الفهرس 
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Abstract
The aim of the present study was to assess the problem of the double burden of stunting and excess weight among preschool children in Itay Albarud city, Elbeheira governorate, Egypt. The study objectives were: (1) To assess the prevalence of stunting and excess weight among preschool children in Itay Albarud, and (2) To study the relation between excess weight with concurrent stunting and associated risk factors among preschool children in Itay Albarud. Subjects and methods: This study is a cross sectional study that was carried-out on 445 children aged less than 6 years old and recruited at nursery schools under supervision of Ministry of Education in Itay Albarud, in the academic year 2019/2020. The tools used in this study included: (1) A predesigned questionnaire formed of three parts that covered socio-demographic data, feeding patterns of the child and health history and status of the child and his mother, and (2) Measurement of weight and height to calculate the anthropometric measurements and BMI of the child and his parents. The results of the current study revealed that more than three quarters of the studied children (78.4%) had normal weight and height, (11.5%) were overweight and obese, and (8.1%) had stunted growth, while (2%) had double burden of stunted growth and OWOB. There were significant differences as regards sex and age of the children. The majority of cases with OWOB or with double burden of stunting and OWOB were girls and in the age group between 60 - <72 months. On the contrary, stunting was common in boys and in the age group between 48 - <60 months. Approximately, two thirds (66.7%) of children suffering from stunted growth or the double burden were living in rural areas, but 70.6% of children with OWOB were from urban areas. About half of families of children with double burden (55.6%) had more than 3 children in the family and the affected child order came after the third. However, the majority of families of OWOB (90.2%) and stunted children (61.1%) had less than three children (92.2%) and (66.7%) of the affected children ranked before the third. In relation to birth interval, most children in the double burden group (66.7%) were more than 36 months apart from their preceders, while less than half of OWOB group (43.1%) and 33.3% of the stunted group children were the first babies for their families. Regarding vaccination, nearly all children received their vaccinations regularly. Mothers of more than half of the children with double burden (55.6%), two thirds of those with OWOB (68.6%), and less than half of stunted children (47.2%) underutilized primary health care services during pregnancy (less than 4 visits to primary health care centers/units). Less than half of mothers of the double burden group and the stunted group (44.4%) started follow up visits during pregnancy by the third trimester, but almost two thirds of the OWOB group mothers started their visits by the first trimester. Mothers of children of more than half of the double burden group and the stunted group (55.6%) did not take vitamins and minerals supplementation during pregnancy, while nearly all mothers of OWOB children (96.1%) and normal children (94.3%) took their supplementations regularly. Regarding health problems that mothers suffered during pregnancy, mothers of less than one quarter (22.2%) of double burden children suffered from antepartum hemorrhage and anemia and received blood transfusion. About one third of the same group suffered from hypertension with preeclampsia (33.3%), while the minority suffered from gestational diabetes (11.1%). Concerning preterm labor, about one third of double burden children (33.3%) and one quarter of stunted children (25.0%) were preterm. Regarding type of birth, the majority of studied children were born by cesarean sections performed by physicians at hospitals. As regards birth weight of studied children, about one third of double burden children (33.3%) were born overweight. On the other hand, one quarter of the same group and one third of stunted children were underweight. Less than half of double burden children and majority of OWOB and normal children had normal weight at birth. About one third of double burden children (33.3%) and less than one quarter of stunted children (19.4%) were incubated after birth as they had neonatal jaundice. Regarding lactation type, less than half of children in the double burden group (44.4%) and more than one third of OWOB children were bottle-fed, while about one third (33.3%) of children in the double burden group were breastfed and started breast feeding within 24 hours. As regards duration of exclusive breast feeding, less than half of double burden children, OWOB and one quarter of stunted children were not exclusively breastfed. On the other hand, about one quarter of double burden children were breastfed for less than 4 months. Regarding the start of weaning, more than half of double burden group (55.6%), about two thirds of OWOB group (64.7%) and (61.1%) of stunted children started weaning before the age of 6 months. Regarding meals prepared by mothers and carried by their children to the nursery schools to be eaten there, the majority of studied children had meals sent by their mothers. The study showed also that, at home, about half of double burden children consume more than 3 main meals and 3-4 snacks per day, with significant differences regarding types of snacks. During infancy, about one quarter of double burden children (22.2%) suffered from severe gastroenteritis with dehydration and one third of the same group suffered from severe respiratory tract infections, recurrent nephritis and urinary tract infections (UTIs). Regarding history of chronic diseases, two thirds of the double burden group suffered chronic diseases such as bronchial asthma, congenital disease, autoimmune disease and hypothyroidism. The majority of OWOB children (80.3%) and normal children (94.0%) had no history of chronic diseases. As regards parasitic infestation, slightly less than half of the double burden group (44.4%) had previous parasitic infestations that were not treated until the time of the study. Nearly, one third of stunted group children (30.6%) had history of treated parasitic infections, while the majority of OWOB children (80.4%) and normal children (77.9%) were not previously affected with parasitic infestations. The minority of studied children had history of rickets. Only 11.1 % of double burden group, 8.3% of stunted group had history of previously treated rickets. Less than half of double burden (44.4%) and about one third of stunted children (33.3%) had history of anemia that is not yet treated. By observing pallor in the studied children, more than three quarters of double burden group (77.8%), more than half of OWOB group (52.9%) and (55.6%) of stunted group and only one third of normal group (38.7%) had the slightest degree of pallor. Less than half of double burden children (44.4%) were treated with corticosteroids; of them, three quarters (75.0%) had been treated for more than one month. On the contrary, most of OWOB group (90.2%), stunted group (86.1%) and normal group (94.6%) were not previously treated with corticosteroids or treated for less than one month. The study revealed also a significant difference concerning mothers’ age at the time of delivery as well as fathers’ age. At the time of birth, three quarters of mothers of double burden children were more than 30 years, while mothers of most of OWOB, stunted and normal children were less than 30 years. Regarding parents’ education, fathers of one third of double burden children had two years institute education (33.3%) and another third had university education (33.3%), while more than half of their mothers had secondary education. Less than half of fathers and mothers of OWOB children (41.2%) were university educated, while less than half of stunted children mothers and fathers finished their education at the secondary stage. The study showed that more than half of fathers of double burden children (55.6%) and more than one third of stunted group fathers were businessmen, while less than half of OWOB group fathers (49.0%) were professional employees. Regarding mothers’ work, about two thirds of double burden group (66.7%) and stunted group (69.4%) mothers were housewives, while more than half of mothers of OWOB (51.0%) were professional employees. Concerning height of parents, the heights of less than one quarter (22.2%) of double burden children mothers were <1.5 m, while BMI of most of them (77.7%) were between 25 - >30. Regarding fathers’ height, all fathers of double burden children were more than 1.5 m with no significant difference regarding BMI. About one third of children with double burden and near half of the stunted children had stunted relatives in their families with no significant difference regarding degree of relevance. More than three quarters of double burden children (77.8%) and more than half of the stunted group (55.6%) were exposed to smoking at home with no significant difference between studied children regarding type of smoking. The study revealed a significant difference between the studied children regarding socio-economic status of the family. More than half of the families of double burden children had enough income for daily needs, while the income for one quarter was low. More than three quarters of families of the same group had large household size (>5) and one third had unsuitable houses. About one quarter of these families had unsanitary water supply, unsanitary sewage disposal, and insufficient food. Electricity was not available for 11.1% of these families, while in 55.6% of houses garbage were collected locally.