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The Trends and Determinants of the Double Burden of Malnutrition among Women and Children in Nigeria Using Pooled DHS Data from 2013, 2018, and 2024

Omokanye¹ SA, Oguizu² AD, Oweghoro³ BM, Haruna⁴ HA · 15 Sept 2026

Abstract

Abstract Background The double burden of malnutrition (DBM) occurs when maternal overweight/obesity and child stunting co-occur in the same household and is a public health challenge in Nigeria amid the ongoing nutrition transition. Trends, geographic disparities and multilevel factors influencing DBM have not previously been explored using pooled nationally representative data. This study examined the national trend, geographic inequalities, and individual-, household- and community-level determinants of DBM among mother–child pairs in Nigeria using the 2013, 2018, and 2024 Nigeria Demographic and Health Surveys (NDHS). Methods We analysed pooled cross-sectional data from the NDHS, with mother–child pairs (n = 48,445) as the unit of analysis. DBM was defined as household co-occurrence of maternal overweight/obesity (BMI ≥ 25 kg/m²) and child stunting (HAZ < − 2 SD). Survey weights were applied in Stata 18 to account for the complex sampling design. Descriptive statistics summarised prevalence patterns; survey-weighted logistic regression identified determinants. Regional and state-level geographic differences were assessed. Statistical significance was set at p < 0.05. Results DBM prevalence increased from 5.88% (95% CI: 5.46–6.34) in 2013 to 6.79% (95% CI: 6.17–7.48) in 2018, before declining to 5.66% (95% CI: 5.03–6.37) in 2024, with significant temporal variation (F = 3.54, p = 0.029). Households surveyed in 2018 had higher odds of DBM than in 2013 (OR = 1.17; 95% CI: 1.02–1.33; p = 0.021). Regional and state differences were not statistically significant (p = 0.240 and p = 0.097, respectively). Higher maternal education (AOR = 0.58; 95% CI: 0.36–0.92), richer (AOR = 0.59; 95% CI: 0.37–0.92) and richest household wealth (AOR = 0.34; 95% CI: 0.21–0.56), and female child sex (AOR = 0.68; 95% CI: 0.55–0.83) were associated with lower odds of DBM. Child age 12–23 months (AOR = 2.71; 95% CI: 1.99–3.70) and 24–59 months (AOR = 2.53; 95% CI: 1.90–3.36), and residence in the North East (AOR = 1.84; 95% CI: 1.20–2.82) and North West (AOR = 1.66; 95% CI: 1.18–2.34) increased the likelihood of DBM, while residence in the South South was protective (AOR = 0.64; 95% CI: 0.44–0.94). Conclusions Despite a relatively low prevalence, DBM remains a public health problem among mother–child pairs in Nigeria. Socio-economic inequalities, maternal education, household wealth, child characteristics and regional disparities are important determinants. Tackling maternal overweight/obesity and child stunting simultaneously in Nigeria requires strengthening integrated nutrition programmes, investing in female education, improving household economic conditions, and pursuing region-specific investments. Clinical trial registration Not applicable. This is not a clinical trial and therefore did not need to be registered.