Trends and determinants of the triple burden of malnutrition in Ghana; Analyses of two decades of demographic and health survey datasets

Anaemia, undernutrition and obesity remain complex public health challenges. Their coexistence among households, commonly known as the triple burden of malnutrition (TBM) is a new concept that lacks scholarship within the maternal and child nutrition discourse in Ghana. This study therefore aimed to evaluate the trends and factors associated with TBM among mothers and their children aged 0-59 months in Ghana. This study combined and analysed datasets from the Ghana Demographic and Health Survey from 2003 to 2022. Prevalence and multivariable logistic regression were used to evaluate the trends and determinants of TBM among 11,925 mother-child pairs using complex sample procedures. The pooled prevalence of TBM was 6.7% (5.7 - 6.7). This reduced from 7.6% (6.6 - 8.7) in 2003 to 5.0% (4.1-6.2) in 2022. Male children [AOR 2.23, 95% CI:1.33 - 3.74, p = 0.002] were more likely to suffer TBM than female children. Large birth size [AOR 0.30, 95% CI: 0.17 - 0.54, p < 0.001] and breastfed children [AOR 0.13, 95% CI:0.05 - 0.34, p < 0.001] were less likely to suffer TBM. Women with no education [AOR 5.14, 95% CI:1.16 - 22.75, p < 0.031] and those with inadequate dietary diversity [AOR 2.53, 95% CI:1.50 - 4.26, p < 0.001] were more likely to suffer TBM. Also, high-wealth [AOR 0.13, 95% CI:0.05 - 0.33, p < 0.001] and rural households [AOR 0.34, 95% CI: 0.05 - 0.33, p < 0.001] were less likely to suffer TBM. Although the prevalence of TBM reduced over the past two decades, the pooled estimate remains high in Ghana. The associated factors include breastfeeding, childbirth size, maternal education, dietary diversity, wealth and urbanicity. Strategies that promote breastfeeding, improve dietary diversity and ensure equitable distribution of resources are urgently needed to mitigate the TBM.