Dual burden of malnutrition among married women of reproductive age: a comparative study of Bangladesh, India and Nepal

The dual burden of malnutrition (DBM), defined as the coexistence of undernutrition and overnutrition within the same population, is a well-recognized major public health concern in lower middle-income countries (LMICs). This growing burden increases morbidity and mortality, impairs physical and cognitive development and quality of life, and places pressure on healthcare systems and socioeconomic development. Addressing DBM is essential for achieving SDG 2 (Zero Hunger) SDG 3 (Good Health and Well-being). This study aimed to investigate DBM among married women of reproductive age in LMICs particularly in Bangladesh, India and Nepal. A comparative cross-sectional study was conducted using demographic health survey (DHS) data from Bangladesh (BDHS 2022, n = 9,366), India (NFHS-5, 2019–2021, n = 72,336), and Nepal (NDHS 2022, n = 5,451). Married women aged 15–49 years with complete BMI data were included, while pregnant women and those with missing data were excluded. Descriptive statistics were used to estimate the prevalence of DBM, chi-square test was performed to assess associations between variables, and multinomial logistic regression analysis was conducted to identify the factors associated with DBM. Statistical significance was set at p < 0.05. The prevalence of overweight was highest in Bangladesh (36.91%), followed by Nepal (30.54%) and India (27.10%), whereas underweight was most prevalent in India (12.23%), meanwhile Bangladesh and Nepal exhibited prevalence of 9.61% and 9.54% respectively. For undernutrition, respondent’s age (15–24 years) was the only common determinant across Bangladesh, India, and Nepal. Partner’s education (no education), contraceptive use (traditional), and wealth index (poor) were common associated factors between Bangladesh and India, while toilet facilities (hygienic) were common between India and Nepal. Among the country-specific factors, age at first marriage (< 18 and 18–24 years) was identified for Bangladesh, drinking water source (safe) for Nepal, and respondent’s age (25–34 years), household size (1–4 and 5–7 members), partner’s education (primary and secondary), respondent’s education (no education, primary, and secondary), residence (urban), wealth index (middle), respondent’s occupation (not working and agriculture), and partner’s occupation (professional/clerical/sales) for India. For overnutrition, common associated factors across all three countries included respondent’s age (15–24 years), age at first marriage (< 18 years), residence (urban), and respondent’s education (no education). Household size (1–4 and 5–7 members), wealth index (poor and middle), contraceptive use (modern), and partner’s occupation (agriculture) were common between Bangladesh and India, whereas the occupations of respondents and partners (professional/clerical/sales) were shared between Bangladesh and Nepal. Partner’s education (no education and primary), contraceptive use (traditional), and toilet facilities (hygienic) were specific to India, while decision-making regarding visits to relatives’ houses was unique to Nepal. The coexistence of undernutrition and overnutrition among married women of reproductive age in Bangladesh, India, and Nepal confirms the presence of DBM. While some socio-economic factors were common, others varied by country, reflecting socioeconomic, demographic, and household differences. These findings highlight the need for country-specific interventions focusing on age, early marriage, education, economic status, contraceptive use, and access to safe water and sanitation.