Introduction The double burden of malnutrition, defined as the coexistence of undernutrition and overnutrition within the same individual, is an emerging public health challenge in low- and middle-income countries undergoing rapid urbanization. In Ghana, the rising prevalence among under-five children underscores the need for context-specific evidence. This study examined the prevalence and predictors of the double burden of malnutrition among under-five children in a selected urban area in Ghana.

Methods A hospital-based cross-sectional study was conducted among 271 mother-child pairs using a semi-structured questionnaire and standardized anthropometric measurements. Nutritional status was assessed using the World Health Organization’s Child Growth Standards. The double burden of malnutrition was defined as the co-occurrence of underweight or overweight with any form of stunting within the same child. Descriptive statistics, Chi-square tests, and binary logistic regression were used to analyze the data.

Results The prevalence of the double burden of malnutrition among the sampled children was 31.37%. Significant predictors included child’s age (OR=1.034; p=0.002), low physical activity levels (OR=6.22; p=0.001 for inactive children), lack of breastfeeding (OR=11.82; p=0.001), non-exclusive breastfeeding (OR=6.06; p=0.001), absence of formula feeding (OR=2.16; p=0.043), and early introduction of semi-solid foods (OR=0.28; p=0.019 for introduction at 6–8 months versus <6 months). Additionally, maternal tertiary education was protective against the double burden of malnutrition (OR=0.24; p=0.032).

Conclusion The findings highlight the multifactorial nature of DBM in urban Ghana, shaped by child feeding practices, physical activity, and maternal education. Addressing DBM will require integrated public health strategies that promote optimal infant feeding, physical activity, and maternal health education, particularly in urban poor communities.

The authors have declared no competing interest.

The authors received no funding

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Ethical clearance for this study was obtained from the Komfo Anokye Teaching Hospital Institutional Review Board (KATH/IRB/2023). Written informed consent was obtained from all participating mothers after the purpose and procedures of the study were explained. Participation was voluntary, and confidentiality was ensured through anonymized data collection and secure data storage.

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The datasets are available from the corresponding author upon reasonable request. Data sharing is subject to obtaining ethical clearance from a recognized institutional review board. Interested researchers and institutions should contact the first author, Deborah Balapou, at beckweldebbygmail.com.