Socio-demographic and economic determinants of overweight and obesity in preschool children in Palestine: analysis of data from the Palestinian Multiple Indicator Cluster Survey

Obesity is a global public health issue and worldwide rates of childhood obesity are ten times higher than 40 years ago. A limited number of studies have been conducted to determine the prevalence of preschool obesity and overweight and associated factors in Palestinian children. The aim of this study was to examine sociodemographic and economic factors associated with preschool overweight and obesity in Palestinian children younger than 5 years of age. We used data from the fifth Palestinian Multiple Indicator Cluster Survey (MICS5), a cross-sectional survey of a representative sample of Palestinian households in 2014. The analysis was based on 6853 children (after excluding children whose z-score was out of range or not measured) below 5 years of age (46% [3152 out of 6853] in the Gaza Strip and 54% [3701 out of 6853] in the West Bank), drawn from 7816 completed surveys of a multi-stage cluster sample (99% response rate). The z-scores for BMI-for-age of children were used to evaluate weight status. Underweight, overweight, and obesity were defined as the proportion of preschool children with z-score values of 2 SDs or less, greater than 2 SDs, and greater than 3 SDs, respectively, from the WHO Child Growth Standards. Covariates included gender, age, area and region, number of children per household, mother's level of education, marital status of the mother, mother's age at birth, and wealth quantile (which we used as a composite indicator of wealth, with the first quintile representing the poorest households, and the fifth quintile representing the wealthiest households). We used multiple logistic regression analysis to estimate adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The overall prevalence of overweight and obesity in Palestinian children (birth to 5 years) was 8·8% (95% CI 8·1–9·4); 7·3% were overweight and 1·5% were obese. The prevalence of underweight was 1·4%. The odds of overweight and obesity were lower among children in the Gaza Strip than in the West Bank (AOR=0·74; 95% CI 0·61–0·90). Girls were less likely to be obese and overweight than boys (AOR=0·75; 95% CI 0·63–0·89). Children under 4 years of age had a higher risk of being obese and overweight than children aged 4–5 years. Children who lived in the wealthiest households (fifth quintile) were more likely to be overweight and obese than children in the poorest (first) quintile (AOR=1·36; 95% CI 1·09–1·71). The prevalence of obesity and overweight among preschool chil