Relationship of Stunting and Overweight in Egyptian children under five years of age: Trends and associated risk factors
Authors: Ghosh Shibani , Namirembe Grace , Moaz Marwa , Pokharel Ashish , Marino‐Costello Elizabeth , Griffiths Jeffrey K , Webb Patrick 
Published: June 2021

Background

In Egypt, rates of child overweight and obesity are consistently increasing. While progress has been made in the reduction of stunting, Egypt's rate of 21% is still higher than countries in the region that have the same GDP.

Objectives

The objectives were to to examine and understand the trends and variability of malnutrition in all its forms (over and under nutrition) in Egyptian children under five, across time, regions and socio‐economic status and examine associated factors.

Methods

DHS data from 1988 to 2014 were downloaded cleaned and analyzed using SAS (Statistical Analysis Software). Anthropometric indicators for children under five were calculated using the WHO 2006 growth reference. Descriptive statistics of dependent variables (stunting, overweight, overweight in stunted children, wasting, Z‐scores of HAZ, WAZ and WHZ) and independent variables (maternal BMI, occupation, education, birth size, birth order, maternal age at first birth, wealth index, infant and young child feeding practices) were computed. Bivariate analysis was conducted using logistic regression models. Multi‐variate analysis utilized the log‐binomial regression model (PROC GENMOD) to adjust for complex variation structures in the data.

Results

Rates of stunting steadily decreased from 36% in 1988 to 20% in 2014. Severe stunting reduced from 16.5% to 9.6%. Overweight went from 7 % in 1988 to 13% in 2014. The percentage of stunted children who are overweight went from 9% in 1988 to 34% in 2014. Stunting across wealth categories changed over time with rates being higher in the low socio‐economic categories until 2005 while 2008 and 2014, the data show a flat line across wealth index. Multivariate analysis shows that boys were more likely to be stunted (Prevalence ratio PR= 1.11, p <0.001). Factors associated with stunting were birth order (PR =1.02, p<0.05) and number of children under five. Factors protective against stunting included location (rural PR=0.86, p<0.001), secondary school education in the mother (PR=0.90, P<0.001), obese BMI category (compared to underweight), birth size (very large to smaller than average compared to very small), and household size (p<0.05).

Factors that were protective against being overweight as a stunted child included being a boy (PR=0.88, p<0.001) and age of the child (PR=0.995, p<0.0001). Factors that increased the risk of being overweight as a stunted child included secondary education in mothers (PR=1.11, p<0.05), maternal occupation (PR=1.01, p<0.001), BMI category (all categories compared to underweight), household size, very large to normal birth size compared to very small birth size and ever being breast fed.

Conclusion

In Egypt, stunting has decreased but overweight has increased in the population over time. More concerning is the increased prevalence of overweight in a stunted child. In recent surveys, wealth is not a factor associated with either stunting or being overweight in a stunted child. Key factors such as birth size and maternal BMI that have traditionally been used in policy initiatives, as markers of reducing stunting on the other hand are associated with increased overweight.

Support or Funding Information

This study is supported by the USAID Feed the Future Innovation Lab for Nutrition, USAID Bureau for Food Security and USAID Egypt.