Rapid review of interventions for addressing the dual burden of malnutrition in low- and middle-income countries
Sabahat Naz, Umber Khan, Tahani Waqar, Munazza Ilyas, Gerardo Zavala Gomez, Romaina IqbalIntroduction
The dual burden of malnutrition (DBM), particularly in low- and middle-income countries (LMICs), poses a significant public health concern. Interventions, such as double-duty actions (DDAs) that can simultaneously address undernutrition and overnutrition, are essential. Therefore, this rapid review aimed to synthesise peer-reviewed articles on nutrition-based DDA interventions to address DBM in LMICs.
Methods
We used Cochrane Rapid Review Methods and guidelines for reporting systematic reviews. We performed a literature search on PubMed, EBSCO CINAHL, Wiley Cochrane Library and Scopus. We included English-language randomised, non-randomised and preintervention and postintervention studies conducted in LMICs that evaluated nutrition-based interventions and reported both undernutrition and overnutrition outcomes at the individual, household or population level. We summarised intervention characteristics, including delivery method, frequency and components. We included the primary and secondary outcomes across studies to capture intervention effectiveness. We reviewed the quantitative effects of the outcomes, where available, such as reductions in stunting and overweight/obesity.
Results
We synthesised evidence from 12 studies, primarily conducted in school settings, with one extending to both schools and the community. Most studies addressed DBM at the individual or population level among children and adolescents aged 5–19 years, while one study considered DBM at the household level, recruiting stunted children with overweight/obese mothers. The interventions mainly promoted nutrition education and integrated strategies such as behaviour change communication, subsidised snacks, kitchen gardening, nutritional supplementation, hygiene promotion and physical activity education. The effectiveness of DDA interventions varied across studies, with three studies demonstrating dual benefit by improving both undernutrition and overnutrition outcomes simultaneously, whereas other interventions primarily improved undernutrition alone, worsening or failing to address the overnutrition component, or showed no effect on DBM indicators but benefited intermediate outcomes, such as knowledge, attitude, dietary diversity and food security.
Conclusion
DDAs have the potential to address dual forms of malnutrition among children and adolescents, though effectiveness remains inconsistent. Addressing the shared drivers of DBM, extending the intervention duration, targeting various age groups and implementing household-level DBM may enhance its impact and applicability in LMICs.
PROSPERO registration number
CRD42024578962.