Nutritional disparities between urban poor and non-poor Malaysian children under five in the context of the COVID-19 pandemic: a cross-sectional study

BACKGROUND: Rapid urbanisation in Asia has widened intra-urban nutritional disparities, particularly among urban-poor children during periods of compromised food security. METHODS: This cross-sectional study aimed to investigate nutritional disparities among children under five in an urban locality during the COVID-19 pandemic. We recruited 717 children aged 6-59 months from July 2020 to June 2023 across three sites in Selangor, Malaysia. Preterm or small-for-gestational-age children and those with incomplete data were excluded. Dietary intake was assessed by 24-h recall adapted from WHO-IYCF and FAO-WDD tools. Anthropometric indices were weight-for-age, length/height-for-age, and weight-for-length/height z-scores. Malnutrition indicators were WHO-defined underweight, stunting, wasting, and overweight. Associations of sociodemographic factors and minimum dietary diversity with malnutrition indicators were analysed. RESULTS: 357 urban-poor and 360 urban non-poor children were recruited. Urban-poor children had lower mean weight and height z-scores than urban non-poor children (-0.77 [SD 1.20] vs -0.46 [SD 1.17], p < 0.001; -0.73 [SD 1.06] vs -0.46 [SD 1.21], p = 0.002). Underweight prevalence was higher among urban-poor children (13.2% vs 7.0%, p = 0.009). Among children aged 6-23 months, dietary diversity scores were lower in the urban-poor group (mean DDS 5.02 vs 5.60, p < 0.001), with lower breastfeeding prevalence (47.5% vs 59.8%, p = 0.007). Intake of sugar-sweetened beverages and foods was higher in both urban-poor age groups (52.9% vs 30.0%, p < 0.001; 80.4% vs 59.7%, p = 0.003). In multivariable models, urban poverty increased the odds of underweight (adjusted OR 1.99 [95% CI 1.19, 3.32], p = 0.008). Higher birth weight z-scores were protective against underweight (adjusted OR 0.65 [95% CI 0.47, 0.91], p = 0.013) and wasting (adjusted OR 0.68 [95% CI 0.49, 0.94], p = 0.018), while higher birth length z-scores were protective against stunting (adjusted OR 0.65 [95% CI 0.49, 0.87], p = 0.004). Achieving minimum dietary diversity was protective against underweight (adjusted OR 0.46 [95% CI 0.23, 0.92], p = 0.029). CONCLUSION: Urban-poor children had lower anthropometric z-scores, higher underweight prevalence, poorer early-childhood dietary diversity, and higher intake of sugar-sweetened beverages and foods. Targeted socioeconomic and nutrition support is needed for urban-poor families.