Double Burden of Malnutrition among Children Under Five in Pakistan: Evidence from Pakistan Demographic and Health Survey 2017–18

Malnutrition in Pakistan presents a dual challenge, with high levels of undernutrition persisting alongside a rising prevalence of childhood overweight. The coexistence of these conditions in the same population, often referred to as the DBM, is an emerging but underexplored concern. Objective: To examine the prevalence and determinants of stunting, underweight, wasting, and overweight among children under five years in Pakistan. Methods: It was a cross-sectional secondary analysis of the data on the Pakistan Demographic and Health Survey (PDHS) 2017. A total of 150 children aged 0-59 months and whose anthropometric data were complete, were analyzed. The WHO child growth standards were used to determine the nutritional status. Descriptive statistics, bivariate tests, and multivariate logistic regression were used. Results: Overall, 53.3% of children were stunted and 22.7% were overweight, while 13.3% exhibited individual-level DBM. Stunting was uniformly high across wealth quintiles, whereas overweight rose from 10.0% in the poorest to 36.7% in the richest quintile. Regression analysis showed that the age variable was found to contribute to stunting (adjusted odds ratio (aOR): 1.06, 95 per cent confidence interval (CI): 1.0325.29, p=0.023), and children in the wealthiest households were over five times more likely to be overweight (aOR: 5.14, 95 per cent CI: 1.3725.29, p=0.023). Conclusions: These findings reveal a pronounced DBM among Pakistani children. Integrated strategies are urgently needed to address chronic undernutrition while preventing the rise of childhood overweight.