Developing an Original Epidemiological Framework for Monitoring the Double Burden of Malnutrition in Nigerian Communities

The double burden of malnutrition, encompassing the coexistence of undernutrition and overweight or obesity within the same population or household, is increasingly prevalent in Nigerian communities undergoing nutrition transition but lacks an adapted epidemiological monitoring framework for the Nigerian surveillance context. This study developed an original epidemiological framework for monitoring the double burden of malnutrition in Nigerian communities. A framework development methodology was employed across four phases. Phase one conducted a systematic review of 52 publications on double burden of malnutrition measurement and monitoring in sub-Saharan African contexts (2015 to 2024). Phase two conducted primary research through a multi-site cross-sectional survey of 1,200 households across six communities representing different nutrition transition stages in Lagos, Kano, Enugu, Port Harcourt, Makurdi, and Damaturu, measuring both undernutrition (stunting, wasting, anaemia) and overnutrition (overweight, obesity) indicators simultaneously at household, mother-child dyad, and individual levels. Phase three developed the Nigerian Double Burden of Malnutrition Monitoring Framework (NDBMMF) through synthesis of review findings and primary data patterns. Phase four validated the framework through expert consultation with 18 nutrition epidemiology and surveillance specialists. The NDBMMF introduces four original monitoring dimensions: household-level double burden classification, mother-child double burden dyadic assessment, nutrition transition stage indicators for community stratification, and an Integrated Malnutrition Surveillance Score enabling double burden tracking within routine HMIS. Recommendations include integration of the NDBMMF into the National Nutrition and Health Survey cycle and DHIS2 indicator set.

Keywords: double burden of malnutrition, nutrition monitoring framework, Nigeria, nutrition transition, epidemiology