Double Burden of Malnutrition among Children Under Five in Pakistan: Evidence from Pakistan Demographic and Health Survey 2017–18: Double Burden of Malnutrition in Pakistan: Evidence from PDHS 2017–18

Irzah Farooq; Manahl Imran; Nadeem Ahmad

doi:10.54393/pbmj.v8i8.1303

Authors

Irzah Farooq Department of Public Health, University of Punjab, Lahore, Pakistan
Manahl Imran College of Statistics Sciences, University of Punjab, Lahore, Pakistan
Nadeem Ahmad The University of Sydney, New South Wales, Australia

DOI:

https://doi.org/10.54393/pbmj.v8i8.1303

Keywords:

Malnutrition, Stunting, Overweight, Double Burden, Pakistan Demographic and Health Survey

Abstract

Malnutrition in Pakistan presents a dual challenge, with high levels of undernutrition persisting alongside a rising prevalence of childhood overweight. The coexistence of these conditions in the same population, often referred to as the DBM, is an emerging but underexplored concern. Objective: To examine the prevalence and determinants of stunting, underweight, wasting, and overweight among children under five years in Pakistan. Methods: It was a cross-sectional secondary analysis of the data on the Pakistan Demographic and Health Survey (PDHS) 2017. A total of 150 children aged 0-59 months and whose anthropometric data were complete, were analyzed. The WHO child growth standards were used to determine the nutritional status. Descriptive statistics, bivariate tests, and multivariate logistic regression were used. Results: Overall, 53.3% of children were stunted and 22.7% were overweight, while 13.3% exhibited individual-level DBM. Stunting was uniformly high across wealth quintiles, whereas overweight rose from 10.0% in the poorest to 36.7% in the richest quintile. Regression analysis showed that the age variable was found to contribute to stunting (adjusted odds ratio (aOR): 1.06, 95 per cent confidence interval (CI): 1.0325.29, p=0.023), and children in the wealthiest households were over five times more likely to be overweight (aOR: 5.14, 95 per cent CI: 1.3725.29, p=0.023). Conclusions: These findings reveal a pronounced DBM among Pakistani children. Integrated strategies are urgently needed to address chronic undernutrition while preventing the rise of childhood overweight.

References

World Health Organization, United Nations Children's Fund. The UNICEF-WHO-World Bank Joint Child Malnutrition Estimates (JME) Standard Methodology: Tracking Progress On SDG Indicators 2.2. 1 On Stunting, 2.2. 2 (1) on Overweight and 2.2. 2 (2) On Wasting. World Health Organization. 2024 Sep.

Popkin BM, Corvalan C, Grummer-Strawn LM. Dynamics of the Double Burden of Malnutrition and the Changing Nutrition Reality. The Lancet. 2020 Jan; 395(10217): 65-74. doi: 10.1016/S0140-6736(19)32497-3. DOI: https://doi.org/10.1016/S0140-6736(19)32497-3

Wells JC, Sawaya AL, Wibaek R, Mwangome M, Poullas MS, Yajnik CS et al. The Double Burden of Malnutrition: Aetiological Pathways and Consequences for Health. The Lancet. 2020 Jan; 395(10217): 75-88. doi: 10.1016/S0140-6736(19)32472-9. DOI: https://doi.org/10.1016/S0140-6736(19)32472-9

National Institute of Population Studies (NIPS) [Pakistan]. Pakistan Demographic and Health Survey 2017–18. National Institute of Population Studies Pakistan and ICF. 2019.

Shahid M, Cao Y, Shahzad M, Saheed R, Rauf U, Qureshi MG et al. Socio-Economic and Environmental Determinants of Malnutrition in Under Three Children: Evidence from PDHS-2018. Children. 2022 Mar; 9(3): 361. doi: 10.3390/children9030361. DOI: https://doi.org/10.3390/children9030361

Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, De Onis M et al. Maternal and Child Undernutrition and Overweight in Low-Income and Middle-Income Countries. The Lancet. 2013 Aug; 382(9890): 427-51. doi: 10.1016/S0140-6736(13)60937-X. DOI: https://doi.org/10.1016/S0140-6736(13)60937-X

Chilot D, Belay DG, Merid MW, Kibret AA, Alem AZ, Asratie MH et al. Triple Burden of Malnutrition among Mother–Child Pairs in Low-Income and Middle-Income Countries: A Cross-Sectional Study. British Medical Journal Open. 2023 May; 13(5): e070978. doi: 10.1136/bmjopen-2022-070978. DOI: https://doi.org/10.1136/bmjopen-2022-070978

Khan MT, Zaheer S, Shafique K. Maternal Education, Empowerment, Economic Status and Child Polio Vaccination Uptake in Pakistan: A Population-Based Cross-Sectional Study. British Medical Journal Open. 2017 Mar; 7(3): e013853. doi: 10.1136/bmjopen-2016-013853. DOI: https://doi.org/10.1136/bmjopen-2016-013853

Elmighrabi NF, Fleming CA, Dhami MV, Agho KE. Childhood Undernutrition in North Africa: Systematic Review and Meta-Analysis of Observational Studies. Global Health Action. 2023 Dec; 16(1): 2240158. doi: 10.1080/16549716.2023.2240158. DOI: https://doi.org/10.1080/16549716.2023.2240158

Ghattas H, Acharya Y, Jamaluddine Z, Assi M, El Asmar K, Jones AD. Child‐Level Double Burden of Malnutrition in the MENA and LAC Regions: Prevalence and Social Determinants. Maternal and Child Nutrition. 2020 Apr; 16(2): e12923. doi: 10.1111/mcn.12923. DOI: https://doi.org/10.1111/mcn.12923

De Onis M, Borghi E, Arimond M, Webb P, Croft T, Saha K et al. Prevalence Thresholds for Wasting, Overweight and Stunting in Children Under 5 Years. Public Health Nutrition. 2019 Jan; 22(1): 175-9. doi: 10.1017/S1368980018002434. DOI: https://doi.org/10.1017/S1368980018002434

Wali N, Agho KE, Renzaho AM. Factors Associated with Stunting among Children Under 5 Years in Five South Asian Countries (2014–2018): Analysis of Demographic Health Surveys. Nutrients. 2020 Dec; 12(12): 3875. doi: 10.3390/nu12123875. DOI: https://doi.org/10.3390/nu12123875

Seferidi P, Hone T, Duran AC, Bernabe-Ortiz A, Millett C. Global Inequalities in the Double Burden of Malnutrition and Associations with Globalization: A Multilevel Analysis of Demographic and Health Surveys From 55 Low-Income and Middle-Income Countries, 1992–2018. The Lancet Global Health. 2022 Apr; 10(4): e482-90. doi: 10.1016/S2214-109X(21)00594-5. DOI: https://doi.org/10.1016/S2214-109X(21)00594-5

Talukder A, Kelly M, Sayeed MA, Gray D, Sarma H. Defining Double Burden of Malnutrition Across Individual, Household and Population Level: A Narrative Review. Nutrition and Dietetics. 2025 Aug. doi: 10.1111/1747-0080.70037. DOI: https://doi.org/10.1111/1747-0080.70037

Wells JC, Marphatia AA, Amable G, Siervo M, Friis H, Miranda JJ et al. The Future of Human Malnutrition: Rebalancing Agency for Better Nutritional Health. Globalization and Health. 2021 Oct; 17(1): 119. doi: 10.1186/s12992-021-00767-4. DOI: https://doi.org/10.1186/s12992-021-00767-4

Hawkes C, Ruel MT, Salm L, Sinclair B, Branca F. Double-Duty Actions: Seizing Programme and Policy Opportunities to Address Malnutrition in All Its Forms. The Lancet. 2020 Jan; 395(10218): 142-55. doi: 10.1016/S0140-6736(19)32506-1. DOI: https://doi.org/10.1016/S0140-6736(19)32506-1

Nyaga SR. Double Duty Actions. In Global Trends in Nutrition and Health Through the Life Course: 98th Nestlé Nutrition Institute Workshop, October 2022. 2024 Mar; 98: 1.

Ali Z, Saaka M, Adams AG, Kamwininaang SK, Abizari AR. The Effect of Maternal and Child Factors on Stunting, Wasting, and Underweight among Preschool Children in Northern Ghana. BioMed Central Nutrition. 2017 Apr; 3(1): 31. doi: 10.1186/s40795-017-0154-2. DOI: https://doi.org/10.1186/s40795-017-0154-2

Mrema JD, Elisaria E, Mwanri AW, Nyaruhucha CM. Prevalence and Determinants of Undernutrition among 6‐to 59‐Months‐Old Children in Lowland and Highland Areas in Kilosa District, Tanzania: A Cross‐Sectional Study. Journal of Nutrition and Metabolism. 2021; 2021(1): 6627557. doi: 10.1155/2021/6627557. DOI: https://doi.org/10.1155/2021/6627557

Tamir TT, Techane MA, Dessie MT, Atalell KA. Applied Nutritional Investigation Spatial Variation and Determinants of Stunting Among Children Aged Less Than 5 Y in Ethiopia: A Spatial and Multilevel Analysis of Ethiopian Demographic and Health Survey 2019. Nutrition. 2022 Nov; 103: 111786. doi: 10.1016/j.nut.2022.111786. DOI: https://doi.org/10.1016/j.nut.2022.111786

Gough EK, Stephens DA, Moodie EE, Prendergast AJ, Stoltzfus RJ, Humphrey JH, Manges AR. Linear Growth Faltering in Infants Is Associated with Acidaminococcus Sp. and Community-Level Changes in Gut Microbiota. World Review of Nutrition and Dietetics. 2016; 114: 125-6. doi: 10.1186/s40168-016-0149-2. DOI: https://doi.org/10.1186/s40168-016-0149-2

Udeechee U and Sahu BP. Factors Associated with Malnutrition Among Under-5 Children in India: A Study on National Family Health Survey-5. In Nutrition and Food Security in India: Enriching the Cycle of Research, Public Policy and Practice. Singapore: Springer Nature Singapore. 2025 Oct: 105-117. doi: 10.1007/978-981-96-7230-1_8. DOI: https://doi.org/10.1007/978-981-96-7230-1_8