The Trends and Determinants of the Double Burden of Malnutrition among Women and Children in Nigeria Using Pooled DHS Data from 2013, 2018, and 2024

In many parts of the world, the challenge of hunger is no longer just about a lack of food. A complex shift is taking place where families face two opposing nutritional problems at the same time. On one side, children may be too small for their age because they have not received enough nutrients to grow, a condition known as stunting. On the other side, their mothers may carry too much weight, a sign of over-nutrition. When these two conditions exist within the same home, scientists call it the double burden of malnutrition. This situation is not a simple case of having too little or too much; it is a sign that a society is changing, often moving from a time of scarcity to one where cheap, energy-dense foods are available but not always nutritious. Understanding why this happens in the same household is crucial, because fixing one problem without addressing the other can leave families vulnerable. If a mother is overweight but her child is stunted, it suggests that the family has access to enough calories to gain weight, but perhaps not the right kind of food to help a child grow tall and strong.

Researchers in Nigeria set out to understand this specific puzzle by looking at a massive collection of data gathered over more than a decade. They combined information from three separate national surveys conducted in 2013, 2018, and 2024, creating a single, powerful picture of nearly 48,500 mother-and-child pairs across the country. Their goal was to see how common this double burden had become, whether it was changing over time, and what factors made it more or less likely to happen. By analyzing this data, they could move beyond guessing and see the real patterns of who was affected and where.

The study revealed that this double burden is a persistent reality in Nigeria, though its prevalence has fluctuated. In 2013, about 5.9 percent of households had a mother who was overweight or obese while her child was stunted. This number rose to nearly 6.8 percent in 2018 before dipping slightly to 5.7 percent in 2024. While the numbers went up and down, the researchers found that the change over time was statistically significant, meaning it was a real shift and not just random chance. However, the overall rate remained relatively low, hovering below 7 percent throughout the entire period. This suggests that while the problem is present and serious, it has not exploded into a crisis affecting the majority of families, yet it remains a public health concern that requires attention.

One of the most interesting findings was that this problem does not seem to be tied to a specific geographic region in a simple way. When the researchers looked at the six major regions of Nigeria, they found no statistically significant difference in the rates of the double burden between them. Similarly, when they broke the data down by individual states, the differences they saw were not strong enough to be considered definitive once the complex way the data was collected was taken into account. Some states appeared to have higher rates and others lower, but the study could not confirm that these were true, lasting differences caused by location alone. This implies that the issue is widespread and driven by factors that cut across the entire country, rather than being confined to a specific corner of the map.

Instead of geography, the study pointed to the social and economic circumstances of the family as the true drivers. The likelihood of a household facing this double burden was strongly linked to the mother's education and the family's wealth. Mothers with a higher level of education were significantly less likely to be in this situation compared to those with no formal schooling. Similarly, families with more money were much less likely to face the double burden than the poorest families. The data showed a clear gradient: as a family's wealth increased, the odds of the double burden decreased. This suggests that having resources and knowledge helps families navigate the nutritional transition better, allowing them to avoid the trap of having an overweight mother and a stunted child simultaneously.

The age and sex of the child also played a major role. The risk of this double burden was much higher for children between the ages of one and five years compared to infants under one year. This aligns with the understanding that the period when a child starts eating solid foods alongside breast milk is a critical and vulnerable time for growth. Additionally, the study found that female children were less likely to be part of a double-burden household than male children. This finding adds a layer of complexity, suggesting that biological or social factors related to the child's sex may influence how nutrition is distributed or how health outcomes manifest within the home.

The researchers also looked at whether the place where a family lived, such as a city or a rural village, made a difference. Surprisingly, the study found no significant link between living in an urban or rural area and the double burden. However, the broader region did matter. Families living in the North East and North West regions were more likely to face this double burden compared to those in the central region, while families in the South South region were less likely to face it. This indicates that while the specific state might not be the deciding factor, the broader cultural, economic, and environmental context of a large region does influence nutritional outcomes.

Ultimately, this research paints a picture of a nation in transition, where the old challenges of undernutrition are mixing with new challenges of overnutrition. The study concludes that the double burden is not a random occurrence but is deeply rooted in social inequality. It is more likely to happen in poorer households where mothers have less education and in specific regions where structural disadvantages persist. The findings suggest that to solve this problem, interventions cannot simply focus on one issue or the other. Instead, programs need to be integrated, addressing the needs of both the mother and the child at the same time. By investing in women's education, improving household incomes, and tailoring support to the specific needs of different regions, Nigeria can begin to untangle this complex nutritional knot and ensure that both mothers and children thrive.