Social Stratification, Diet Diversity and Malnutrition among Preschoolers: A Survey of Addis Ababa, Ethiopia

Abstract

In Sub-Saharan Africa, being overweight in childhood is rapidly rising while stunting is still remaining at unacceptable levels. A key contributor to this double burden of malnutrition is dietary changes associated with nutrition transition. Although the importance of socio-economic drivers is known, there is limited knowledge about their stratification and relative importance to diet and to different forms of malnutrition. The aim of this study was to assess diet diversity and malnutrition in preschoolers and evaluate the relative importance of socioeconomic resources. Households with children under five (5467) were enrolled using a multi-stage sampling procedure. Standardized tools and procedures were used to collect data on diet, anthropometry and socio-economic factors. Multivariable analysis with cluster adjustment was performed. The prevalence of stunting was 19.6% (18.5-20.6), wasting 3.2% (2.8-3.7), and overweight/obesity 11.4% (10.6-12.2). Stunting, overweight, wasting and limited diet diversity was present in all social strata. Low maternal education was associated with an increased risk of stunting (Adjusted odds ratio (AOR): 1.8; 1.4-2.2), limited diet diversity (AOR: 0.33; 0.26-0.42) and reduced odds of being overweight (AOR: 0.61; 0.44-0.84). Preschoolers in Addis Ababa have limited quality diets and suffer from both under-and over-nutrition. Maternal education was an important explanatory factor for stunting and being overweight. Interventions that promote diet quality for the undernourished whilst also addressing the burgeoning problem of being overweight are needed. software, S.A.; validation, H.Y.B., Y.B. and S.A.; formal analysis, H.Y.B., S.A.; investigation, H.Y.B., Y.B.; resources, H.Y.B., M.J., Y.B., B.A., E.-C.E.; data curation, E.-C.E., S.A.; writing-original draft preparation, H.Y.B.; writing-review and editingsupervision, H.Y.B.; project administration, H.Y.B., Y.B., E.-C.E.; funding acquisition, H.Y.B., M.J., Y.B., B.A., E.-C.E. All authors have read and agreed to the published version of the manuscript.

Child dietary diversity and food (in)security as a potential correlate of child anthropometric indices in the context of urban food system in the cases of north-central Ethiopia

“…In the urban settings, the rate of malnutrition among underfive children was persistently higher, and the nutrition transition phenomenon impacted the health of children in which the rate of obesity has been radically progressed and that ultimately attributed to many lifethreatening non-communicable diseases including dietrelated cardio-metabolic risk and cancer [6,23,24]. The prevalence of chronic undernutrition in these urban settings was much higher than from studies conducted in urban settings of Ethiopia in Arba Minch (18.7%) [25], Addis Ababa (19.6%) [17], Kersa district (8.9%) [26], rural Kenya (32%) [27], South Africa (35%) [28], and urban cities of South Africa, Umlazi (28%), Rietvlei (20%), and Paarl (17%) [4]. However, it was less than the findings in rural and pre-urban areas in Ethiopia such as Humbo districts (75%) [29], Merhabete district (52.4%) [30], Libo-kemekem district (49.4%) [31], and Lalibela town (47.3%) [32].…”

“…All children aged between 6 and 59 months that have resided in the study area for the last 6 months were included in the study sample, while any child with a severe medical problem, lack of household head or caregivers, or physical deformity was excluded from the study. The largest sample (512 mother-child pairs) was taken from a study conducted in Ethiopia by considering maternal education as a predictor for child stunting and overweight [ 17 ] with the assumptions that 95% of confidence level, 80% of power, 1.7 the odds of being stunting when the mother is not educated, and 24.3% of child stunting among uneducated mothers. Three sub-cities from Dessie and two kebeles from Combolcha town were selected randomly.…”

Epidemiology, Predisposing Factors, Biomarkers, and Prevention Mechanism of Obesity: A Systematic Review

“…According to the framework, the basic causes including poverty, social condition, and political, economic, ecological, and other factors were the root reason for any form of malnutrition [13]. Different literature studies explicitly identified sociodemographic factors that were highly correlated with obesity, for example, older age [2,6], married (marital status) [14], low wealth index [6,10,[15][16][17], urban residency [6,10,16,18], being female [2,9], learning in private schools [2,9,19,20], easy accessibility of junk and fired or energy-dense foods and packed animal source foods due to free trade policy [2], rural to urban migration, replacement of local agribusiness with food retail [21], higher education level [6,7,22], and being pregnant [6,18]. In contrary to the previous findings, a study conducted among French women shows that having a higher income, a higher occupational class, and a higher educational level and having hot water at home reduce the occurrence of obesity [23] although the pathophysiology of hot water at home and obesity occurrence was not yet studied.…”

Nutritional status and dietary diversity of school-age children living with HIV: a cross-sectional study in Phnom Penh, Cambodia

“…In the Infant and Young Child Feeding guidelines published by the United Nations, dietary diversity scores of pre-school children are dichotomized: children who had at least four of the seven food groups were considered to have adequately diversi ed dietary intake [29]. In our study, we dichotomized the score using median as there is no recommended cut-off points for our study population (school-age children) [16][17][18][19][20][21]. The median of the children's dietary diversity scores was calculated to determine the cutoff point between lower and higher dietary diversity.…”

“…Along with micronutrient supplementation, su cient dietary diversity is considered a key to improving overall nutritional and health status of children living with HIV [12][13][14]. A number of recent studies have explored risk factors for undernutrition, using dietary diversity score developed by the Food and Agriculture Organization [15][16][17][18][19][20]. Dietary diversity score, which consists of a simple count of food groups that an individual has consumed over the preceding 24 hours, is considered a proxy for nutrient adequacy of the diet of individuals [21].…”