Background: Malnutrition includes both undernutrition and overnutrition, and remains a major contributor to morbidity and mortality in children under five. Stunting is associated with impaired cognitive development, reduced future productivity, and increased risk of chronic disease, while childhood overweight and obesity negatively affect physical, social, and emotional wellbeing. The coexistence of stunting with overweight/obesity—known as the double burden of malnutrition—is an emerging public health concern in Southern Africa, yet local data remain limited.

Methods: This study is a sub‑analysis of a quantitative, descriptive cross‑sectional design conducted at two child welfare clinics using convenience sampling. Data were collected from 338 mother–child pairs through structured questionnaires and anthropometric checklists. Height‑for‑age Z‑scores were generated using WHO Anthro software. Data were captured in Excel and analysed using STATA 17 and Epi Info 7.2.5. Combined stunting and overweight/obesity (CSO) was defined as concurrent stunting (HAZ < −2 SD) and overweight/obesity (WHZ > +2 SD) in the same child.

Results: Stunting prevalence was 19.2% (n=65), while 20% (n=66) of children were overweight. The prevalence of CSO was 5.47% (95% CI: 0.37–0.90). Among children with CSO, 63.2% were male, indicating a higher proportion in boys, although this difference was not statistically significant. The highest frequency of stunting occurred in the 24–35‑month age group.

Conclusion: The CSO prevalence observed in this study is notably higher than previously reported regional estimates, suggesting a potential rise in the double burden of malnutrition in Eswatini. Further investigation into the determinants of CSO is warranted to inform targeted interventions and guide policymakers in addressing this emerging public health challenge.

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