Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
Centre for Public Health Research, Equity and Human Flourishing, Torrens University, Adelaide Campus, Adelaide, SA, 5000, Australia.
BMC Pediatr. 2023 May 5;23(1):218. doi: 10.1186/s12887-023-04037-7.
Double burden of childhood malnutrition is a condition where undernutrition (stunting) along with overweight and obesity coexist within individuals, households, and populations. It reflects a new layer of malnutrition and an understudied phenomenon in many low-income settings. To date, the prevalence and factors that are associated with concurrent stunting and overweight or obesity (overweight/obesity) (CSO) in the same children have not been well researched in Ethiopia. Hence, this study aimed to assess the prevalence, trends, and factors associated with the coexistence of stunting and overweight or obesity among children aged 0-59 months in Ethiopia.
Pooled data from 2005, 2011 and 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 23,756 (weighted sample) children aged 0-59 months were included in the study. Height-for-age z-scores (HAZ) less than - 2 SD and weight-for-height z-scores (WHZ) above 2 SD were calculated, and children were classified as stunted and overweight/obese, respectively. A child who is simultaneously stunted and overweight/obese was considered as having HAZ below - 2 SD and WHZ above 2 SD computed into a variable named CSO, and reported as a binary outcome (yes or no). Multilevel logistic regression analysis that adjusts for sampling weights and clustering was used to identify factors associated with CSO.
The prevalence of stunting, overweight or obesity, and CSO among under-five children was 43.12% [95% CI: (42.50, 43.75%)], 2.62% [95% CI: (2.42, 2.83%)], and 1.33% [95% CI: (1.18, 1.48%)], respectively. The percentage of CSO children was reported to have declined from 2.36% [95% CI: (1.94-2.85)] in 2005 to 0.87% [95%CI: (0.07-1.07)] in 2011, and the same appeared to have increased slightly to 1.34% [95%CI: (1.13-1.59)] in 2016. Children who were currently breastfeeding [AOR: 1.64, 95%CI: (1.01-2.72)], born to an overweight mother [AOR: 2.65, 95%CI: (1.19-5.88)], and lived in families with 1-4 household members [AOR: 1.52, 95%CI: (1.02-2.26)] were significantly associated with CSO. At the community level the odds of having CSO were higher among children included from EDHS-2005 [AOR: 4.38, 95%CI: (2.42-7.95)].
The study revealed that less than 2% of children had CSO in Ethiopia. CSO was linked to factors at both the individual (i.e. breastfeeding status, maternal overweight, and household size) and community-levels. Overall, the study findings indicated the necessity of focused interventions to simultaneously address double burden of childhood malnutrition in Ethiopia. To further combat the double burden of malnutrition, early identification of at-risk children, including those born to overweight women and children living with multiple household members, is indispensable.
儿童双重营养不良是指在个体、家庭和人群中存在营养不足（发育迟缓）和超重或肥胖共存的情况。它反映了一种新的营养不良层次，也是许多低收入环境中研究不足的现象。迄今为止，埃塞俄比亚尚未很好地研究过在同一儿童中同时存在发育迟缓与超重或肥胖（超重/肥胖）（CSO）的患病率及其相关因素。因此，本研究旨在评估埃塞俄比亚 0-59 月龄儿童中发育迟缓与超重或肥胖共存的患病率、趋势和相关因素。
本研究使用了 2005 年、2011 年和 2016 年埃塞俄比亚人口与健康调查（EDHS）的汇总数据。共有 23756 名（加权样本）0-59 月龄儿童纳入研究。计算身高别年龄 z 分数（HAZ）小于-2 标准差和体重别身高 z 分数（WHZ）大于 2 标准差，并将儿童分别归类为发育迟缓或超重/肥胖。将同时发育迟缓且超重/肥胖的儿童归类为 HAZ 小于-2 标准差和 WHZ 大于 2 标准差的儿童，并将其归类为 CSO，并报告为二项结果（是或否）。使用多水平逻辑回归分析调整了抽样权重和聚类，以确定与 CSO 相关的因素。
五岁以下儿童发育迟缓、超重或肥胖和 CSO 的患病率分别为 43.12%[95%CI：（42.50，43.75%）]、2.62%[95%CI：（2.42，2.83%）]和 1.33%[95%CI：（1.18，1.48%）]。CSO 儿童的比例报告从 2005 年的 2.36%[95%CI：（1.94-2.85）]下降到 2011 年的 0.87%[95%CI：（0.07-1.07）]，而在 2016 年似乎略有上升至 1.34%[95%CI：（1.13-1.59%）]。目前正在母乳喂养的儿童[AOR：1.64，95%CI：（1.01-2.72）]、母亲超重的儿童[AOR：2.65，95%CI：（1.19-5.88）]和家庭人口为 1-4 人的儿童[AOR：1.52，95%CI：（1.02-2.26）]与 CSO 显著相关。在社区层面，来自 EDHS-2005 的儿童更有可能出现 CSO[AOR：4.38，95%CI：（2.42-7.95）]。
研究表明，埃塞俄比亚不到 2%的儿童存在 CSO。CSO 与个人层面（即母乳喂养状况、母亲超重和家庭规模）和社区层面的因素有关。总体而言，研究结果表明，需要有针对性的干预措施来同时解决埃塞俄比亚儿童双重营养不良的问题。为了进一步应对营养不良的双重负担，必须及早发现高危儿童，包括那些出生于超重妇女的儿童和与多个家庭成员一起生活的儿童。
