Dietary diversity moderates household economic inequalities in the double burden of malnutrition in Tanzania

Abstract

Objective: Improved food availability and a growing economy in Tanzania may insufficiently decrease pre-existing nutritional deficiencies and simultaneously increase overweight within the same individual, household, or population, causing a double burden of malnutrition (DBM). We investigated economic inequalities in DBM at the household level, expressed as a stunted child with an overweight/obese mother, and the moderating role of dietary diversity in these inequalities. Design:We used cross-sectional data from the 2015-2016 Tanzania Demographic and Health Survey. Setting: Nationlly representative survey across all regions. Participants: 2,867 children (aged 6-23 months) and their mothers (aged 15-49 years). The participants were categorized into two groups based on their dietary diversity score: achieving and not achieving minimum dietary diversity. Results: The prevalence of DBM was 5.6% (SD=0.6) and significantly varied by regions (ranging from 0.6%-12.2%). Significant interaction was observed between dietary diversity and household wealth index (p for interaction=0.01). The prevalence of DBM monotonically increased with greater household wealth among those who did not achieve minimum dietary diversity (p for trend=0.002; however, but this association was attenuated in those who achieved minimum dietary diversity (p for trend=0.15), particularly for the richest households (p=0.43). Analyzing household wealth index score as a continuous variable yielded similar results (odds ratio [95% confidence interval]: 2.05 [1.32-3.19] for non-achievers of minimum dietary diversity, 1.39 (0.76-2.54) for achievers). Conclusions: Greater household wealth was associated with higher odds of DBM in Tanzania; however, achieving minimum dietary diversity may mitigate the negative impact of household economic status on DBM.