Socio-economic and rural-urban disparities in the double burden of childhood malnutrition in sub-Saharan Africa.

Background: Despite global efforts to reduce child malnutrition, sub-Saharan Africa (SSA) continues to face a high burden of childhood stunting, wasting, and overweight. Although nutrition interventions target disadvantaged populations, disparities in malnutrition reduction remain underexplored. This study examines the influence of household wealth and rural-urban residence on childhood stunting, wasting, and overweight in SSA.

Methods: Using nationally representative Demographic and Health Survey (DHS) data from two time points across 22 SSA countries, we employed generalized linear models (GLMs) to estimate adjusted odds ratios (AORs) and assess temporal trends. Models accounted for socioeconomic and demographic confounders, with between-country variability quantified using random effects.

Results: Higher household income was associated with decreased odds of stunting (AOR: 0.81; 95% CI: 0.80-0.82) and wasting (AOR: 0.80; 95% CI: 0.79-0.81), but increased odds of overweight (AOR: 1.22; 95% CI: 1.17-1.27). Rural residence, older age (24-59 months), and male sex were significantly associated with higher odds of stunting and wasting (p < 0.001). Temporal trends indicated significant declines in the odds of stunting (AOR: 0.67; 95% CI: 0.66-0.68), wasting (AOR: 0.58; 95% CI: 0.57-0.59), and overweight (AOR: 0.64; 95% CI: 0.60-0.68) over time. Moderate between-country variability was observed across models, with standard deviations ranging from 0.32 to 0.41.

Conclusion: These findings highlight a shift in public health priorities, emphasizing the need for adaptive and inclusive nutrition strategies. Policy responses should adopt a comprehensive approach to address the double burden of under- and overnutrition among children.