Individual, household and community factors associated with the double burden of malnutrition within Nigerian households

Double burden of malnutrition has been reported in Nigeria. However, there is a dearth of information about its occurrence at the household-level, and the associated factors. Understanding this will help in designing appropriate intervention programmes. This study therefore aimed to determine the prevalence of the double burden of malnutrition at household-level and to identify the associated factors. This was a population-based study using 10,256 mother-child dyads from the Nigeria demographic and health survey (NDHS) data. The double burden of malnutrition at household-level was defined as the co-existence of overweight/obesity in the mother and undernutrition (stunting, underweight, wasting, thinness and anaemia) in her child. A wide range of explanatory variables were included at child (age, sex, size at birth, twin status, birth order, breastfeeding status, dietary diversity), mother (age, education, marital status, occupation, parity, dietary diversity), household (household head, size, water source, toilet facilities, wealth index) and community levels (residence, region). A binary logistic regression analysis was used to identify the associated factors, and the adjusted odds ratios(OR) and 95% confidence intervals(CI) were reported, with level of significance set at p < 0.05. STATA (version 17) was used for data analysis. The prevalence of the double burden of malnutrition was 12.2%. The mean ages (and standard deviations) of the children and their mothers were 31.8 ± 16.0 months and 30.3 ± 6.8 years respectively. After fully adjusting for all explanatory variables, factors that remained significantly associated with the double burden of malnutrition were children > 24 months (OR: 0.7; 95% CI 0.6–0.9 compared with < 24 months), multiple births (OR: 1.6; 95% CI 1.1–2.4, compared with single birth), mother’s age (OR: 1.02, 95% CI 1.01–1.04), secondary education (OR: 1.6; 95% CI 1.1–2.2, compared with nil education), mothers who attained minimum dietary diversity (OR: 0.8; 95% CI 0.7–1.0, compared with those who did not), richest wealth index (OR: 2.9; 95% CI 1.8–4.9, compared with poorest wealth index) and South South (OR: 1.8; 95% CI 1.3–2.4, compared with North Central region). The double burden of malnutrition in this study was associated with child (age, multiple gestation), mother (age, education and dietary diversity), household (wealth index) and community (region) factors. Findings highlight the need for integrated policies addressing both child undernutrition and maternal obesity, targeting socioeconomic and regional inequalities to reduce Nigeria’s double burden of malnutrition.