Physical and socioeconomic environments are associated with concurrent malnutrition in neighborhoods, households and individuals in Sub-Saharan Africa

This study aims to determine the extent to which physical and socioeconomic environments are associated with the “dual burden” of malnutrition and its component conditions in Sub-Saharan Africa (SSA). We used Demographic and Health Survey (DHS) data from 29 countries in SSA from 2005-2011 (n=155,238 households), and geocoded DHS cluster data with LandScan population density data to examine spatial determinants and clustering of concurrent forms of malnutrition at neighborhood scales. We identified the co-occurrence of maternal overweight (MO) (body mass index ≥ 25 kg/m²) and anemia (MA) (hemoglobin < 120 g/L) among non-pregnant mothers, and, in the same households, co-existing MO and child stunting (CS) (height-for-age Z-score < -2) in the oldest child aged 6-59 months. The prevalence of CS was 37%, MO and MA were 20% and 40%, respectively, 5.8% of households had concurrent MO and CS, and concurrent MO and MA was 7.7%. Rural location was negatively associated with dual burden households (OR: 0.79; 95% CI: 0.64-0.97) and with concurrent MO and MA (OR: 0.68; 95% CI: 0.61-0.75). Maternal employment in agriculture was independently negatively associated with both MA and MO (OR: 0.93; 95% CI: 0.87-0.99; OR: 0.73; 95% CI: 0.69-0.78, respectively). Household wealth was positively associated with both dual burden manifestations while years of maternal education were negatively associated with the household dual burden (OR: 0.97; 95% CI: 0.95-0.99). We further examined heterogeneity in spatial clustering of MO, MA and CS across urbanicity gradients. Undernutrition and overweight coexist throughout SSA at regional, household and individuals scales.