Dual burden of malnutrition among mother-child dyads in Mozambique: Findings from the Demographic and Health Survey 2022-2023.

INTRODUCTION

Nutritional challenges are a global public health concern, especially among children under five in sub-Saharan African countries. The coexistence of an overweight/obese mother and an underweight child in the same household is recognized as a dual burden of malnutrition (DBM). This study estimated the prevalence, identified associated factors, and assessed socioeconomic inequalities in DBM among mother-child dyads in Mozambique.

METHODS

We used nationally representative, cross-sectional data from the Mozambique Demographic and Health Survey 2022-2023 (n = 3,605 mother-child dyads). Child undernutrition and maternal BMI status were calculated using the World Health Organisation (WHO) standard guidelines. The outcome variable, DBM, was defined as the presence of child undernutrition condition (stunting, wasting or underweight) with corresponding maternal overweight/obesity. Multivariable binary logistic regression, Erreygers's concentration index, and concentration curve analyses were performed, accounting for the complex survey design, to determine associated factors and social inequalities.

RESULTS

The prevalence of DBM was 5.5% [95% CI: 4.6, 6.6]. Mothers aged ≥ 34 years [aOR (95% CI): 4.01(1.44, 11.14); p < 0.05] and mothers with four or more children [aOR (95% CI): 2.68(1.29, 5.57); p < 0.05] had higher odds of DBM. Rural residence and using unimproved toilet facilities (latter an indicator) were also significantly associated with DBM. Additionally, maternal age modified the association between women's empowerment and mother-child DBM. Women aged 15-19 years at the lowest and highest empowerment levels were more likely to experience DBM than women 20 years or older. A positive and statistically significant concentration index indicates that wealth-related inequalities exist, with DBM more concentrated among wealthier mother-child dyads.

CONCLUSION

Our study highlights the occurrence of household-level DBM in Mozambique. These findings emphasize the need for targeted interventions addressing social and economic inequalities, including poor sanitation, a marker of broader household deprivation. Prioritizing integrated maternal-child nutrition interventions within national strategies is essential to improving equity in nutrition and health outcomes.