Objectives To estimate Global, Regional, and National prevalence of Malnutrition, specifically Coexisting forms of malnutrition (CFM) and its various types: Coexistence of underweight with stunting (CUS), Coexistence of underweight with wasting (CUW), Coexistence of underweight with wasting & stunting (CUWS), Coexistence of stunting with overweight/obesity (CSO) among children under five years in low- and middle-income countries (LMICs). Methods This cross-sectional observational study utilized latest nationally representative Demographic and Health Surveys (DHS) datasets of 62 LMICs corresponding to six global regions from 2006 to 2024. Data of 541,707 children aged 0 to 59 months with complete anthropometry were analysed descriptively (prevalence estimates) and inferentially (multivariate logistic regression). Results The global malnutrition prevalence among children was 43.9%, of which CFM was observed among 20.9% children. Among various CFM types, CUS was highly prevalent (11.8%), followed by CUW (4.2%), CUWS (3.2%), and CSO (2.1%). South & Southeast Asian had highest CFM prevalence of 29.6%, while Central Asia and Latin America & Caribbean reported the lowest CFM prevalence of 8.1% and 6.2%, respectively. Among all the LMIC included, Timor-Leste exhibited the highest CFM at 41.8%. In general, children aged between 12 to 35 months had 2-3 times higher odds of various forms of CFM. However, female sex, maternal education, improvement in socioeconomic status, medium to large family size showed significantly lower odds with various forms of CFM. Conclusions This study advances the understanding of CFM’s prevalence, determinants, and regional variations, filling a critical gap in global nutrition research. The findings serve as a reminder to reinvest in efforts to protect children from malnutrition during their early years of life. Governments and other global health sector must invest in a well-established system of nutrition surveillance for addressing CFM, informing targeted interventions to improve child health outcomes in LMICs.

Objectives: To examine whether complete absence of vegetable and fruit consumption (Zero Vegetable or Fruit - ZVF) independently associates with anemia among children aged 0-59 months in Tajikistan, and to identify key maternal and socioeconomic determinants of childhood anemia. Design: Cross-sectional analysis using recent 2023, nationally representative Demographic and Health survey data from Tajikistan. Setting: National population based study across all regions of Tajikistan (urban and rural areas) using two stage stratified cluster sampling. Participants: 2,355 children in age group 0-59 months with complete data on hemoglobin levels and dietary intake in the preceding 24 hours residing in households selected from 2023 Tajikistan Demographic and Health Survey were included in this study. Main Outcome Measures: Primary outcome, childhood anemia status (hemoglobin <10.5g/dl for 6-23 months, <11g/dl for 24-59 months, altitude-adjusted per WHO 2024 criteria). Results: Among Tajik children under 5 years, 36.1% of children consumed no vegetables or fruits in the preceding 24 hours and the prevalence of anemia was 33.2%. Adjusted odds in our study revealed no association of ZVF consumption with anemia (OR=0.85, 95% CI: 0.63 to 1.14). Significant associations emerged for maternal anemia which increased child anemia odds by 48% (OR=1.48, 95% CI: 1.16 to 1.88), richest index had 60% lower anemia odds compared to the poorest (OR=0.39, 95% CI: 0.27 to 0.56) and low birth size increased anemia risk two fold (OR=1.92, 95% CI: 1.31 to 2.81).Each additional daily meal consumption reduced anemia odds by 14% (OR=0.86, 95% CI: 0.76 to 0.98). Conclusions: Child anemia in Tajikistan is not primarily driven by specific dietary factors but maternal nutritional status during pregnancy, birth outcomes, and socioeconomic disparities are main drivers. This novel null finding on ZVF intake, underscores that non dietary drivers predominate, informing targeted interventions aligned with SDG2 (Zero hunger). Thus integrated approaches aim to address maternal nutrition, antenatal care, wealth inequalities, and feeding frequency promotion. What is already known on this topic: Over 40% of children under five globally are affected by childhood anemia with dietary factors like low fruit and vegetable intake considered important contributors. However, the specific impact of complete absence (zero consumption) of vegetables and fruits on childhood anemia needs to be explored particularly in Central Asian countries like Tajikistan as here the dietary pattern differ from other low- and middle-income settings. What this study adds: This first nationally representative Central Asian study showed that downstream factor that’s the zero vegetable or fruit consumption had no association with childhood anemia in Tajikistan. Instead upstream factors like maternal anemia during pregnancy, household wealth disparities, small birth size, and meal frequency emerged as primary determinants, challenging dietary-centric intervention approaches. How this study might affect research, practice or policy: These findings redirect anemia prevention strategies towards integrated interventions addressing maternal nutrition during pregnancy, poverty alleviation, improved antenatal care for fetal growth monitoring, and feeding frequency promotion rather than focusing solely on vegetable or fruit consumption. This evidence informs sustainable development goals (SDG) aligned nutrition policies requiring upstream determinants to be prioritized alongside dietary diversity programs in similar settings. Key Points: Core Issues: This study explored whether complete absence of vegetable and fruit consumption (ZVF) associates with childhood anemia (below five years) in Tajikistan thereby challenging dietary-centric intervention approaches by examining maternal and socioeconomic determinants. Findings: The research found no significant association between zero vegetable or fruit consumption with childhood anemia, but identified maternal anemia during pregnancy, household wealth disparities, small birth size, and meal frequency as primary drivers. Meaning: This novel null finding of our research redirects anemia prevention strategies from dietary diversity alone toward integrated upstream interventions addressing maternal nutrition, poverty alleviation, antenatal care quality, and feeding frequency informing SDG-aligned policies in Central Asia and similar Lower-and Middle-income countries.

Objective: This study aimed to estimate the trends, projections, and determinants of standalone and coexisting forms of malnutrition (CFM) at the global, regional, national, and individual level among children under five in low- and middle-income countries (LMICs). It also assessed the projection trajectory towards the 2030 global nutrition targets (GNTs) for child growth including stunting, wasting, obesity, and CFM. Methods: Data from 48 LMICs were analyzed using the Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS). Children with complete anthropometry were included for national- and individual-level descriptive analyses. Projected prevalence of each form of malnutrition, including CFM, was calculated using the Annual Rate of Change. Inferential analyses employed generalized linear regression models with two-way interaction terms to identify determinants of each malnutrition type. Findings: By 2030, 22 of 48 LMICs are projected to achieve the GNT of stunting, wasting, and obesity, that is up from 10 countries currently, while Yemen and Zimbabwe are expected to remain off-track. Stunting is the most prevalent form, affecting 42 countries, with nine nations projected to have over 50% of children affected by a form of malnutrition. Wasting, obesity, and CFM are rising in several countries. Maternal education and household wealth were the strongest determinants, with children of uneducated mothers and from poorest households at the highest risk. Inequalities are narrowing slowly by 1–2% per year, and marked regional disparities persist. Conclusions: Many LMICs are off-track to meet child-growth targets when CFM is considered alongside standalone indicators. The government and global health partners must strengthen nutrition surveillance systems and equity-focused policies and programs to routinely capture CFM and prevent as well as manage all forms of malnutrition at the national and individual levels.

Empyema thoracic arising from a retroperitoneal source via a transdiaphragmatic nephropleural fistula is among its exceptionally rare causes. This report describes successful management with single-stage combined thoracic and urological surgery. A young female with long-standing nephrolithiasis and recent percutaneous nephrolithotomy, presented with respiratory distress. Initial management included emergent tube thoracostomy for a gross right pyopneumothorax confirmed by computed tomographic (CT) scan of chest. Escherichia coli was cultured from pleural fluid and urine samples. Further contrast enhanced CT findings confirmed Empyema thoracic, transdiaphragmatic nephropleural fistula and lower pole renal cortical defects with emphysematous pyelonephritis. Single-stage right thoracotomy and decortication, repair of the diaphragmatic rent and right nephrectomy achieved excellent outcomes. This case highlights transdiaphragmatic nephropleural fistula as a rare cause of empyema thoracic.

Background: Coexisting forms of malnutrition (CFM) represent a critical global health priority, particularly among children under 5, owing to their severe consequences and elevated mortality risk compared to standalone forms of malnutrition. This study was aimed at assessing the relationship between household water, sanitation, and hygiene (WASH) conditions and CFM among children under 5 years in Pakistan. Subjects and Method: This cross‐sectional study utilized data from the last two waves of the Pakistan Demographic and Health Survey (PDHS) conducted in 2012–2013 and 2017–2018. From these datasets, data for a total of 6874 children aged between 0 and 59 months were included for analysis. Children who were non‐de jure residents, deceased at the time of survey, or had missing or flagged anthropometric data (outliers) were excluded. The data was analyzed using bivariate and multivariate logistic regression models. The four CFM outcomes examined were coexistence of underweight with wasting (CUW), coexistence of underweight with stunting (CUS), coexistence of underweight, wasting, and stunting (CUWS), and coexistence of stunting with overweight/obesity (CSO), each defined using WHO anthropometric cut‐off values ( z ‐score ≤ −2 SD for undernutrition indices and ≥ +2 SD for overweight/obesity). Results: Key findings revealed three distinct WASH‐nutrition patterns. First, improved drinking water access was strongly associated with concurrent under‐ and overnutrition. CUW and CSO had lower odds by 85% and 59%, respectively. Second, infection prevention played a significant role. Children without diarrhea and fever in the last 14 days were associated with lower odds of CSO by 38%–45%, highlighting the protective role of infection prevention. Third, socioeconomic and maternal factors showed divergent effects. Children of highly educated mothers had 72% lower odds of CUS compared to uneducated mothers. Both maternal and paternal employment had a protective role in various forms of CFM. Additionally, children from the richest households demonstrated decreased odds of CUW (OR: 0.13, CI: 0.05–0.34) but increased odds of CSO (OR: 2.43, CI: 1.46–4.03), signifying a nutritional transition associated with affluence. Conclusion: This study is among the first to demonstrate that distinct WASH indicators differentially shape coexisting malnutrition patterns in Pakistani children under 5. Improved drinking water access mitigates concurrent undernutrition. Higher household wealth paradoxically elevates the risk of stunting–overweight coexistence, underscoring the dual burden of malnutrition in transitioning economies. These findings call for integrated WASH‐nutrition policies with equity‐sensitive approaches to accelerate Pakistan′s progress toward SDGs 2 and 6.