The coexistence of undernutrition and over-nutrition (i.e. overweight and obesity) or diet-related non-communicable diseases is known as the double burden of malnutrition. The double burden of malnutrition was previously commonly observed in developed and affluent communities, but, as early as 1996, it was noticed in the low-to-middle income countries (LMICs). The double burden of malnutrition can manifest at the individual level when the development of two or more forms of malnutrition is observed simultaneously. For example, an individual child often manifests as stunting or micronutrient deficiencies co-occurring with overweight or obesity. On the household level, the double burden of malnutrition may arise from contrasting forms of malnutrition in multiple family members. For example, when a mother is overweight and a child is underweight. While at the population level, both undernutrition and overweight are prevalent in the same community, nation, or region (1). The exception is Africa where the slower rates of decline in the prevalence of undernutrition has been overtaken by population growth so that the absolute number of stunted children is rising. In many regions, economic transition is causing a rapid increase in the number of overweight and obese people. The rapidity of this rise is such that many nations bear the simultaneous burdens of under- and overnutrition; termed the “double burden” of malnutrition (2).
Undernutrition remains one of Tanzania’s greatest human development challenges. Despite displaying a seemingly ‘low’ and ‘acceptable’ rates of acute malnutrition, the burden1 of undernourished children is one of the highest in the East African region. An estimated 450,000 children in Tanzania are acutely malnourished or wasted, with over 100,000 suffering from the most severe form of acute malnutrition. Tanzania has one of the highest undernutrition burdens in East and Southern Africa, threatening not only individual lives but the next generation’s economic advancement in lost educational achievement, lost income, and lost opportunities. High rates and high burden Despite Tanzania’s steady trends in the reduction of the rates of undernutrition over the last two decades, the prevalence and the burden of undernutrition remains high in country. Due to the rate of population growth outstripping the rate of reduction, the absolute numbers of stunted and wasted children are high, and in some instances increasing. Rates are about percentage whilst burden is about the actual caseload or number. In Tanzania, acute malnutrition rates are low (below 5% is considered ‘low severity’) but the actual number of acutely malnourished children is high (over 450,000).
Study of the malnutrition in Tanzania showed 4 key observations:
1. Though malnutrition rates in Tanzania have decreased for children under five since 1999, it is still highly prevalent and statistics are worryingly high in some regions of the country.
2. As part of renewed commitment in addressing child undernutrition, the Tanzanian government has recently launched a comprehensive five-year National Multi-Sectoral Nutrition Action Plan.
3. The primary drivers of undernutrition in Tanzania are: climate change, political continuity, demographic change, poverty, urbanisation and gender inequality.
4.In six regions (Dodoma, Ruvuma, Rukwa, Kigoma, Katavi and Geita), chronic malnutrition exceeds 40%. In three regions, more than half children are chronically malnourished – Iringa (51.3%), Njombe (51.5%), and Kagera (51.9%). Overall, more than 2.7 million children under five in Tanzania are stunted, which affects their future learning, productivity.
Sources used:
– https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7412-y
– https://www.who.int/nutrition/double-burden-malnutrition/infographics/en/
– https://www.karger.com/Article/FullText/487383
– https://www.iris-france.org/wp-content/uploads/2017/03/Tanzania-Final-report.pdf
East Africa 
Hi everyone,
What a great blog you’ve been writing. The page looks very neat. Compliments to how you have arranged all the different posts. In a blink of an eye, I can tell what i want to read and where I can find it. As for this blog post, very informative, I have learned quite a lot. I was wondering if you know why the burden of undernourished children is so high in Tanzania. What is different than any other surrounding countries in East Africa? Perhaps you can explain that in any of your next blog posts. Really looking forward to it, keep up the good work!
Cheers, Amber
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Hi Amber,
In Tanzania, significant progress has been made in addressing all forms of malnutrition among children under five over the last decade. The prevalence of chronic malnutrition in the country is still categorised as “very high”. Undernutrition remains one of Tanzania’s greatest human development challenges. Despite displaying a seemingly ‘low’ and ‘acceptable’ rates of acute malnutrition, the burden of undernourished children is one of the highest in the East African region. This is threatening not only individual lives but the next generation’s economic advancement in lost educational achievement, lost income, and lost opportunities. This is why this blog is focussing on Tanzania.
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Hi everyone,
First of all, your blog looks really really professional and just like Amber mentioned, you can immediately see what all the blogposts will be about. Good job on that.
Regarding this blogpost, I have a question about the part where you mention that “The double burden of malnutrition was previously commonly observed in developed and affluent communities”. Maybe I missed that piece of information in one of the previous blogposts, but I was wondering what you mean with ‘previously’ , when is that exactly? Is that 1 year ago, 10 years ago, after 1996, or before that?
And what is the cause of undernutrition within these developed and afflunt communities?
Moreover, regarding the 2nd paragraph, be careful with the words you use when talking about malnutrition. Of course you’ve place the word ‘acceptable’ between quotation marks, but still it is a bit of a tricky word to use when talking about undernutrition – especially when you don’t give any other, more striking numbers, to compare it with.
To conclude, I don’t really understand what the part about Tanzania adds to this blogpost. You’re blogpost is about the double burden of malnutrition, but when talking about Tanzania you only cover the undernutrition part. I don’t see any data / information on overweight/obesity in Tanzania.
Kind regards,
Eva Feijt
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Hi everyone!
I really liked to read your blog. Especially the fact that a double burden can exist within one and the same household was new to me. First I did not quite get what the double burden of malnutrition consisted of but you made it really clear! Do you have an explanation with the example of a mother being overweight and a kid being underweight? I wonder how that can develop over time and if that is a situation that happens more often.
All in all very interesting blog, looking forward to the next(:
Jasmijn
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Hi Jasmijn,
Poor nutrition continues to cause nearly half of deaths in children under five, while low- and middle-income countries now witness a simultaneous rise in childhood overweight and obesity – increasing at a rate 30% faster than in richer nations.
This double burden of malnutrition can exist at the individual level when a mother may be overweight or anaemic and a child is underweight – and at the population level – where there is a prevalence of both undernutrition and overweight in the same community, nation or region.
Moreover, the relationship between undernutrition and overweight and obesity is more than a coexistence. Reflected in the epidemiology and supported by evidence, undernutrition early in life – and even in utero – may predispose to overweight and noncommunicable diseases such as diabetes and heart disease later in life. Overweight in mothers is also associated with overweight and obesity in their offspring. Rapid weight gain early in life may predispose to long-term weight excess. These are just some of the examples of biological mechanisms, which along with environmental and social influences, are increasingly understood as important drivers in the global burden of malnutrition across the lifecourse.
A study by Dieffenbach and Stein indicates that the increasing prevalence of stunted children and overweight mother pairs is due to the increasing prevalence of overweight mothers and the decreasing prevalence of childhood stunting and that the underlying factors remain the same (1).
The results from a study in Africa corroborate the findings of other recent studies that reported the association of chronic malnutrition in children with maternal overweight / obesity (2).
You can find the two studies below!
1. Susan Keino, Guy Plasque GE and B van den B. Determinants of stunting and overweight among young children and adolescents in Africa [Internet]. [cited 2019 Dec 9]. Available from: https://journals.sagepub.com/doi/pdf/10.1177/156482651403500203
2. Silva D e., Valente A, Borges A, Dias C, Almeida F, Cruz JL, et al. Relationship between the mothers’ nutritional status with that of a child population from são Tomé principe, “africa.” Rev Bras Saude Matern Infant. 2017;17(2):327–35.
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