Dual, High and Worsening Burden of Malnutrition Among Under‐5 Children Living in Malawi's Cities: Evidence From the 2015/16 and 2024 Demographic and Health Surveys

Abstract

This study examined the structure of, relationship between, and changes in the burden of undernutrition (stunting) and overnutrition (overweight) among children under the age of 5 years living in the cities of Blantyre, Lilongwe, Mzuzu, and Zomba in Malawi. We analyzed the prevalence of undernutrition and overnutrition from the 2015/16 Malawi Demographic and Health Survey (MDHS), which we compared with anthropometric results of the 2024 MDHS that were published in the Key Indicators Report released in February 2025. We calculated the prevalence of moderate stunting and the contribution of severe stunting and moderate stunting to overall stunting in each city. Anthropometric results were available for a weighted sample of 256 children in 2015/16 and 351 children in 2024. Compared to 2015/16, prevalence of stunting and overweight increased in all cities, with Lilongwe, the capital, recording the largest increase in both stunting (86.7%) and overweight (118.6%). Except for Mzuzu city, which experienced a <i>high</i> prevalence of stunting (24.7%), the prevalence of stunting and overweight were <i>very high</i> (range 31.1%-41.5%) in the other three cities in 2024. Regarding overweight, prevalence ranged from <i>medium</i> (5 to < 10%) in Blantyre and Lilongwe to <i>high</i> (10 to < 15%) in Mzuzu and Zomba. The contribution of severe stunting to overall stunting more than quadrupled from 7% in 2015/16 to 30.6% in 2024 in Lilongwe. We conclude that children who live in Malawi's four cities have a dual burden of malnutrition, with <i>very high</i> prevalence of stunting and <i>medium</i> to <i>high</i> prevalence of overweight. Most of the children are moderately stunted. Nutrition policies and strategies for city dwellers should be formulated and implemented to improve nutrition. A larger study that aims to understand the structure and determinants of malnutrition in the cities is required.