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Background: Childhood obesity is an emerging public health problem globally. Although previously a problem of high-income countries, overweight and obesity is on the rise in low- and middle-income countries. This paper explores the factors associated with childhood obesity and overweight in Uganda using data from the Uganda Demographic and Health Survey (UDHS) of 2016. Methods: We used Uganda Demographic and Health Survey (UDHS) 2016 data of 4338 children less than 5 years. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. Overweight and obesity were combined as the primary outcome. Children whose BMI z score was over two were considered as overweight while those with a BMI z score greater than three were considered as obese. We used multivariable logistic regression to determine factors associated with obesity and overweight among children under 5 years of age in Uganda. Results: The prevalence of overweight and obesity was 5.0% (217/4338) (95% CI: 4.3–5.6), with overweight at 3.9% (168/4338: 95% CI: 3.2–4.3) and obesity at 1.1% (49/4338: 95% CI: 0.8–1.5). Mother’s nutritional status, sex of the child, and child’s age were associated with childhood obesity and overweight. Boys were more likely to be overweight or obese (aOR = 1.81; 95% CI 1.24 to 2.64) compared to girls. Children who were younger (36 months and below) and those with mothers who were overweight or obese were more likely to have obesity or overweight compared to those aged 49–59 months and those with underweight mothers respectively. Children from the western region were more likely to be overweight or obese compared to those that were from the North. Conclusion: The present study showed male sex, older age of the children, nutritional status of the mothers and region of residence were associated with obesity and overweight among children under 5 years of age.
UDHS 2016 was a nationally representative cross-sectional study conducted using validated questionnaires. UDHS is a periodical survey that is carried out every 5 years as part of the MEASURE DHS global survey and collects Information on demographic, health and nutrition indicators. The survey was conducted between June 2016 and December 2016 using stratified two-stage cluster sampling design that resulted in the random selection of a representative sample of 20,880 households [22, 23]. The households were randomly selected in two stages: clusters (or enumeration areas) were drawn in the first stage and then a count within each cluster led to a list of households from which was conducted a systematic sampling with equal probability [22]. A detailed explanation of the sampling process is available in the UDHS 2016 report [22]. A systematic random draw was conducted amongst the selected households to choose households whose women/ mothers’ and children’s anthropometric measurements (weight and height) were taken. Anthropometric measurements were done on a subsample of about one-third of households [22]. Weight was taken with an electronic SECA 878 flat scale while a Shorr Board® measuring board was used for height [22]. Children less than 24 months were measured lying down. Our secondary analysis excluded children whose BMI z-score were missing or was recorded as “Flagged cases”. Flagged cases were defined as more than 5 SD above or below the standard population median (Z-scores) based on the WHO Child Growth Standards [24]. In the children’s dataset, a final weighted sample of 4338 was analyzed after excluding flagged cases and those with missing values. Written permission to access the whole UDHS database was obtained through DHS program website at the address https://dhsprogram.com/. The BMI z-scores based on WHO 2006 reference population were used to assess obesity and overweight [25]. Children whose BMI z score was over two were considered as overweight and those with a BMI z score greater than three were considered as obese [25]. Independent variables were categorized into children, parents’ and household characteristics that were chosen basing on previous studies [25–27] and availability in the UDHS data base. Maternal nutritional status (underweight defined as body mass index (BMI) less than (<) 18.50 kg/m2, normal between 18.50 kg/m2 and 24.99 kg/m2 and overweight or obesity between 25.0 kg/m2 and above 30.0 kg/m2) [23, 28], mother’s level of education (no education, primary, secondary and tertiary), father’s level of education (no education, primary, secondary and tertiary), mother’s age (15–24, 25–34, 35–49), mother’s marital status (married and not married), mother’s working status (working and not working). Mother’s marital status was excluded from the multivariable model because data on father’s level of education was missing for children whose mothers were not married (separated, widowed and never been in a formal or informal relationship). Wealth index is a measure of relative household economic status and was calculated by DHS from information on household asset ownership using Principal Component Analysis (categorized into quintiles: richest, richer, middle poorer and poorest) [22], type of residence (urban and rural), number of household members (less than 5 and 5 and above), sex of household head (female and male) and region (North, East, West and Central). Age of the child in months (0–12, 13–24, 24–36, 37–48, 49–59), sex of the child (male and female) and stunting status (categorized as stunted and not stunted) defined as height-for-age Z-score is below minus two standard deviations (− 2 SD) from the median of the reference population [22]. We used the SPSS analytic software version 25.0 Complex Samples package for this analysis. Weighted data was used to account for the unequal probability sampling in different strata. Frequency distributions were used to describe the background characteristics of the children. Pearson’s chi-squared tests were used to investigate the significant differences between childhood obesity and overweight and the explanatory variables. Bivariable logistic regression was also conducted and we present crude odds ratio (COR), 95% confidence interval (CI) and p-values. Variables included in our multivariable model were determined a priori during literature review [29]. All variables in the model were assessed for collinearity, which was considered present if the variables had a variance inflation factor (VIF) greater than 10. However, none of the factors had a VIF above 3. Sensitivity analyses were done excluding underweight children so that a comparison was made between overweight and obese children and normal weight children. We also conducted sensitivity analyses excluding children less than 2 years since some literature suggests that BMI is not an appropriate index for that age group.
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