Socio-demographic characteristics of participants
A total of 42,568 children under 5 years were included in the study. Of these, there was a close percentage in terms of age. A little more than one-third (34%) and (33%) were between 0-18 months and above 38 months, respectively. With regards to sex, the majority (52%) were males and the remaining 48% were females. Children who were born with low birth weights were approximately 15% whereas the majority (83%) weighed between 2.5-4.0 kg at birth, with only 2% weighing above 4.0 kg. Most (68%) of the children lived in rural areas whereas the remaining 32% were in urban areas. Less than a quarter (7%) had access to a bicycle while the majority (93%) had access to a car. In terms of food consumption, about 4 percent were commonly given carbohydrate foods whereas more than a quarter (30%) were commonly given protein foods. More than half (56.4%) were commonly consuming fatty foods whereas less than a quarter (8.8%) were commonly consuming fruits (Table 2).
For mothers’ sociodemographic characteristics, more than a quarter (32%) were adolescents (11-19 years), the majority (63%) were young adults (20-28 years), and the remaining 5% were considered adults (29 years and above). Most mothers (56%) had attained secondary level education, one-fifth (20%) had no formal education, 15% had higher level education, and the least (9%) had primary education. For wealth index, there was a close percentage among poor and rich mothers, with each having approximately 38% and the remaining 24% being among those in the middle class of wealth. Mothers who were overweight or obese were 34% whereas 65% were neither overweight nor obese. The vast majority (98%) were married and most of them (68%) did not visit a postnatal clinic after birth, whereas 32% attended postnatal clinics after birth. In terms of a child’s father’s educational level, more than half (56%) had secondary level education, followed by higher level education (17%), primary education (14%), and no formal education (13%). Most (88%) of the fathers were not working at the time of the survey whereas 12% were gainfully employed (Table 2).
Table 2: Participant characteristics
Variable
|
N=42,568
(%)
|
Weighted %
(C.I)
|
Child Variables
|
Age of Child (months)
|
|
|
0-18 months
|
14, 568 (34.25)
|
34.08 (0.33-0.35)
|
19-37 months
|
13,642 (32.01)
|
32.01 (0.31-0.33)
|
38+ months
|
14,358 (33.74)
|
33.91 (0.33-0.35)
|
|
|
|
Sex of Child
|
|
|
Male
|
22,057 (51.82)
|
52.20 (0.51-0.53)
|
Female
|
20,511 (48.18)
|
47.80 (0.47-0.49)
|
|
|
|
Birth Weight
|
|
|
< 2.5 kg
|
3,326 (14.08)
|
14.67 (0.14-0.16)
|
2.5-4.0 kg
|
19,662 (83.24)
|
82.90 (0.82-0.84)
|
>4.0 kg
|
633 (2.68)
|
2.42 (0.02-0.03)
|
|
|
|
Place of Residence
|
|
|
Urban
|
16,771 (39.40)
|
32.47 (0.31-0.34)
|
Rural
|
25,797 (60.60)
|
67.52 (0.66-0.69)
|
|
|
|
Access to Bicycle
|
|
|
No
|
37,299 (92.72)
|
92.84 (0.92-0.93)
|
Yes
|
2,927 (7.28)
|
7.16 (0.07-0.08)
|
|
|
|
Access to car
|
|
|
No
|
36,500 (90.75)
|
92.53 (0.91-0.93)
|
Yes
|
3,719 (9.25)
|
7.47 (0.07-0.08)
|
|
|
|
Child given carbohydrate foods
|
|
|
No
|
32,448 (95.67)
|
95.95 (0.95-0.96)
|
Yes
|
1,469 (4.33)
|
4.04 (0.04-0.05)
|
|
|
|
Child given protein foods
|
|
|
No
|
23,669 (69.66)
|
69.50 (0.68-0.71)
|
Yes
|
10,307 (30.34)
|
30.49 (0.29-0.32)
|
|
|
|
Child given fatty foods
|
|
|
No
|
3,808 (44.19)
|
43.93 (0.42-0.46)
|
Yes
|
4,809 (55.81)
|
56.49 (0.54-0.58)
|
|
|
|
Child given fruits
|
|
|
No
|
31,008 (91.29)
|
91.12 (0.90-0.92)
|
Yes
|
2,957 (8.71)
|
8.88 (0.08-0.10)
|
|
|
|
Mothers’ Variables
|
Maternal Age at First Birth
|
N=42,568 (%)
|
Weighted % (C.I)
|
11-19
|
13,246 (31.12)
|
31.54 (0.30-0.32)
|
20-28
|
26,916 (63.23)
|
63.13 (0.62-0.64)
|
29 +
|
2,406 (5.65)
|
5.32 (0.05-0.06)
|
|
|
|
Mother’s Education Level
|
|
|
No education
|
8,440 (19.83)
|
19.87 (0.19-0.21)
|
Primary
|
3,804 (8.94)
|
9.01 (0.08-0.10)
|
Secondary
|
23,811 (55.94)
|
55.93 (0.55-0.57)
|
Higher
|
6,513 (15.30)
|
15.19 (0.14-0.16)
|
|
|
|
Wealth Index
|
|
|
Poor
|
16,637 (39.08)
|
38.30 (0.37-0.40)
|
Middle
|
8,844 (20.78)
|
24.00 (0.23-0.25)
|
Rich
|
17,087 (40.14)
|
37.69 (0.36-0.39)
|
|
|
|
Mother’s BMI
|
|
|
Not overweight/Obese
|
28,637 (67.79)
|
65.08 (0.64-0.66)
|
Overweight/obese
|
13,605 (32.21)
|
34.92 (0.34-0.36)
|
|
|
|
Mother’s marital status
|
|
|
Not marriage
|
684 (1.61)
|
1.60 (0.01-0.02)
|
Marriage/Cohabiting
|
41,884 (98.39)
|
98.40 (0.98-0.99)
|
|
|
|
Antenatal Visit
|
|
|
No
|
6,115 (14.37)
|
13.98 (0.13-0.15)
|
Yes
|
36,435 (85.63)
|
86.01 (0.85-0.87)
|
|
|
|
Postnatal Visit
|
|
|
No
|
22,673 (69.05)
|
67.78 (0.67-0.69)
|
Yes
|
10,164 (30.95)
|
32.21 (0.31-0.33)
|
Fathers’ variables
|
|
|
Father’s Education Level
|
|
|
No education
|
5,723 (13.45)
|
13.67 (0.13-0.14)
|
Primary
|
5,836 (13.71)
|
14.00 (0.13-0.15)
|
Secondary
|
23,940 (56.25)
|
55.58 (0.54-0.57)
|
Higher
|
7,060 (16.59)
|
16.74 (0.16-0.18)
|
|
|
|
Current work status
|
|
|
Not working
|
37,240 (87.58)
|
87.55 (0.87-0.88)
|
Working
|
5,275 (12.41)
|
12.44 (0.12-0.13)
|
Note: C.I=Confidence interval; N= Total number of respondents
Prevalence of overweight and obesity in Egypt
As shown in Figure 1, the overall prevalence of childhood overweight and obesity was approximately 17% (CI=0.17-0.19). In 2014 alone, the prevalence rate was 16.9% (CI=0.16-0.18), and in 2008 the prevalence was 20.3% (CI=0.20-0.23). Although the prevalence of overnutrition is still high as of 2014, the findings show a slight decrease in childhood overweight and obesity between the two survey periods.
(Figure 1 here)
Factors associated with overweight and obesity among under-five children in Egypt
There was a significant association between childhood overweight and obesity and the following factors: children aged 19 and 37 months (OR = 1.39, C.I = 1.25-1.55, p= 0.001), children in rural residence (OR = 0.83, C.I = 0.73-0.94, p 0.003), children given protein foods (OR = 1.22, C.I = 1.10-1.36, p= 0.001), children given fatty foods (OR = 1.45, C.I = 1.26-1.67, p=0.001), children given fruits (OR = 1.27, C.I = 1.09-1.49, p= 0.001), children belonging to mothers aged 29 years or more (OR = 1.22, C.I = 1.01-1.49, p= 0.04), children belonging to rich mothers (OR = 1.29, C.I = 1.14-1.46 p= 0.001), children belonging to mothers who attended postnatal healthcare (OR = 1.12, C.I = 1.02-1.24 p= 0.020), and children belonging to fathers who were gainfully employed (OR = 1.21, C.I = 1.07-1.37 p= 0.002) (Table 3).
The data was then adjusted to confirm the associations between the identified explanatory variables and the childhood undernutrition indicators (overweight and obesity). We found that overweight and obesity were significantly associated with children aged 19 and 37 months (AOR =1.32, C.I =1.05-1.65, p 0.015), children with a birthweight of 4.1kg and above (AOR =2.45, C.I =1.25-4.81, p= 0.010), children given protein foods (AOR =1.29, C.I =1.02-1.63, p 0.029), and rich mothers (AOR =2.19, C.I=1.54-3.11, p 0.001) (Table 3).
These results imply that children aged 19-37 months had 1.32 higher odds of becoming overweight or obese compared to those younger and older (<19 months and >37 months). Those who weighed more than 4.1 kg had 2.45 times higher odds of being overweight or obese compared to those who weighed lesser. Children who significantly consumed protein foods had 1.29 higher odds of becoming overweight or obese relative to those who consumed other food types. With regards to maternal factors, those belonging to rich mothers had 2.19 higher odds of becoming overweight or obese compared to those belonging to poor mothers and mothers with an average level of wealth (Table 3).
Table 3: Logistic regression of associations between explanatory variables and overnutrition
Variable
|
Unadjusted
|
Adjusted
|
Child Variables
|
Age of Child (months)
|
OR (95% C.I)
|
P-value
|
OR (95% C.I)
|
P-value
|
0-18 months
|
Ref.
|
|
Ref.
|
|
19-37 months
|
1.39 (1.25-1.55)
|
0.000
|
1.32 (1.05-1.65)
|
0.015
|
38+ months
|
1.01 (0.89-1.14)
|
0.904
|
0.99 (0.74-1.31)
|
0.925
|
Sex of Child
|
|
|
|
|
Male
|
Ref.
|
|
Ref.
|
|
Female
|
0.96 (0.88-1.04)
|
0.364
|
1.04 (0.85-1.28)
|
0.705
|
Birth Weight
|
|
|
|
|
< 2.5 kg
|
Ref.
|
|
Ref.
|
|
2.5-4.0 kg
|
0.99 (0.83-1.18)
|
0.951
|
1.19 (0.82-1.71)
|
0.360
|
4.1 + kg
|
1.20 (0.8-1.75)
|
0.336
|
2.45 (1.25-4.81)
|
0.010
|
Place of Residence
|
|
|
|
|
Urban
|
Ref.
|
|
Ref.
|
|
Rural
|
0.83 (0.73-0.94)
|
0.003
|
0.97 (0.75-1.25)
|
0.801
|
Access to Bicycle
|
|
|
|
|
No
|
Ref.
|
|
Ref.
|
|
Yes
|
0.86 (0.72-1.03)
|
0.103
|
0.88 (0.59-1.30)
|
0.514
|
Access to car
|
|
|
|
|
No
|
Ref.
|
|
Ref.
|
|
Yes
|
0.99 (0.84-1.17)
|
0.932
|
1.23 (0.97-1.58)
|
0.087
|
Child given carbohydrate foods
|
|
|
|
|
No
|
Ref.
|
|
Ref.
|
|
Yes
|
0.96 (0.76-1.21)
|
0.753
|
0.92 (0.72-1.18)
|
0.601
|
Child given protein foods (eggs and meats)
|
|
|
|
|
No
|
Ref.
|
|
Ref.
|
|
Yes
|
1.22 (1.10-1.36)
|
0.000
|
1.29 (1.02-1.63)
|
0.029
|
Child given fatty foods
|
|
|
|
|
No
|
Ref.
|
|
Ref.
|
|
Yes
|
1.45 (1.26-1.67)
|
0.000
|
0.92 (0.73-1.17)
|
0.524
|
Child given fruits
|
|
|
|
|
No
|
Ref.
|
|
Ref.
|
|
Yes
|
1.27 (1.09-1.49)
|
0.003
|
1.22 (0.88-1.69)
|
0.23
|
Mothers’ variables
|
Maternal Age at First Birth
|
|
|
|
|
11-19
|
Ref.
|
|
Ref.
|
|
20-28
|
1.01 (0.91-1.13)
|
0.80
|
1.15 (0.89-1.49)
|
0.28
|
29 +
|
1.22 (1.01-1.49)
|
0.04
|
1.53 (0.92-2.54)
|
0.10
|
Mother’s Education Level
|
|
|
|
|
No education
|
Ref.
|
|
Ref.
|
|
Primary
|
1.22 (1.03-1.46)
|
0.021
|
1.42 (0.87-2.31)
|
0.16
|
Secondary
|
1.24 (1.10-1.39)
|
0.000
|
1.31 (0.88-1.93)
|
0.18
|
Higher
|
1.33 (1.14-1.57)
|
0.000
|
1.14 (0.66-2.00)
|
0.63
|
Wealth Index
|
|
|
|
|
Poor
|
Ref.
|
|
Ref.
|
|
Middle
|
1.02 (0.89-1.16)
|
0.810
|
2.02 (1.43-2.85)
|
0.000
|
Rich
|
1.29 (1.14-1.46)
|
0.000
|
2.19 (1.54-3.11)
|
0.000
|
Mother’s BMI
|
|
|
|
|
Not overweight/Obese
|
Ref.
|
|
Ref.
|
|
Overweight/obese
|
1.03 (0.94-1.15)
|
0.464
|
0.98 (0.75-1.26)
|
0.851
|
Marital status
|
|
|
|
|
Not marriage
|
Ref.
|
|
Ref.
|
|
Marriage
|
1.12 (0.74-1.67)
|
0.593
|
1.50 (0.52-4.33)
|
0.448
|
Antenatal Visit
|
|
|
|
|
No
|
Ref.
|
|
Ref.
|
|
Yes
|
1.03 (0.91-1.16)
|
0.609
|
1.24 (0.91-1.69)
|
0.175
|
Postnatal Visit
|
|
|
|
|
No
|
Ref.
|
|
Ref.
|
|
Yes
|
1.12 (1.02-1.24)
|
0.020
|
0.87 (0.67-1.12)
|
0.052
|
Fathers’ variables
|
|
|
|
|
Father’s Education Level
|
|
|
|
|
No education
|
Ref.
|
|
Ref.
|
|
Primary
|
1.18 (0.99-1.42)
|
0.478
|
1.19 (0.74-1.92)
|
0.474
|
Secondary
|
1.05 (0.91-1.21)
|
0.481
|
1.13 (0.76-1.79)
|
0.482
|
Higher
|
1.23 (1.03-1.46)
|
0.479
|
1.06 (0.63-1.80)
|
0.813
|
Current work status
|
|
|
|
|
Not working
|
Ref.
|
|
Ref.
|
|
Working
|
1.21 (1.07-1.37)
|
0.002
|
1.08 (0.78-1.50)
|
0.630
|
Note: C.I=Confidence interval; Ref=reference; OR=Odds Ratio