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ABSTRACT Background Developing countries are now facing double burden of undernutrition and overnutrition among children and adults. We aimed to explore the double burden of malnutrition among children aged 24-59 months by household’s socioeconomic status in South Asian context. Methods Children with valid information on height and weight from the latest Demographic and Health Survey from Bangladesh, India, Pakistan, Maldives, and Nepal were included in this study. Underweight and overweight were defined according to definitions of World Health Organisation and International Obesity Task Force, respectively. We used multiple logistic regressions to estimate the association of socioeconomic status with childhood underweight and overweight. Results South Asian countries had significant burden of underweight, ranging from 19% in Maldives to 38% in India. Bangladesh, India, and Nepal had prevalence of overweight between 2% and 4%, whereas Pakistan and Maldives had prevalence of 7% and 9%, respectively. Households with higher wealth index and education were consistently associated with lower odds of underweight children. When compared to poorest households, richest households had higher odds of being overweight in Bangladesh (OR 1.96, 95% CI 1.27-3.02) and India (OR 1.53, 95% CI 1.41-1.66) while lower odds of being overweight in Pakistan (OR 0.22, 95% CI 0.14-0.34). Households with higher education were more likely to have overweight children in Bangladesh and India. Conclusions Childhood underweight is associated with lower socioeconomic conditions while there is a substantial burden of childhood overweight in higher socioeconomic groups. These disparities by socioeconomic conditions should be considered while developing national nutrition programs and strategies. KEY MESSAGES <jats:list list-type="bullet"><jats:list-item> In South Asia, there is a substantial burden of undernutrition among under-five children while a differential burden of overnutrition is also seen. <jats:list-item> Household wealth and educational attainment were inversely associated with childhood underweight. <jats:list-item> Children in households with higher levels of wealth and educational attainment were more likely to be overweight in Bangladesh and India, while evidence supporting such association was not clear for other South Asian countries. <jats:list-item> The urban-rural difference in the burden of childhood underweight and overweight can be explained by the distributions of households’ socioeconomic status.

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