# Prevalence and Determinants of the Double Burden of Malnutrition in Iraq: A Cross-Sectional Study

## TL;DR

This study examines the dual problem of undernutrition and overnutrition in Iraqi children and identifies factors that contribute to both.

## Contribution

The study is novel in analyzing both undernutrition and overnutrition simultaneously in Iraqi children, providing insights into their shared determinants.

## Key findings

- Wasting was more common in five-year-olds and children from middle-income families.
- Mixed feeding and delayed complementary feeding were linked to higher rates of both wasting and overweight.
- Overweight children were more likely to have mothers with primary or secondary education.

## Abstract

Malnutrition in children mirrors socioeconomic status and plays a key role in health, economic, and social impacts. The double burden of malnutrition has attracted considerable attention from healthcare institutions and organizations. For the past three decades, studies on malnutrition have been restricted to focusing on only undernutrition or overnutrition. This study aimed to determine the dual burden of malnutrition and its contributing factors in Iraq. A cross-sectional study was conducted to determine the prevalence and contributing factors of malnutrition in 646 kindergarten children across the country. A questionnaire was used to collect data on the participants and their families. Data were analyzed using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York). The chi-square test was used to assess the relationship between variables and both forms of malnutrition, and statistical significance was evaluated at p < 0.05.

Results showed that wasting was found in 18 children (2.8%). Five-year-old children were more likely to be wasted than four-year-olds, and those who began complementary feeding after six months had higher rates of wasting. Children who received mixed feeding were more wasted compared to those who were breastfed or bottle-fed. Additionally, children of housewife mothers and those from middle-income families were more likely to experience wasting than those from low- or high-income families.

In addition, 48 children (7.5%) were found to be overweight. There was no statistically significant difference between the sexes. Five-year-olds were more affected than four-year-olds, and those who received mixed feeding were more affected than those who were exclusively breastfed or bottle-fed. Children of mothers who had completed primary or secondary education were more likely to be overweight, although no statistically significant difference was found based on parental education level or maternal employment status. Furthermore, children who began complementary feeding after six months and those from middle-income families were more likely to be overweight.

These findings contribute to a better understanding of the prevalence and contributing factors of both forms of malnutrition.