A multilevel analysis of the double burden of malnutrition among under-five children within the same household in Indonesia

Agnes Boenardy (Research and Development Department, Sinergi Sehat Indonesia, Yogyakarta, Indonesia)
Fumihiko Yokota (Kyushu University, Fukuoka, Japan)
Anak Agung Sagung Indriani Oka (Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition (SEAMEO RECFON), Jakarta, Indonesia)
Megan Chong Hueh Zan (Division of Nutrition, Dietetics and Food Science, IMU University, Kuala Lumpur, Malaysia)
Minh Anh Nguyen (National Institute of Nutrition, Ministry of Health, Hanoi, Vietnam)
Ahnav Bil Auvaq (Research and Development Department, Sinergi Sehat Indonesia, Yogyakarta, Indonesia)
Ahmad Putra Hadaetana (Research and Development Department, Sinergi Sehat Indonesia, Yogyakarta, Indonesia)
Intan Aziizah (Research and Development Department, Sinergi Sehat Indonesia, Yogyakarta, Indonesia)
Nurholis Majid (Research and Development Department, Sinergi Sehat Indonesia, Yogyakarta, Indonesia)

Berita Kedokteran Masyarakat
Vol 42 No 05 (2026)

Purpose: Indonesia faces a persistent double burden of malnutrition (DBM), in which undernutrition and overnutrition coexist within populations. Although national stunting rates have declined, other nutritional challenges persist across provinces, with moderate-to-high rates indicating a complex nutritional transition. This study aims to identify individual, household, and contextual factors influencing the DBM among children in the same household and to provide evidence-based recommendations for region-specific, sustainable interventions. Methods: Using cross-sectional data from the Indonesian Nutrition Status Survey (SSGI) 2024, we analyzed 0-59-month-old children using multilevel logistic regression. Progressive models examined individual, household, and contextual (district or provincial) determinants of DBM, defined as the coexistence of undernutrition and overnutrition within households. Results: The prevalence of household-level DBM was 0.08%. In adjusted models, residing in Java–Bali was associated with significantly lower odds of DBM (OR = 0.39; 95% CI: 0.27–0.57). Children without birth certificates had significantly higher odds of experiencing DBM (OR=1.70; 95% CI: 1.48–1.95). Exclusive breastfeeding was associated with lower odds of DBM (OR = 0.54; 95% CI: 0.48–0.61). Households having more than one child under five showed substantially higher odds of DBM (OR = 3.30; 95% CI: 2.93–3.71), and district-level DBM remained a strong contextual predictor (OR = 2.01; 95% CI: 1.66–2.45). At the contextual level, the district-level DBM index remained strong contextual predictor. Conclusion: Household-level DBM among children in Indonesia exists but remains rare, yet it signals emerging intra-household nutritional inequalities and complexity. Key determinants include household structure, exclusive breastfeeding, birth certificate ownership, region disparities, and district-level contextual factors. These findings highlight the need for integrated, multilevel interventions that address both undernutrition and overnutrition, particularly in vulnerable households and underserved areas.