# 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

## TL;DR

Under-five children in Malawi's cities face rising rates of both stunting and overweight, with the capital city showing the largest increase.

## Contribution

The study reveals a worsening dual burden of malnutrition in urban Malawi, with new evidence of increasing severity and prevalence over time.

## Key findings

- Stunting and overweight rates increased in all four cities between 2015/16 and 2024.
- Lilongwe had the highest increase in both stunting (86.7%) and overweight (118.6%).
- Moderate stunting remains the dominant form of undernutrition among children.

## 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 high prevalence of stunting (24.7%), the prevalence of stunting and overweight were very high (range 31.1%–41.5%) in the other three cities in 2024. Regarding overweight, prevalence ranged from medium (5 to < 10%) in Blantyre and Lilongwe to high (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 very high prevalence of stunting and medium to high 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.

Stunting and overweight prevalence among under five children rose across all four Malawian cities between 2015/16 and 2024, with the capital city registering the most dramatic increase of 86.7% and 118.6% respectively. By 2024, stunting prevalence moved from low to high for Lilongwe and Zomba, low to medium for Mzuzu, and, high to very high for Blantyre. Overweight increased by about 2‐fold in Blantyre and Lilongwe, with, 2.7 and 6.1 percentage point increase in Mzuzu and Zomba, respectively. Overall, stunting increased from 20.8% to 37.6%, and overweight from 6.1% to 10.3% over the period.