Risk factors for the double burden of malnutrition in children younger than 5 years in the Gaza Strip: a systematic review

Abstract

BackgroundMalnutrition, the coexistence of both undernutrition and obesity, poses a considerable public health and economic burden worldwide. Globally, undernutrition is the largest cause of death in children younger than 5 years, being responsible for 3·1 million, or approximately 45%, of deaths in this population. Conversely, WHO estimated that, in 2016, 41 million children younger than 5 years were overweight or obese. The global problem of malnutrition can be ascribed to changing dietary and lifestyle habits and to the epidemiological transition of most countries. Developing communities, such as in the Gaza Strip, are thus subject to a double burden of preexisting widespread undernutrition and emerging obesity and chronic diseases. MethodsA systematic search and literature review was done in PubMed, Embase, and the Cochrane Library for articles discussing risk factors for obesity and undernutrition among Palestinians. Additionally, we reviewed UN Relief and Works Agency and Ministry of Health of the occupied Palestinian territory health annual reports. We included all original, population-based studies, irrespective of their design or publication status, language, or age of participants. We independently screened titles, abstracts, and full texts for eligibility, then extracted relevant data and assessed the risk of bias. We pooled the most common reported risk factors for the double burden of malnutrition in the occupied Palestinian territories (Gaza Strip and West Bank) for the period of June, 2017, to June, 2018. FindingsOf 432 publications retrieved, we included 23 eligible articles. The pooled risk factors for undernutrition and obesity in the Gaza Strip were poverty and poor socioeconomic situations (63%), poor awareness of healthy diets and lifestyle among communities (26%), developmental transition and urbanisation (6%), and others (5%). The political situation and the blockade in the Gaza Strip contributed to different weights of the risk factors above mentioned. All studies had a moderate to high risk of bias, especially selection bias. Annual health reports of UN Relief and Works Agency and Ministry of Health of the occupied Palestinian territory showed that overweight was in high prevalence in children younger than 5 years (6·5%), as were other problems of undernutrition, such as stunting (7·1%). InterpretationThe poor political and socioeconomic situation in Gaza compound the risk factors contributing to the high prevalence of malnutrition in the area. In addition, awareness about healthy lifestyles is scarce, which increases the prevalence of overweight and obesity in children. Urbanisation and developmental factors such as globalisation and technological developments added a small risk of overweight and obesity. FundingNone.