Double burden of malnutrition among households in Ethiopia: a systematic review and meta-analysis

Abstract

Introduction: The double burden of malnutrition (DBM) at the household level has increased in sub-Saharan African countries as a result of rapid changes in global food systems and growing urbanization. The presence of overweight or obese mothers with undernourished (stunted, wasted, or underweight) children within the same household holds particular significance. However, no comprehensive study or meta-analysis has been conducted to summarize the national evidence of the double burden of malnutrition in mother-child pairs. Therefore, the purpose of this study was to determine the pooled prevalence of the double burden of malnutrition at the household level in Ethiopia in 2024.

Methods: This systematic review and meta-analysis was conducted on the prevalence of the double burden of malnutrition and associated factors among households in Ethiopia, using an advanced search of electronic databases and search engines. The standardized Joanna Briggs Institute (JBI) method was used to extract data from a Microsoft Excel spreadsheet and evaluate the quality of each article. The analysis was performed using STATA V.17. A random-effects model was used to conduct the meta-analysis. Heterogeneity was assessed using the I² and Q tests.

Results: A total of seven publications met the inclusion criteria, including data from 56,877 and 43,770 mother-child pairs for the systematic review and meta-analysis, respectively. The pooled prevalence of the double burden of malnutrition among the mother-child pairs was 8.30% (95% confidence interval (CI): 1.51, 15.09). The heterogeneity test revealed extremely high heterogeneity (I² = 99.91%; p = 0.00). In the subgroup analysis based on sample size, the pooled estimated prevalence of the double burden of malnutrition was high for a sample size of fewer than 1,000 mother-child pairs (11.69% (95% CI: 3.11, 20.28)). The pooled estimate from the subgroup analysis of the data collected 8 years ago was 8.61% (95% CI: 1.11, 22.33). Residence, household size, housing quality, wealth index, household food security status, mother's age and educational status, and child's age are some of the factors that influence the double burden of malnutrition among mother-child pairs.

Conclusion: In Ethiopia, the double burden of malnutrition among mother-child pairs is rapidly emerging. As a result, double-duty interventions should be implemented to address this issue, taking into account multiple factors at the household level.

Systematic review registration: The protocol for the systematic review and meta-analysis was registered under the registration ID CRD42024517778 with the PROSPERO (International Prospective Register of Systematic Review and Meta-analysis).

Keywords: Ethiopia; double burden; households; malnutrition; meta-analysis; mother–child pairs; systematic review.

Figure 1

Flow diagram of the studies included in the review of the DBM among mother–child pairs in households in Ethiopia, 2024.

Figure 2

Pooled estimates of the DBM among the mother–child pairs in households in Ethiopia, 2024.

Figure 3

Subgroup analysis by sample size of the DBM among the mother–child pairs in households in Ethiopia, 2024.

Figure 4

Subgroup analysis by the date of the data collection period for the DBM among the mother–child pairs in households in Ethiopia, 2024.

Figure 5

Funnel plot depicting publication bias.

Figure 6

Symmetric presentation of the data after the trim-and-fill method for the analysis of publication bias.

Figure 7

The sensitivity test of the pooled estimates of DBM among mother–child pairs at households in Ethiopia, 2024.