Socioeconomic Differentiation in the Nutrition Transition: A Mixed-Methods Study of Zambian Households

Background/Rationale: The socioeconomic differentiation of the nutrition transition in Zambia represents a critical intersection of public health, development, and equity. Malnutrition, encompassing undernutrition (wasting, stunting, underweight, and micronutrient deficiencies) and overnutrition (overweight, obesity, and nutrition-related non-communicable diseases or NR-NCDs), is a pressing concern both globally and in Zambia. This research explores the coexistence of undernutrition and overnutrition, a phenomenon termed the multiple burdens of malnutrition, and its socioeconomic differentiation among various socioeconomic groups. The coexistence of different forms of malnutrition is observed at individual, household, and population levels. For instance, households might experience disparities such as an overweight mother and an underweight child. At the population level, different forms of malnutrition exist within the same communities. These dynamics underscore the complexity of Zambia’s nutrition transition and raise critical questions about its drivers, trends, and socioeconomic differentiation. Objectives/Aims/Research Question: Existing studies in Zambia have typically focused on either undernutrition or overnutrition, with an overwhelming focus on undernutrition, and have failed to address their coexistence and uneven distribution across socioeconomic groups. This research seeks to bridge this gap by providing a comprehensive analysis of the multiple burdens of malnutrition in Zambia from a socio-economic perspective. The main research question this study will attempt to address is to analyse and understand the socioeconomic differentiation of the nutrition transition on different socioeconomic groups, household food consumption practices, and intra-household dynamics in Zambia. Methodological Approach: This study employs a mixed-methods sequential design. The quantitative component utilises nationally representative Zambia Demographic and Health Survey (ZDHS) datasets from six rounds (1992, 1996, 2001, 2007, 2013–2014, and 2018). Statistical methods, including descriptive analysis, trend analysis, and logistic regression models, identify patterns, determinants, and associations related to malnutrition. The qualitative component enriches this analysis through primary data collection, including household interviews, focus group discussions, and key informant interviews. These methods explore intra-household dynamics, food consumption practices, and the organisation of everyday life that influences nutritional outcomes. The use of an interdisciplinary approach that integrates qualitative interviews and quantitative logistic regression analysis allowed generates richer and more comprehensive understanding of the socioeconomic differentiation in the nutrition transition of Zambian households. Results: The results show that childhood malnutrition increased during Zambia’s structural adjustment programme (1992–2001) but declined with sustained economic growth between 2001 and 2018, although it still remains high. The stunting rates declined from 53 per cent in 2001 to 35 per cent in 2018. Nevertheless, disparities persist, with rural children facing risks due to seasonal food insecurity and limited dietary diversity. Rising overweight and obesity rates have been observed across different socioeconomic groups. Socioeconomic factors such as income, education, and employment significantly influence nutrition outcomes. Wealthier households access more diverse and nutritious foods, while poorer households rely on monotonous diets. Educated mothers ensure better child nutrition, but their economic participation in the labour market sometimes compromises caregiving and meal preparation. Cultural norms that prioritise men’s dietary needs influence intra-household nutritional disparities. Poor urban households depend on purchased foods and often opt for cheaper, processed food options due to affordability constraints and availability. In contrast, rural households focus on subsistence farming and frequently sell their crops for income, neglecting household nutritional needs. Seasonal income fluctuations further exacerbate rural food insecurity. Conclusion and Implications: By addressing the socioeconomic differentiation of the nutrition transition, this research contributes to understanding Zambia’s multiple burdens of malnutrition. The findings suggest the complex interaction of economic, social, and cultural factors shaping nutrition outcomes, offering insights for policy interventions aimed at reducing nutritional disparities across different socioeconomic groups.