Prevalence and determinants of double and triple burden of malnutrition among mother– child pairs in Lesotho: pooled analysis of DHS 2009, 2014 and 2023

Background The simultaneous occurrence of under- and over-nutrition among households is an emerging public health problem in Sub-Saharan Africa. In Lesotho, the increasing burden of overweight in mothers alongside persistent child undernutrition is indicative of this double burden crisis. However, research on the magnitude and drivers of household double and triple burden malnutrition among mother-child pairs is limited. The objective of this study is to report on household double and triple malnutrition burden prevalence and the correlates among mother-child (MC) pairs in Lesotho. Methods The research pooled cross-sectional data from Lesotho Demographic and Health Surveys in 2009, 2014, and 2023 (representing a total of 4,150 mother-child pairs). Women’s and children’s record data files were combined, and the sample weights were used to adjust for sampling design. Survey-weighted univariable and multivariable logistic regression models were estimated to determine factors associated with the household's double burden and triple burden of malnutrition, adjusting for socioeconomic, demographic, and biological covariates. Result The HDBM and HTBM prevalence was estimated at 14.9% and 3.6%, respectively in the pooled analysis. HDBM trended in a U-shape up to 18.3% in 2023, and HTBM more than doubled to 6.0%in the same year Analysis found women from middle class households were more likely to engage in HDBM (aOR = 1.63, 95% CI: 1.17–2.28) and those with four or more children comprising an over two-fold increase in cumulative odds (aOR = 2.23, 95% CI: 1.45–3.42). Breastfeeding was highly protective with reduced odds of HDBM (aOR = 0.69, 95% CI: 0.53–0.91) and HTBM (aOR = 0.61, 95% CI: 0.40–0.94). In 2023, women were at a significantly greater risk of HTBM than in 2009 (aOR = 1.89, 95% CI: 1.21–2.97). Conclusion This study confirms that Lesotho experiences a significant double and triple burden of malnutrition at the household level. The dual burden of maternal overnutrition and child undernutrition, and their overlap with micronutrient inadequacy, adds a layer of complexity to the public health problem. This burden is significantly affected by key social and biological determinants, including household economic status, parity and maternal height. The increasing trend emphasises the urgent requirement for synergy among public health policies that would tackle simultaneously all forms of malnutrition through a combination approach addressing common underlying determinants.