Peri‐urban, but not urban regions, in Bolivia are associated with the double burden of malnutrition among children and within households
Authors: Jones Andrew D , Hoey Lesli , Blesh Jennifer , Janda Kathryn 
Published: November 2023

Many low‐ and middle‐income countries (LMICs) have experienced rapid urbanization in recent decades. In particular, the population of semi‐urban regions on the peripheries of cities has grown markedly, often decoupled from economic development. At the same time, traditional diets have been replaced by increased consumption of highly refined foods, vegetable oils, and foods with added sugars that have contributed to an increasing prevalence of obesity while under nutrition and associated disease remains a persistent challenge. In this study, we examine the co‐occurrence of under nutrition and overweight, or the “double burden” of malnutrition, across an urban‐rural transect in two rapidly transitioning regions of Bolivia. Our specific objective is to assess the association of urbanicity with the double burden of malnutrition and its component conditions. We used data from a quantitative survey of 3,848 households implemented in 2015 in the cities of El Alto and Montero, Bolivia. Five double burden characterizations were assessed: 1) concurrent overweight and anemia among women of reproductive age (WRA), 2) concurrent stunting and overweight among preschool‐aged children (PSC), 3) concurrent anemia and overweight among PSC, 4) households with an overweight adult WRA and a stunted PSC, and 5) households with an overweight adult WRA and an anemic PSC. Standard protocols were carried out for assessing child and adult heights and weights, and Hemocue machines were used to assess hemoglobin (Hb) concentrations. Hb concentrations were adjusted for elevation and smoking status. Across both study regions, 68.3% of adult women were overweight or obese, 58.7% were anemic, 11.5% of preschool‐aged children were overweight, 17.4% were stunted, and 70.9% were anemic. Regional differences were stark with greater stunting and anemia observed in El Alto, and greater adult overweight observed in Montero. In adjusted logistic regression models, children residing in peri‐urban, but not urban regions, had higher odds of stunting (OR 95% CI: 1.5 (1.1, 2.0)), and overweight (1.6 (1.1, 2.4)), respectively, as compared to rural areas. Children residing in urban areas had lower odds of anemia (0.52 (0.36, 0.75)) than children living in rural areas, but there was no difference in these odds between peri‐urban and rural areas. Children residing in peri‐urban, but not urban areas, had higher odds of concurrent anemia and overweight (1.6 (1.0, 2.5)), and of being stunted while living in a household with an overweight or obese adult woman (1.9 (1.3, 2.8)). Urbanicity was not associated with the other double burden conditions. Residents of peri‐urban regions in Bolivia may be especially vulnerable to concurrent under nutrition and obesity. Explicit nutritional monitoring of these regions, distinct from urban regions, would likely strengthen the design and targeting of policies and interventions aimed at mitigating the nutritional double burden.Support or Funding InformationThis research was supported by the Daniel and Nina Carasso Foundation.