Evidence of a Double Burden of Malnutrition in Urban Poor Settings in Nairobi, Kenya.

Elizabeth W Kimani-Murage,Stella K Muthuri,Samuel O Oti,Steven Van De Vijver,Martin K Mutua,Catherine Kyobutungi,Rachel A Nugent

doi:10.1371/journal.pone.0129943

Abstract

BackgroundMany low- and middle-income countries are undergoing a nutrition transition associated with rapid social and economic transitions. We explore the coexistence of over and under- nutrition at the neighborhood and household level, in an urban poor setting in Nairobi, Kenya.MethodsData were collected in 2010 on a cohort of children aged under five years born between 2006 and 2010. Anthropometric measurements of the children and their mothers were taken. Additionally, dietary intake, physical activity, and anthropometric measurements were collected from a stratified random sample of adults aged 18 years and older through a separate cross-sectional study conducted between 2008 and 2009 in the same setting. Proportions of stunting, underweight, wasting and overweight/obesity were dettermined in children, while proportions of underweight and overweight/obesity were determined in adults.ResultsOf the 3335 children included in the analyses with a total of 6750 visits, 46% (51% boys, 40% girls) were stunted, 11% (13% boys, 9% girls) were underweight, 2.5% (3% boys, 2% girls) were wasted, while 9% of boys and girls were overweight/obese respectively. Among their mothers, 7.5% were underweight while 32% were overweight/obese. A large proportion (43% and 37%%) of overweight and obese mothers respectively had stunted children. Among the 5190 adults included in the analyses, 9% (6% female, 11% male) were underweight, and 22% (35% female, 13% male) were overweight/obese.ConclusionThe findings confirm an existing double burden of malnutrition in this setting, characterized by a high prevalence of undernutrition particularly stunting early in life, with high levels of overweight/obesity in adulthood, particularly among women. In the context of a rapid increase in urban population, particularly in urban poor settings, this calls for urgent action. Multisectoral action may work best given the complex nature of prevailing circumstances in urban poor settings. Further research is needed to understand the pathways to this coexistence, and to test feasibility and effectiveness of context-specific interventions to curb associated health risks.

Highlights

An overweight/obesity transition in low- and middle-income countriesRapid changes in diet and physical activity patterns have resulted in an increasing prevalence of overweight and obesity–referred to as the overweight/obesity transition–among low- and middle-income countries (LMICs), such as those comprising Sub-Saharan Africa (SSA) [1]
This study found very high levels of undernutrition stunting among children aged less than five years living in the urban poor settings studied
This study confirms a coexistence of child, maternal and adult under- and over-nutrition, including early-life undernutrition with over-nutrition in adulthood in the same neighbourhood, and child undernutrition and maternal overnutrition in the same household

Summary

Introduction

An overweight/obesity transition in low- and middle-income countries. Rapid changes in diet and physical activity patterns have resulted in an increasing prevalence of overweight and obesity–referred to as the overweight/obesity transition–among low- and middle-income countries (LMICs), such as those comprising Sub-Saharan Africa (SSA) [1]. A recent systematic review by Norris et al (2014) demonstrated a rise in adult obesity prevalence in Africa, in Northern African countries, and especially among women [2]. Recent systematic review evidence revealed a transition towards increasing proportions of overweight/obesity over time among school-aged children (5 to 17 years) in SSA [7]. We explore the coexistence of over and undernutrition at the neighborhood and household level, in an urban poor setting in Nairobi, Kenya

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