To examine the prevalence of and factors associated with different forms of household-level double burden of malnutrition (DBM) in Ethiopia.

We defined DBM using anthropometric measures for adult overweight (BMI ≥ 25 kg/m2), child stunting (height-for-age Z-score <-2 sd) and overweight (weight-for-height Z-score ≥2 sd). We considered sixteen biological, environmental, behavioural and socio-demographic factors. Their association with DBM forms was assessed using generalised linear models.

We used data from two cross-sectional studies in an urban (Addis Ababa, January–February 2018), and rural setting (Kersa District, June–September 2019).

Five hundred ninety-two urban and 862 rural households with an adult man, adult woman and child <5 years.

In Addis Ababa, overweight adult and stunted child was the most prevalent DBM form (9 % (95 % CI 7, 12)). Duration of residence in Addis Ababa (adjusted OR (aOR) 1·03 (95 % CI 1·00, 1·06)), Orthodox Christianity (aOR 1·97 (95 % CI 1·01, 3·85)) and household size (aOR 1·24 (95 % CI 1·01, 1·54)) were associated factors. In Kersa, concurrent child overweight and stunting was the most prevalent DBM form (11 % (95 % CI 9, 14)). Housing quality (aOR 0·33 (95 % CI 0·20, 0·53)), household wealth (aOR 1·92 (95 % CI 1·18, 3·11) and sanitation (aOR 2·08 (95 % CI 1·07, 4·04)) were associated factors. After adjusting for multiple comparisons, only housing quality remained a significant factor.

DBM prevalence was low among urban and rural Ethiopian households. Environmental, socio-economic and demographic factors emerged as potential associated factors. However, we observed no common associated factors among urban and rural households.

To examine changes in the spatial clustering of malnutrition in children under 5 years of age (under-5s) for the period 1999 to 2011 in Bangladesh.

We used data from four nationally representative Demographic and Health Surveys (DHS) conducted in 1999–2000, 2004, 2007 and 2011 in Bangladesh involving a total of 24 211 under-5s located in 1661 primary sampling units (PSU; geographical unit of analysis) throughout Bangladesh. The prevalence of stunting (height/length-for-age Z-score <−2), underweight (weight-for-age Z-score <−2) and wasting (weight-for-height/length Z-score <−2) at each PSU site and for each survey year were estimated based on the WHO child growth standard. The extent of spatial clustering was quantified using semivariograms.

Whole of Bangladesh.

Children under 5 years of age.

Our results demonstrate that in 1999–2000 most PSU throughout Bangladesh experienced stunting, underweight and wasting prevalence which exceeded the WHO thresholds. By 2011, this situation improved, although in two of the six divisions (Barisal and Sylhet) PSU still exhibited higher levels of malnutrition compared with other divisions of the country. The pattern of spatial clustering for stunting, underweight and wasting also changed between 1999 and 2011 both at national and sub-national (division) levels.

We identified divisions where malnutrition indicators (stunting, underweight and wasting) remain highly clustered and other divisions where they are more widely spread in Bangladesh. This has important implications on how interventions for malnutrition need to be delivered (geographically targeted interventions v. random interventions) within each division of the country.