Malnutrition and double burden of disease: the African dilemma of non-communicable disease

The double burden of malnutrition (DBM), characterized by the coexistence of undernutrition and overnutrition, remains a major public health challenge in Africa. Sub-Saharan Africa continues to report some of the highest global rates of stunting, wasting, and underweight, with stunting affecting up to 57.7% of children under five, while overweight and obesity are rising sharply, particularly in urban populations. This review synthesizes published evidence on the prevalence, mechanisms, and socio-environmental drivers of malnutrition-related non-communicable diseases (NCDs) across the continent. Literature was identified through a narrative review of peer-reviewed articles, institutional datasets, and global health reports published between 2000 and 2025. Biological pathways, including early-life nutritional deprivation, micronutrient deficiencies, and obesity-induced inflammation, interact with food insecurity, rapid urbanization, and socioeconomic inequalities to increase NCD risk. Effective interventions include community-based nutrition programs, food fortification policies, fiscal measures such as sugar taxes, and technology-enabled approaches like mHealth. Strengthening public-private partnerships and integrating nutrition and NCD prevention within health, agriculture, and social protection systems are essential. In addition, greater emphasis on implementation capacity, equitable policy design, and improved monitoring systems is critical for ensuring sustainable impact. Addressing Africa’s double burden requires coordinated, context-specific, and multisectoral strategies to reduce both undernutrition and overnutrition and improve long-term population health outcomes.