Researchers want countries in East and Southern Africa to adopt an integrated approach to deal with the “double burden” of child malnutrition – the coexistence of child over nutrition (overweight and obesity) alongside undernutrition (stunting and wasting).

A study published in PLOS Global Public Health on April 25, 2023 found high numbers of children suffering from stunting and wasting in poorer households in East and Southern Africa while richer homes had overweight children.

“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 globalisation and rapid urbanisation,” said Semira Manaseki-Holland, a researcher from the University of Birmingham.

The researchers are calling for policies that target vulnerable populations to avoid further widening socioeconomic and urban-rural inequalities.

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Priority countries

Researchers focused on malnutrition in 13 of the 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 percent in Namibia to 42.8 percent in Mozambique.

In East Africa, stunting in Kenya stood at 25.9 percent, Uganda (28.1 percent), Rwanda (37.9 percent) and 34.1 percent in Tanzania.
Wasting prevalence varied from 2.3 percent in Rwanda to 11.7 percent in Comoros, Kenya (4.2 percent), Tanzania (4.9 percent) and in Uganda it was 3.8 percent.

WHO defines wasting as low weight-for-height. It often indicates recent and severe weight loss although it can also persist for a long time. It usually occurs when a person has not had food of adequate quality and quantity and/or they have had frequent or prolonged illnesses.

Overweight prevalence (including obesity) ranged from 3.7 percent in Tanzania, Uganda (4.0 percent), Kenya (4.2 percent), Rwanda (8.1 percent) and 13.5 percent in South Africa.

“Regional stunting and wasting prevalence were higher among children living in the poorest households, with mothers with the lowest educational level and in rural areas. In contrast, regional overweight (including obesity) prevalence was higher among children living in the richest households, with mothers with the highest educational level and urban areas,” said the findings.

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“Parent’s socio-cultural beliefs may influence their child’s body shape ideals. In some sub-Saharan African countries, overweight and obesity have historically been considered to be a sign of wealth,” added the findings.

“It is vital to avoid strategies that solve one nutrition problem while worsening another,” said co-author Rishi Caleyachetty from the University of Warwick, citing strategies that promote obesity by endorsing high consumption of energy-dense but not necessarily micronutrient-rich foods.