Higher numbers of malnourished children suffering from stunting and wasting are found in poorer households in East and Southern Africa, whilst more overweight children live in the richest homes, a new study reveals.

Researchers are now calling for an integrated approach in the region to tackling the 'double burden' of child malnutrition – the coexistence of child overnutrition (overweight and obesity) alongside undernutrition (stunting and wasting).

The phenomenon in East and Southern Africa is the reverse of highly developed countries, where a higher prevalence of child overweight and obesity children is typically found in lower socioeconomic groups.

Publishing their findings in PLOS Global Public Health, a group of researchers has uncovered the magnitude of socioeconomic and urban-rural inequalities in the population-level double burden of malnutrition among under-fives in the region.

Co-author Semira Manaseki-Holland, from the University of Birmingham commented: "The presence of a double burden of malnutrition reflects the region's ongoing challenges with poverty, food insecurity, infectious diseases, droughts, floods, and conflict as well as the presence of the obesogenic environment driven by globalization and rapid urbanization.

"Our findings re-emphasize the need for an integrated approach to tackling the population-level double burden, with policy makers targeting specific populations that are vulnerable to child malnutrition, to avoid further widening of socioeconomic and urban-rural inequalities."

Researchers focussed on malnutrition on 13 out of 17 priority countries, as defined by the World Health Organisation – Comoros, Eswatini, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe.

Stunting prevalence ranged from 22.3% in Namibia to 42.8% in Mozambique, whilst wasting prevalence varied from 2.3% in Rwanda to 11.7% in Comoros. Overweight prevalence (including obesity) ranged from 3.7% in Tanzania to 13.5% in South Africa.

Co-author Rishi Caleyachetty, from the University of Warwick, commented: "Addressing these inequalities relating to the 'double burden' in this region requires strategies that address why certain subgroups became more exposed to these nutrition problems. Equally, it is vital to avoid strategies that solve one nutrition problem while worsening another."

Researchers cite inadvertently promoting overweight and obesity by endorsing high consumption of energy-dense but not necessarily micronutrient-rich foods as an example of such unintended consequences. They recommend that beneficiaries of supplementary food programmes should not be selected solely on socioeconomic status, but on nutritional assessment and monitored for changing needs and true effectiveness.

With slow progress to tackle child undernutrition in Africa, the global health community has simultaneously seen a rapid rise in child overweight and obesity. The African region has the highest burden of childhood stunting and one of the highest burdens of childhood overweight in Africa.

Importantly, the region is off track to achieve the UN Sustainable Development Goal 2 aim to end all forms of hunger and malnutrition by 2030. WHO considers the double burden of child malnutrition as a major global health challenge for African countries – particularly in East and Southern Africa.

"The aftermath of the COVID-19 pandemic, surging oil and food prices are likely to be a time of worsening socioeconomic conditions and reduced public spending," added Semira Manaseki-Holland. "Policymakers seeking to address the double burden of malnutrition need to make careful decisions regarding the targeting of limited resources."