Location-specific predictors of double burden of malnutrition among Nigerian Mother-Child pairs: Re-evaluating dietary quality and socioeconomic factors.

The double burden of malnutrition (DBM), classified as the coexistence of maternal overweight or obesity or maternal undernutrition and child undernutrition or childhood overweight/obesity, within the same household, is an increasing concern in Nigeria. Drivers of DBM may differ by location due to urbanization, socioeconomic gradients, and dietary transitions. This study examined location-specific predictors of DBM among Nigerian mother-child pairs, with a focus on child dietary quality, maternal education, household food insecurity, and wealth index. A descriptive cross-sectional study using a stratified multistage sampling technique was conducted among 1,295 mother-child pairs (children aged 6 – 23 months) across four Nigerian cities. Child nutritional status was assessed using WHO growth standards, and maternal BMI was classified according to WHO adult cutoffs. Household food insecurity, dietary diversity, minimum meal frequency, and wealth index were measured using validated tools. Associations between predictors and DBM were examined using chi-square tests and generalized estimating equations, including interaction and stratified analyses by location. DBM prevalence was 37.4%, with the most frequent phenotype being overweight mothers and undernourished children (34%). Semi-urban residence (adjusted odds ratio AOR: 2.11; 95% CI: 1.93-2.30), food secure households (AOR: 1.22; 95% CI: 1.09-1.37), and not meeting the minimum meal frequency (AOR: 1.41; 95% CI: 1.04-1.92) were associated with an increased risk of DBM. DBM among Nigerian mother-child pairs is shaped by dietary factors. Context-specific interventions are needed, with a focus on improving child diet quality in semi-urban areas.