Peer-reviewed article

Double and triple burden of malnutrition and the role of geo-socio-ecological factors in Ethiopia: a bayesian geostatistical analysis.

Dessie G, Li J, Nghiem S, Doan T · 30 Sept 2025

Abstract

Background Developing countries face a nutrition transition, leading to a double or triple burden of malnutrition. In Ethiopia, the extent and socioecological drivers of this burden remain understudied. This study aims to analyze the spatial distribution of the double and triple burden of malnutrition and the role of socioeconomic and environmental factors in children aged 6-59 months. Method Data on stunting and overweight/obesity were obtained from the 2016 Ethiopian Demographic and Health Survey (EDHS), while data on micronutrient deficiencies were sourced from the Ethiopian Public Health Institute. A geostatistical model using Integrated Nested Laplace Approximation (INLA) within a Bayesian framework was employed to examine the role of Geo-socio-ecological Factors and predict the distribution of overweight/obesity, stunting, and micronutrient deficiencies and their co-occurrence. Result We observed significant overlaps in different types of malnutrition: stunting and overweight/obesity in Oromia; and overweight/obesity and zinc deficiency in Amhara, Tigray, Oromia, and Somali regions. There was also a notable regional variation in the triple burden of malnutrition: Oromia region faces overweight/obesity, stunting, and iron deficiency, while the central Ethiopia and Amhara regions experience overweight/obesity, stunting, and vitamin A deficiency. The Diphtheria Tetanus Pertussis (DTP) vaccine was negatively associated with vitamin A deficiency (β = -0.23; 95% CrI: -0.43, -0.04) and stunting (β = -0.13; 95% CrI: -0.22, -0.04). Additionally, soil nitrogen (g/kg of soil), which affects agricultural productivity, is associated with a decrease in iron deficiency (β = -0.57; 95% CrI: -0.93, -0.23) and zinc deficiency (β = -0.44; 95% CrI: -0.67, -0.19). Conclusion The present finding shows that Ethiopia is experiencing both a double and triple burden of malnutrition, with a significant overlap of overweight/obesity, stunting, and micronutrient deficiencies (i.e. triple burden) across the country. This highlights the need for geographically targeted integration of services that address all forms of malnutrition. The Diphtheria Tetanus Pertussis (DTP) vaccine was negatively associated with stunting and VAD, likely due to its role in reducing infectious and diarrheal diseases, highlighting the potential for integrating health coverage with nutritional intervention. Soil nitrogen density was also negatively associated with iron and zinc deficiencies, possible due to its role on plant growth and nutrient composition, underscoring the need to promote soil-specific fertilizer use as part of nutrition-sensitive agricultural strategies.