Co-existence of maternal overweight, child undernutrition and anaemia in Ethiopia

Despite receiving growing attention, childhood undernutrition in Ethiopia remains endemic. However, the current surge of the “triple burden of malnutrition” (TBM) is more complex and has received less focus. TBM encompasses three types of nutritional problems: a mother being overweight/obese while her child is stunted, wasted, or underweight, and also anaemic (haemoglobin <11 g/dL), within the same household. The study aimed to determine the prevalence of TBM in Ethiopia and to identify associated factors. Data were derived from the Ethiopian Demographic and Health Surveys (EDHS) (2005–2016), examining a total of 20,994 mother–child pairs. 

The study findings indicated that children aged under five years were often anaemic (49.3%, 95% confidence interval (CI): 48.7–49.9)], stunted (43.1%, 95% CI: 42.4–43.7), wasted (10.3%, 95% CI: 9.9–10.7), and underweight [27.6%, 95% CI: 27.0–28.1). It was also found that 3.7% (95% CI: 3.50–3.96) of women were overweight/obese. The overall prevalence of TBM was 2.6% (95% CI: 2.39–2.83).

A multilevel logistic regression model was employed to explore the individual- and community-level factors associated with TBM. Analyses revealed that TBM was more likely among children aged 12–23 months (adjusted odds ratio [AOR]: 2.54, 95% CI: 1.68–3.83), 24–35 months (AOR: 1.54, 95% CI: 1.03–2.29), children perceived by their mothers to be smaller than normal at birth (AOR: 1.94, 95% CI: 1.48–2.56), who experienced fever in the past two weeks (AOR: 1.58, 95% CI: 1.24–2.01), and those living in urban settings (AOR: 1.79, 95% CI: 1.13–2.86). Lower odds of TBM were reported among female children (AOR: 0.59, 95% CI: 0.47–0.72) and those from wealthy households (AOR: 0.69, 95% CI: 0.49–0.98). These findings are consistent with other studies from Ethiopia and beyond.

Maternal occupation and household wealth status were found to be significant drivers at the household level. Children of mothers working in non-agricultural occupations were less likely to report TBM compared to those whose mothers were not in paid employment. The odds of experiencing TBM were significantly lower among children born to mothers who attended antenatal care compared to those whose mothers did not attend antenatal care. Households where children spent time fetching water had higher odds of experiencing TBM compared to those with water access on the premises. This finding may be explained by the fact that access to drinking water can be a proxy indicator for poor health. 
The study’s limitations include its cross-sectional design, which precludes establishing cause-effect relationships. Due to the lack of relevant data in the EDHS, potential confounding factors, such as household food insecurity, were not included, which could have influenced the observed TBM prevalence. Additionally, some variables were subject to social desirability and recall bias.

The study concluded that addressing TBM through double-duty actions is crucial for tackling all forms of malnutrition in Ethiopia and achieving Sustainable Development Goal Two.