Prevalence and Associated Factors of the Double Burden of Malnutrition Among Under-Five Children in Urban Ghana.

The double burden of malnutrition (DBM), reflecting coexisting forms of undernutrition and overnutrition within the same child, is increasingly observed in urbanizing settings. This study assessed the prevalence of child-level DBM and examined factors associated with DBM among children under five years in urban Ghana. A hospital-based cross-sectional study was conducted among 271 mother-child pairs attending a tertiary health facility. Data were collected using a semi-structured questionnaire and standardized anthropometric measurements, and nutritional status was assessed using the World Health Organization Child Growth Standards. DBM was operationally defined as the coexistence of stunting with either underweight or overweight/obesity within the same child. Multivariable logistic regression was used to examine factors associated with DBM. The prevalence of DBM was 31.37%. Higher odds of DBM were associated with increasing child age (AOR = 1.04; 95% CI, 1.01-1.06), low physical activity (inactive: AOR = 5.73; 95% CI, 1.95-16.86), no history of breastfeeding (AOR = 11.79; 95% CI, 2.68-51.84), and non-exclusive breastfeeding (AOR = 5.46; 95% CI, 2.13-14.00). Introduction of semi-solid foods at 6-8 months (AOR = 0.23; 95% CI, 0.10-0.56) and maternal tertiary education (AOR = 0.24; 95% CI, 0.07-0.85) were associated with reduced odds of DBM. DBM is common among under-five children in urban Ghana and is shaped by early-life feeding practices, physical activity, and maternal education, underscoring the need for integrated interventions.