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Socioeconomic status and the double burden of malnutrition in Cambodia between 2000 to 2014: overweight mothers and stunted children
Authors: Michelle K. Nakphong and Hiram Beltran-Sanchez
Source: Public Health Nutrition, DOI:
Topic(s): Biomarkers
Child health
Child height
Maternal health
Wealth Index
Country: Asia
Published: FEB 2021
Abstract: Objective: The Cambodian population has experienced an increase in the proportion of stunted children who have overweight mothers during a period of rapid social and economic growth. We aimed to identify socioeconomic factors associated with this household-level double burden over time. Design: We used data from four Cambodia Demographic and Health Surveys from 2000 to 2014 to study the impact of socioeconomic status (SES) on the link between child stunting and overweight mothers in two periods 2000-2005 vs. 2010-2014. We hypothesized that SES would be a primary factor associated with this phenomenon. Participants: We included 14,988 children under age 5, among non-pregnant mothers aged 15-49 years of age and conducted analysis on a subsample of 1,572 children with overweight mothers. Setting: Nationally-representative household survey across all regions. Results: SES factors, specifically household wealth and maternal employment in service or manual occupations (in 2010-2014), are the main drivers of stunting among children of overweight mothers. Children with overweight mothers in the poorest households are more than twice as likely to be stunted than in the richest in both periods (2000-2005: aOR=2.53, 95%CI: 1.25, 5.13; 2010-2014: aOR=2.61, 95%CI: 1.43, 4.77), adjusting for other SES factors, indicating that despite decreasing income inequality, the poorest continue to bear excess risk of a double burden of malnutrition. Maternal short stature also doubled the likelihood of child stunting in both periods, which suggests intergenerational transmission of adversity and physical underdevelopment. Conclusions: Socioeconomic inequalities should be addressed to reduce disparities in the household-level double burden of malnutrition.