SOCIOECONOMIC DRIVERS OF MALNUTRITION AMONG CAMBODIAN WOMEN: A CROSS-SECTIONAL ANALYSIS OF THE 2021–2022 CAMBODIA DEMOGRAPHIC AND HEALTH SURVEY

Abstract

Background: Cambodia is experiencing a double burden of malnutrition, with persistent undernutrition alongside increasing overweight and obesity among women of reproductive age. Evidence on the socioeconomic patterning of these conditions remains limited. Purpose: To estimate the prevalence of underweight and overweight/obesity among Cambodian women aged 15–49 years and examine their socioeconomic correlates and inequalities. Methods: A cross-sectional analysis was conducted using data from the 2021–2022 Cambodia Demographic and Health Survey. The study included 9,332 non-pregnant women with valid anthropometric measurements. Underweight was defined as body mass index (BMI) < 18.5 kg/m² and overweight/obesity as a BMI ≥ 25.0 kg/m². Multinomial logistic regression accounting for survey weights examined socioeconomic associations, while the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) quantified wealth-related inequalities. Results: Underweight affected 10.8% (95% CI: 9.9–11.7%) of women, whereas 28.2% (95% CI: 26.9–29.5%) were overweight or obese. No significant socioeconomic gradient was observed for underweight. Women in the wealthiest quintile were more likely to be overweight/obese than those in the poorest quintile (RRR = 2.05, 95% CI: 1.56–2.70). Wealth-related inequalities were greatest in rural areas (SII = 0.129; RII = 1.57; p < 0.001). Higher education was associated with a lower relative risk of overweight/obesity (RRR = 0.38, 95% CI: 0.27–0.53). Conclusions: Cambodian women face a substantial double burden of malnutrition with distinct socioeconomic patterns. Policies should combine targeted undernutrition support with population-wide obesity prevention and proportionate attention to wealth- and rural-related inequalities.