Abstract

Child malnutrition and maternal obesity are serious public health issues in Sri Lanka. This study explores the associations between socioeconomic status and the double burden of malnutrition among school-aged children and within their household. A total of 543 primary school children aged 5–10 years (204 boys and 339 girls) in Gampaha District, Sri Lanka, were included in the analysis. The nutritional statuses of thinness, normal, overweight, and obesity for children and mothers were defined according to WHO growth references and body mass index. Maternal education, household equivalent income, and maternal employment were used as socioeconomic status indicators. The proportion of child thinness and overweight was 19.3% and 13.4%, respectively, and that of maternal overweight (body mass index ≥ 25 kg/m2) was 36.5%. A positive correlation was found between maternal body mass index and the child’s body mass index for age z-score in older boys and younger girls. A multivariate stepwise logistic regression analysis showed that lower education of mothers posed a higher association with child thinness (adjusted odds ratio = 2.33, 95% confidence interval: 1.08–5.00). Mothers with overweight and obesity were less likely to have a child with thinness (adjusted odds ratio = 0.30, 95% confidence interval: 0.16–0.58). Maternal employment status and household equivalent income were not significantly, but marginally, associated with child overweight and obesity. Socioeconomic inequality combined with maternal nutritional status affected child malnutrition. These findings suggest that the underlying circumstances within households should be considered to improve child malnutrition.

Highlights

  • Child malnutrition remains a serious public health concern in Sri Lanka [1, 2]

  • Almost half of the mothers were in their 30s, and about 30% were in their 40s

  • This study showed that, in a sample of urban Sri Lankan primary school children, the positive correlation between nutritional status in mothers and their children differed by sex and age

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Summary

Introduction

Child malnutrition remains a serious public health concern in Sri Lanka [1, 2]. Malnutrition (underweight or overweight/obesity) in school-aged children, in children under five years, may continue to pose an increased risk for diseases, cognitive delay, poor academic performance, and lower productivity in later life [3]. In 2015, the Annual Health Bulletin stated that the proportion of wasting (-2 standard deviations (SD) below weight-for-height) and stunting (-2 SD below height-for-age) in the first grade of primary school children (5–6 years old) was 20.3% and 8.7%, respectively [4]. The 2016 Sri Lanka Demographic and Health Survey (DHS) showed that 45.3% of married women of reproductive age (15–49 years) are overweight or obese (body mass index (BMI) > 25 kg/m2) and, this percentage has increased among women living in urban areas (55.8%) [5]

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