Geographical and socioeconomic inequalities in the double burden of malnutrition among women in Southeast Asia: A population-based study

Background Countries in the South and Southeast Asia region grapple with significant challenges due to the double burden of malnutrition (DBM) in women. An understanding of the country specific DBM geographical and socio-economic distribution in South and Southeast Asian countries will enable targeting of DBM interventions towards high-risk populations in the region. This study aimed to analyse anthropometric indicators for women's nutrition at national and subnational levels in seven South and Southeast Asian countries and assess the association between nutritional status and socioeconomic factors.Methods We used population-representative cross-sectional data from the Demographic and Health Surveys con-ducted between 2000 and 2017, for seven South and Southeast Asian countries (Bangladesh, Cambodia, India, Myanmar, Nepal, Pakistan, and Timor-Leste) and estimated national and subnational prevalence of women under-weight and overweight. Using a concentration index (CI), we measured relative and absolute inequality across under-weight and overweight in urban and rural areas in these countries. In addition, we estimated the health achievement index, integrating mean coverage of nutritional status and the distribution of coverage by rural and urban populations.Findings The prevalence of underweight women ranged from 7.0% (95% CI: 7.0-8.0%) in Pakistan in 2017 to 44.0% (95% CI: 42-45%) in Bangladesh in 2000 and overweight from 11.0% (95% CI: 10-12%) in Bangladesh in 2000 to 67.0% (95% CI: 66-68%) in Pakistan in 2017. In most countries, underweight disproportionately affected the poorest. The concentration indices for underweight were significant in all countries and ranged from -0.04 in Cambodia in 2014 to -0.38 in Pakistan in 2017. In contrast, overweight disproportionately affected the richest, with concentration indices for overweight significant in all countries, ranging from 0.16 in Cambodia in 2010 to 0.45 in Bangladesh in 2007. In most of the countries an absolute measure of inequality decreased overtime, whereas relative measures increased. Disachievement of underweight is more pronounced in rural populations compared to the urban ones.Interpretations We noted large geographical and socioeconomic disparities in women DBM in South and Southeast Asian countries, at national and subnational levels. Planning, implementation, and evaluation of existing interven-tion programmes for food and nutrition should be based on subnational level needs and outcomes.