Household-level double burden of malnutrition in Ethiopia: a comparison of Addis Ababa and the rural district of Kersa.

Objective: To examine the prevalence of and factors associated with different forms of household-level double-burden of malnutrition (DBM) in Ethiopia. Design: We defined DBM using anthropometric measures for adult overweight (body mass index (BMI) ≥25 kg/m2, child stunting (height-for-age Z-score <-2 SD) and overweight (weight-for-height Z-score ≥2 SD). We considered 16 biological, environmental, behavioural, and socio-demographic factors. Their association with DBM forms was assessed using generalized linear models. Setting: We used data from two cross-sectional studies in an urban (Addis Ababa, January-February 2018), and rural setting (Kersa District, June-September 2019). Participants: 592 urban and 862 rural households with an adult man, adult woman, and child <5 years. Results: In Addis Ababa, overweight adult and stunted child was the most prevalent DBM form (9% (95% CI 7-12%)). Duration of residence in Addis Ababa (adjusted odds ratio (aOR) 1.03 (95% CI 1.00-1.06)), Orthodox Christianity (aOR 1.97 (95% CI 1.01-3.85)), and household size (aOR 1.24 (95% CI 1.01-1.54)) were associated factors. In Kersa, concurrent child overweight and stunting was the most prevalent DBM form (11% (95% CI 9-14%)). Housing quality (aOR 0.33 (95% CI 0.20-0.53)), household wealth (aOR 1.92 (95% CI 1.18-3.11), and sanitation (aOR 2.08 (95% CI 1.07-4.04)) were associated factors. After adjusting for multiple comparisons, only housing quality remained a significant factor. Conclusions: DBM prevalence was low among urban and rural Ethiopian households. Environmental, socio-economic, and demographic factors emerged as potential associated factors. However, we observed no common associated factors among urban and rural households.