihood of developing DBM compared to urban settings.

Conclusion

DBM is on the rise in households across South and South-east Asian nations, particularly in urban areas and among richest households. Despite several improvements in reducing underweight prevalence, persistent undernutrition remains a significant challenge in the region. Simultaneously, the rising prevalence of obesity is a growing concern. Future research should prioritise identifying country-specific risk factors of DBM and understanding factors contributing to the high prevalence of maternal overweight.