Prevalence and predictors of double burden of malnutrition in Palestinian children younger than 5 years: analysis of data from the Multiple Indicator Cluster Surveys round four

Abstract

BackgroundIn the context of the global nutrition transition, large inequalities in the burden of child undernutrition persist across populations and are often concomitantly reported with increases in rates of overweight in these same communities. We aimed to compare the prevalence of stunting and overweight in Palestinian children younger than 5 years living in Lebanon and the occupied Palestinian territories and to investigate the predictors of undernutrition and overnutrition in these populations. MethodsWe used maternal and child health data, sociodemographic variables, and anthropometric measurements from the 2010 Multiple Indicator Cluster Surveys (MICS) undertaken among Palestinian refugees living in Lebanon (1922 children) and the occupied Palestinian territories (11 273 children). Z-scores for height-for-age and body-mass index-for-age for children younger than 5 years were based on WHO's child growth standards. Prevalence of stunting, overweight, and double burden (ie, children with stunted growth and overweight) was estimated. Logistic regression adjusted for survey design was used to model predictors of stunting, overweight, and double burden (STATA version 13). FindingsPrevalence of stunting, overweight, and double burden were all higher in Lebanon than in the occupied Palestinian territories (for stunting, 10·9% vs 10·1%, p<0·0001; for overweight, 11·3% vs 5·8%, p<0·0001; and for double burden, 3·2% vs 1·9%, p=0·0007). After adjusting for covariates, predictors of stunting were age 6–24 months (p=0·05) and region of residence in Lebanon, with Tyre having the highest probability of stunting (p=0·001). Boys (p=0·02), low level of maternal education (p=0·01), and region of residence predicted stunting in the occupied Palestinian territory, with the highest odds of stunting in central West Bank (p<0·0001). Predictors of being overweight were stunting (in Lebanon, odds ratio [OR] 4·30, 95% CI 2·98–6·20; in the occupied Palestinian territories, OR 4·48, 3·63–5·54), male sex (in Lebanon, OR 0·72, 95% CI 0·53–0·98; in the occupied Palestinian territories, OR 0·79, 0·66–0·96), region (highest odds in Bekaa and Tyre [p=0·003], and Central West Bank [p<0·0001]), and higher wealth index in the occupied Palestinian territories (OR 1·3, 95% CI 1·1–1·5). Double burden varied only by region, with highest odds in Lebanon in Tyre (p=0·006) and in the occupied Palestinian territory in the central West Bank (p<0·0001). InterpretationStunting of growth was a predictor for being overweight in Palestinian children younger than 5 years, with boys at a higher risk than girls. Susceptibility to child malnutrition varied most by region of residence, highlighting the role of structural factors. Nutritional interventions aimed at addressing the common structural determinants of stunting and overweight should be targeted to these subpopulations. FundingFaculty of Health Sciences, American University of Beirut.