Addressing malnutrition in low- and middle-income countries with double-duty actions

Abstract

Multiple forms of malnutrition co-exist (the double burden) in low- and middle-income countries, but most interventions and policies target only one form. Identifying shared drivers of the double burden of malnutrition is a first step towards establishing effective interventions that simultaneously address the double burden of malnutrition (known as double-duty actions). We identified shared drivers for the double burden of malnutrition, to assess which double-duty actions are likely to have the greatest reach in preventing all forms of malnutrition, in the context of the sustainable development goals. We reviewed existing conceptual frameworks of the drivers of undernutrition, obesity and environmental sustainability. Shared drivers affecting all forms of malnutrition and environmental sustainability were captured using a socio-ecological approach. The extent to which drivers were addressed by the five double-duty actions proposed by the WHO was assessed. Overall, eighty-three shared drivers for the double burden of malnutrition were identified. A substantial proportion (75·0%) could be addressed by the five WHO double-duty actions. ‘Regulations on marketing’ and ‘promotion of appropriate early and complementary feeding in infants’ addressed the highest proportion of shared drivers (65·1% and 53·0%, respectively). Twenty-four drivers were likely to be sensitive to environmental sustainability, with ‘regulations on marketing’ and ‘school food programmes and policies’ likely to have the greatest environmental reach. A quarter of the shared drivers remained unaddressed by the five WHO double-duty actions. Substantially more drivers could be addressed with minor modifications to the WHO double-duty actions and the addition of de novo actions.

Actions Targeting the Double Burden of Malnutrition: A Scoping Review

“…From the set of WHO's recommended DDAs, (Table 1) no intervention on regulations on marketing was identified. This was despite their potential to impact DBM through their high percentage of environmental sustainability-shared drivers (62.5%) [20]. School-based food programs, which the DDA identified to yield the second largest impact (45.8%) [20], were the focus of only two studies [15,16].…”

“…This was despite their potential to impact DBM through their high percentage of environmental sustainability-shared drivers (62.5%) [20]. School-based food programs, which the DDA identified to yield the second largest impact (45.8%) [20], were the focus of only two studies [15,16]. These interventions found differential outcomes and a significant impact on reducing thinness, with nevertheless no impact on overweight/obesity of school-aged children in Burkina Faso and Indonesia.…”

Unhealthy eating practices of city-dwelling Africans in deprived neighbourhoods: Evidence for policy action from Ghana and Kenya

“…The overconsumption of unhealthy diets with a high concentration of calories and low micronutrients (energy-dense and nutrient-poor -EDNP), is implicated in the onset of multiple forms of malnutrition ( Pradeilles et al, 2019-a ). Eating practices may also evolve in response to changing contexts ( Jastran et al, 2009 ), such as that accompanying the nutrition transition.…”

Accelerating progress in improving diets and nutrition in Ethiopia

“…Low and middle income countries have always been disproportionately affected by undernutrition. However, in recent years the rise in the prevalence of overweight and obesity has exacerbated the nutrition problem, stretching health systems (Pradeilles et al 2019;WHO 2017). Poverty, poor diets, and low physical activity are some of the social determinants of malnutrition (Perez-Escamilla et al 2018).…”