Kanamori, MarianoCarter-Pokras, OliviaMadhavan, SangeethaFeldman, RobertHe, XinLee, SunminFunding for Open Access provided by the UMD Libraries Open Access Publishing Fund.Background: Africa is facing a nutritional transition where underweight and overweight coexist. Although the majority of programs for orphan and vulnerable children (OVC) focus on undernourishment, the association between OVC primary caregiving and the caregivers’ overweight status remains unclear. We investigated the association between OVC primary caregiving status with women’s overweight status in Namibia, Swaziland and Zambia. Methods: Demographic Health Survey (DHS) cross-sectional data collected during 2006–2007 were analyzed using weighted marginal means and logistic regressions. We analyzed data from 20–49 year old women in Namibia (N 6638), Swaziland (N 2875), and Zambia (N 4497.) Results: The overweight prevalence of the primary caregivers of OVC ranged from 27.0 % (Namibia) to 61.3 % (Swaziland). In Namibia, OVC primary caregivers were just as likely or even less likely to be overweight than other primary caregivers. In Swaziland and Zambia, OVC primary caregivers were just as likely or more likely to be overweight than other primary caregivers. In Swaziland and Zambia, OVC primary caregivers were more likely to be overweight than non-primary caregivers living with OVC (Swaziland AOR = 1.56, Zambia AOR = 2.62) and non-primary caregivers not living with OVC (Swaziland AOR = 1.92, Zambia AOR = 1.94). Namibian OVC caregivers were less likely to be overweight than non-caregivers not living with an OVC only in certain age groups (21–29 and 41–49 years old). Conclusions: African public health systems/OVC programs may face an overweight epidemic alongside existing HIV/AIDS, tuberculosis and malaria epidemics. Future studies/interventions to curb overweight should consider OVC caregiving status and address country-level differences.en-USorphansoverweightAfrica South of the SaharaArticle