Prevalence and key determinants of the triple burden of childhood malnutrition in Southeast Asian countries: a systematic review and meta-analysis within an adapted socio-ecological framework

The triple burden of malnutrition (TBM) is increasing globally, but significant evidence gaps exist regarding its burden and drivers among children in Southeast Asian (SEA) countries. We systematically searched four databases (PROSPERO-CRD42023420129) and Google Scholar through February 2024. We assessed stunting and overweight prevalence among children aged 0–18 years old across four SEA countries (Indonesia, Malaysia, Thailand, and Vietnam) from recent national surveys. We conducted random-effect meta-analyses to estimate the pooled prevalence of micronutrient deficiencies, and the pooled odds ratio for TBM-associated determinants using an adapted socio-ecological framework. 176 studies were included for systematic review, with 132 studies eligible for meta-analysis. Our findings illustrate significant variation in TBM across countries, dependent on region, age, and sex. Pooled prevalence [95% CI] of anemia, iron, vitamin A, and D deficiencies were 25% [22, 29], 14% [10, 18], 6% [4, 8], and 40% [32, 48], respectively (I2>90%). Determinants of the TBM included child-individual factors, poor early-life nutrition, and family household characteristics including maternal nutrition and education, socioeconomic, family size, sanitation, and food security. However, macro-level environmental impacts were less documented. Our findings emphasize the need for robust, timely monitoring of TBM data, including micronutrient biomarkers, and targeted policy intervention in SEA countries.