When undernutrition meets overweight: prevalence and determinants of double burden of malnutrition among women-child pairs in Burkina Faso from the 2021 Demographic and Health Survey

BACKGROUND: Burkina Faso is experiencing a rapid nutritional transition, yet evidence on the double burden of malnutrition (DBM) at household and individual levels remains limited. This study aimed to estimate the national prevalence of DBMs and identify associated factors with a particular focus on the most common type of DBM. METHODS: We used data from the 2021 Burkina Faso Demographic Health Survey, a nationally representative cross-sectional survey. The analysis included 4119 households with 5146 women of reproductive age (15-49 years) and 4114 mother-child pair. Eleven (11) potential combinations of maternal and child nutritional status indicators, defined according to WHO standards (anemia, stunting, wasting, underweight, and overweight/obesity) were assessed. Weighted descriptive and bivariate analyses were conducted to identify the most prevalent double burden of malnutrition (DBM) combination, which was selected as the primary outcome. Factors associated with this outcome were examined using multivariate logistic regression with four nested models incorporating household, maternal, and child level characteristics. RESULTS: Overall, 72% of children were affected by anemia, 23% by stunting, and 17% were in underweight condition. Among women, 53% were living with anemia, 17.9% with underweight, and 7.6% with obesity. The predominant DBM form was children with anemia combined with overweight/obesity in women, affecting 14.3% of households. The individual prevalence of anemia and overweight/obesity in women was 9.47%, while stunting paired with overweight in children affected 3.6% of households. Multivariate analysis identified several independent of the predominant form of DBM: region (aOR = 1.94, 95% CI = 1.09-3.45 for Sahel region vs. Boucle du Mouhoun), household wealth (aOR = 3.1, 95% CI = 1.74-5.53 for richest vs. poorest), place of residence (aOR = 0.6, 95% CI = 0.45-0.79 for rural vs. urban), women's age (aOR = 6.48, 95% CI = 2.53-16.61 for 35-39 years compared to 15-19), and women's occupation (aOR = 2.71, 95% CI = 1.5-4.87 for professional manager vs. not working). CONCLUSION: The most common DBM, child with anemia and maternal overweight/obese women affect more than one in seven households in Burkina Faso, with a higher risk in urban and wealthier settings. Integrated "double duty" interventions are urgently needed to address both mother with overweight/obesity and child with anemia while addressing the structural drivers of nutrition transition and broader social determinants of health.