Export file:


  • RIS(for EndNote,Reference Manager,ProCite)
  • BibTex
  • Text


  • Citation Only
  • Citation and Abstract

Nutrition transition and double burden of malnutrition in Africa: A case study of four selected countries with different social economic development

1 Department of Nutrition and Health Sciences, Ball State University, 2000 W University Avenue, Muncie, Indiana 47306, USA
2 Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, Ball State University, 2000 W University Avenue, Muncie Indiana 47306, USA

Background: Disease and lifestyle patterns have been changing rapidly especially in Africa due to transformation in economic development and urbanization. Research on the magnitude and consequences of these transformations in Africa is limited. This study investigates the shifts in nutritional status in children and adults in four selected low-, middle- and high-income countries in Africa, identifies factors associated with the shifts, and provides recommendations for future studies. Methods: Malawi, Kenya, Ghana, and South Africa were selected based on their Gross Domestic Product (GDP). Nationally representative data were obtained from the 2017 Global Nutrition Report, Demographic Health Surveys (DHSs), and the World Health Organization (WHO) database. Prevalence of underweight, overweight, and obesity were assessed and compared across the countries, gender, residence, and over time. Results: South Africa had the highest GDP and largest prevalence of overweight and obesity rates in children < 5 years old and adults > 18 (13.3% and 51.9%, respectively). Malawi, with the lowest GDP, had the highest stunting rate (37.0%). In all 4 countries, but most notably in South Africa, trends indicated that the increasing prevalence of overweight and obesity was much greater than the declining rate of underweight. Malawi, Kenya, and Ghana had a slight decline in overweight prevalence in children under 5 years. Conclusions: Nutritional shifts are occurring in Africa and seem to be heavily influenced by economic development. The double-burden of malnutrition presents prioritization challenges for policymakers. Attention needs to be shifted towards prevention of obesity, at least in the higher income countries in Africa.
  Article Metrics

Keywords Africa; malnutrition; obesity; overweight; social economic status

Citation: Teresia Mbogori, Kilee Kimmel, Mengxi Zhang, Jay Kandiah, Youfa Wang. Nutrition transition and double burden of malnutrition in Africa: A case study of four selected countries with different social economic development. AIMS Public Health , 2020, 7(3): 425-439. doi: 10.3934/publichealth.2020035


  • 1. Wang Y, Mi J, Shan XY, et al. (2007) Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China. Int J Obes (Lond) 31: 177–188.
  • 2. Wang Y, Chen HJ, Shaikh S, et al. (2009) Is obesity becoming a public health problem in India? Examine the shift from under- to overnutrition problems over time. Obes Rev 10: 456–474.
  • 3. Wang Y, Lobstein T (2006) Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 1: 11–25.    
  • 4. Tzioumis E, Kay MC, Bentley ME, et al. (2016) Prevalence and trends in the childhood dual burden of malnutrition in low-and middle-income countries, 1990–2012. Public Health Nutr 19: 1375–1388.    
  • 5. Steyn NP, McHiza ZJ (2014) Obesity and the nutrition transition in Sub-Saharan Africa. Ann N Y Acad Sci 1311: 88–101.    
  • 6. Steyn NP, Nel JH, Parker W, et al. (2012) Urbanisation and the nutrition transition: A comparison of diet and weight status of South African and Kenyan women. Scand J Public Health 40: 229–238.
  • 7. Abrahams Z, McHiza Z, Steyn NP (2011) Diet and mortality rates in Sub-Saharan Africa: stages in the nutrition transition. BMC Public Health 11: 801.    
  • 8. Wang Y, Monteiro C, Popkin BM (2002) Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia. Am J Clin Nutr 75: 971–977.    
  • 9. Albala C, Vio F, Kain J, et al. (2002) Nutrition transition in Chile: determinants and consequences. Public Health Nutr 5: 123–128.    
  • 10. Min J, Zhao Y, Slivka L, et al. (2018) Double burden of diseases worldwide: coexistence of undernutrition and overnutrition-related non-communicable chronic diseases. Obes Rev 19: 49–61.    
  • 11. Mayosi BM, Flisher AJ, Lalloo UG, et al. (2009) The burden of non-communicable diseases in South Africa. Lancet 374: 934–947.    
  • 12. Popkin BM, Adair LS, Ng SW (2012) Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 70: 3–21.    
  • 13. Romieu I, Dossus L, Barquera S, et al. (2017) Energy balance and obesity: what are the main drivers? Cancer Causes Control 28: 247–258.    
  • 14. Due P, Damsgaard MT, Rasmussen M, et al. (2009) Socioeconomic position, macroeconomic environment and overweight among adolescents in 35 countries. Int J Obes (Lond) 33: 1084–1093.    
  • 15. Global Nutrition Report Stakeholder Group. Global nutrition report 2017: nourishing the SDGs. Bristol, UK: Development Initiatives; 2017. Available from: https://globalnutritionreport.org/reports/2017-global-nutrition-report/ [Accessed 5th November 2018].
  • 16. The Demographic Health Survey Program. Ghana demographic and health survey 1998–2014. Rockville, MD, USA: Ghana Statistical Service, Ghana Health Service, and ICF International. Available from: https://www.dhsprogram.com/data/available-datasets.cfm [Accessed 7th November 2018].
  • 17. The Demographic Health Survey Program. Kenya demographic and health survey 1998–2014. Rockville, MD, USA: Kenya National Bureau of Statistics, Kenya Ministry of Health, Kenya National AIDS Control Council, Kenya Medical Research Institute, Kenya National Council for Population and Development, and ICF International. Available from: https://www.dhsprogram.com/data/available-datasets.cfm [Accessed 7th November 2018].
  • 18. The Demographic Health Survey Program. Malawi demographic and health survey 2000–2016. Zomba, Malawi, and Rockville, MD, USA: National Statistical Office and ICF International. Available from: https://www.dhsprogram.com/data/available-datasets.cfm [Accessed 7th November 2018].
  • 19. The Demographic Health Survey Program. South Africa demographic and health survey 1998–2016. Pretoria, South Africa and Rockville, MD, USA: National Department of Health, Statistics South Africa, South African Medical Research Council, and ICF International. Available from: https://www.dhsprogram.com/data/available-datasets.cfm [Accessed 7th November 2018].
  • 20. World Health Organization. Global Health Observatory data: Child malnutrition country survey results. Available from: http://apps.who.int/gho/data/node.main. [Accessed 5th November 2018].
  • 21. World Health Organization. Global Health Observatory data: Body mass index (BMI). Available from: http://apps.who.int/gho/data/node.main. [Accessed 4th November 2018].
  • 22. Bates K, Gjonça A, Leone T (2017) Double burden or double counting of child malnutrition? The methodological and theoretical implications of stunting overweight in low and middle income countries. J Epidemiol Community Health 71: 779–785.
  • 23. Fernald LC, Neufeld LM (2007) Overweight with concurrent stunting in very young children from rural Mexico: prevalence and associated factors. Eur J Clin Nutr 61: 623–632.    
  • 24. Hawkes C, Harris J, Gillespie S (2017) Changing diets: Urbanization and the nutrition transition. In: 2017 Global Food Policy Report. International Food Policy Research Institution (IFPRI): Washington, DC, USA, 2017, 34–41.
  • 25. Ajayi IO, Adebamowo C, Adami HO, et al. (2016) Urban-rural and geographic differences in overweight and obesity in four sub-Saharan African adult populations: A multi-country cross-sectional study. BMC Public Health 16: 1126.    
  • 26. Sodjinou R, Agueh V, Fayomi B, et al. (2008) Obesity and cardio-metabolic risk factors in urban adults of Benin: relationship with socio-economic status, urbanisation, and lifestyle patterns. BMC Public Health 8: 84.    
  • 27. Kimani-Murage EW, Muthuri SK, Oti SO, et al. (2015) Evidence of a double burden of malnutrition in urban poor settings in Nairobi, Kenya. PLoS One 10: e0129943.    
  • 28. Christensen DL, Eis J, Hansen AW, et al. (2008) Obesity and regional fat distribution in Kenyan populations: impact of ethnicity and urbanization. Ann Hum Biol 35: 232–249.    
  • 29. Neuman M, Kawachi I, Gortmaker S, et al. (2013) Urban-rural differences in BMI in low- and middle-income countries: the role of socioeconomic status. Am J Clin Nutr 97: 428–436.    
  • 30. Kanter R, Caballero B (2012) Global gender disparities in obesity: A review. Adv Nutr 3: 491–498.    
  • 31. Walker AR, Adam F, Walker BF (2001) World pandemic of obesity: the situation in Southern African populations. Public Health 115: 368–372.
  • 32. Holdsworth M, Gartner A, Landais E, et al. (2004) Perceptions of healthy and desirable body size in urban Senegalese women. Int J Obes Relat Metab Disord 28: 1561–1568.    
  • 33. Tateyama Y, Techasrivichien T, Musumari PM, et al. (2018) Obesity matters but is not perceived: a cross-sectional study on cardiovascular disease risk factors among a population-based probability sample in rural Zambia. PLoS One 13: e0208176.    
  • 34. Rguibi M, Belahsen R (2006) Fattening practices among Moroccan Saharawi women. East Mediterr Health J 12: 619–624.
  • 35. Lobstein T, Jackson-Leach R, Moodie ML, et al. (2015) Child and adolescent obesity: part of a bigger picture. Lancet 385: 2510–2520.    
  • 36. World Health Organization (WHO) Consideration of the evidence on childhood obesity for the Commission on Ending Childhood Obesity: report of the ad hoc working group on science and evidence for ending childhood obesity. Geneva, Switzerland: WHO; 2016. Available from: https://apps.who.int/iris/bitstream/handle/10665/206549/9789241565332_eng.pdf?sequence=1& isAllowed=y [Accessed 15th December 2018].
  • 37. Uauy R, Albala C, Kain J (2001) Obesity trends in Latin America: transiting from under-to overweight. J Nutr 131: 893S–899S.    
  • 38. United Nations. Sustainable development goals. Available from: https://www.un.org/sustainabledevelopment/sustainable-development-goals/ (Accessed 20th December 2018].
  • 39. South African Government. National development plan 2030: our future–make it work. Available from: https://www.gov.za/issues/national-development-plan-2030 (Accessed 20th December 2018].
  • 40. Ghana Ministry of Health and the Ghana Health Service. National nutrition policy for Ghana 2013–2017. The Ministry of Food and Agriculture, Ministry of Education, Ministry of Finance, Ministry of Employment and Social Welfare, National Development Planning Commission, and Renewed Efforts Against Child Hunger; 2013. Available from: http://extwprlegs1.fao.org/docs/pdf/gha145267.pdf (Accessed 20th December 2018].
  • 41. Republic of Kenya Ministry of Health. Kenya national strategy for the prevention and control of non-communicable diseases 2015–2020. Nairobi, Kenya: Ministry of Health, MOH/CDC CoAg, IANPHI, Kenya Redcross, and World Health Organization; 2015. Available from: https://www.who.int/nmh/ncd-task-force/kenya-strategy-ncds-2015-2020.pdf [Accessed 20th December 2018].


Reader Comments

your name: *   your email: *  

© 2020 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

Download full text in PDF

Export Citation

Copyright © AIMS Press All Rights Reserved