Concurrent stunting among under-five children in Egypt

Concurrent stunting among under-five children... | F1000Research "use strict";function _typeof(t){return(_typeof="function"==typeof Symbol&&"symbol"==typeof Symbol.iterator?function(t){return typeof t}:function(t){return t&&"function"==typeof Symbol&&t.constructor===Symbol&&t!==Symbol.prototype?"symbol":typeof t})(t)}!function(){var t=function(){var t,e,o=[],n=window,r=n;for(;r;){try{if(r.frames.__tcfapiLocator){t=r;break}}catch(t){}if(r===n.top)break;r=r.parent}t||(!function t(){var e=n.document,o=!!n.frames.__tcfapiLocator;if(!o)if(e.body){var r=e.createElement("iframe");r.style.cssText="display:none",r.name="__tcfapiLocator",e.body.appendChild(r)}else setTimeout(t,5);return!o}(),n.__tcfapi=function(){for(var t=arguments.length,n=new Array(t),r=0;r 3&&2===parseInt(n[1],10)&&"boolean"==typeof n[3]&&(e=n[3],"function"==typeof n[2]&&n[2]("set",!0)):"ping"===n[0]?"function"==typeof n[2]&&n[2]({gdprApplies:e,cmpLoaded:!1,cmpStatus:"stub"}):o.push(n)},n.addEventListener("message",(function(t){var e="string"==typeof t.data,o={};if(e)try{o=JSON.parse(t.data)}catch(t){}else o=t.data;var n="object"===_typeof(o)&&null!==o?o.__tcfapiCall:null;n&&window.__tcfapi(n.command,n.version,(function(o,r){var a={__tcfapiReturn:{returnValue:o,success:r,callId:n.callId}};t&&t.source&&t.source.postMessage&&t.source.postMessage(e?JSON.stringify(a):a,"*")}),n.parameter)}),!1))};"undefined"!=typeof module?module.exports=t:t()}(); dataLayer = dataLayer || []; // Standard GTM initialization - Google Consent Mode handles consent automatically (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl+ '>m_auth=hzk0Vc3qFsQYhCrIoHz68A>m_preview=env-1>m_cookies_win=x';f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-MWFK8L5J'); ;window.NREUM||(NREUM={});NREUM.init={distributed_tracing:{enabled:true},privacy:{cookies_enabled:true},ajax:{deny_list:["bam.nr-data.net"]}}; ;NREUM.loader_config={accountID:"438030",trustKey:"438030",agentID:"772317073",licenseKey:"97f8f67f26",applicationID:"772317073"} ;NREUM.info={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net",licenseKey:"97f8f67f26",applicationID:"772317073",sa:1} ;/*! For license information please see nr-loader-spa-1.236.0.min.js.LICENSE.txt */ (()=>{"use strict";var e,t,r={5763:(e,t,r)=>{r.d(t,{P_:()=>l,Mt:()=>g,C5:()=>s,DL:()=>v,OP:()=>T,lF:()=>D,Yu:()=>y,Dg:()=>h,CX:()=>c,GE:()=>b,sU:()=>_});var n=r(8632),i=r(9567);const o={beacon:n.ce.beacon,errorBeacon:n.ce.errorBeacon,licenseKey:void 0,applicationID:void 0,sa:void 0,queueTime:void 0,applicationTime:void 0,ttGuid:void 0,user:void 0,account:void 0,product:void 0,extra:void 0,jsAttributes:{},userAttributes:void 0,atts:void 0,transactionName:void 0,tNamePlain:void 0},a={};function s(e){if(!e)throw new Error("All info objects require an agent identifier!");if(!a[e])throw new Error("Info for ".concat(e," was never set"));return a[e]}function c(e,t){if(!e)throw new Error("All info objects require an agent identifier!");a[e]=(0,i.D)(t,o),(0,n.Qy)(e,a[e],"info")}var u=r(7056);const d=()=>{const e={blockSelector:"[data-nr-block]",maskInputOptions:{password:!0}};return{allow_bfcache:!0,privacy:{cookies_enabled:!0},ajax:{deny_list:void 0,enabled:!0,harvestTimeSeconds:10},distributed_tracing:{enabled:void 0,exclude_newrelic_header:void 0,cors_use_newrelic_header:void 0,cors_use_tracecontext_headers:void 0,allowed_origins:void 0},session:{domain:void 0,expiresMs:u.oD,inactiveMs:u.Hb},ssl:void 0,obfuscate:void 0,jserrors:{enabled:!0,harvestTimeSeconds:10},metrics:{enabled:!0},page_action:{enabled:!0,harvestTimeSeconds:30},page_view_event:{enabled:!0},page_view_timing:{enabled:!0,harvestTimeSeconds:30,long_task:!1},session_trace:{enabled:!0,harvestTimeSeconds:10},harvest:{tooManyRequestsDelay:60},session_replay:{enabled:!1,harvestTimeSeconds:60,sampleRate:.1,errorSampleRate:.1,maskTextSelector:"*",maskAllInputs:!0,get blockClass(){return"nr-block"},get ignoreClass(){return"nr-ignore"},get maskTextClass(){return"nr-mask"},get blockSelector(){return e.blockSelector},set blockSelector(t){e.blockSelector+=",".concat(t)},get maskInputOptions(){return e.maskInputOptions},set maskInputOptions(t){e.maskInputOptions={...t,password:!0}}},spa:{enabled:!0,harvestTimeSeconds:10}}},f={};function l(e){if(!e)throw new Error("All configuration objects require an agent identifier!");if(!f[e])throw new Error("Configuration for ".concat(e," was never set"));return f[e]}function h(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");f[e]=(0,i.D)(t,d()),(0,n.Qy)(e,f[e],"config")}function g(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");var r=l(e);if(r){for(var n=t.split("."),i=0;i {r.d(t,{D:()=>i});var n=r(50);function i(e,t){try{if(!e||"object"!=typeof e)return(0,n.Z)("Setting a Configurable requires an object as input");if(!t||"object"!=typeof t)return(0,n.Z)("Setting a Configurable requires a model to set its initial properties");const r=Object.create(Object.getPrototypeOf(t),Object.getOwnPropertyDescriptors(t)),o=0===Object.keys(r).length?e:r;for(let a in o)if(void 0!==e[a])try{"object"==typeof e[a]&&"object"==typeof t[a]?r[a]=i(e[a],t[a]):r[a]=e[a]}catch(e){(0,n.Z)("An error occurred while setting a property of a Configurable",e)}return r}catch(e){(0,n.Z)("An error occured while setting a Configurable",e)}}},6818:(e,t,r)=>{r.d(t,{Re:()=>i,gF:()=>o,q4:()=>n});const n="1.236.0",i="PROD",o="CDN"},385:(e,t,r)=>{r.d(t,{FN:()=>a,IF:()=>u,Nk:()=>f,Tt:()=>s,_A:()=>o,il:()=>n,pL:()=>c,v6:()=>i,w1:()=>d});const n="undefined"!=typeof window&&!!window.document,i="undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self.navigator instanceof WorkerNavigator||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis.navigator instanceof WorkerNavigator),o=n?window:"undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis),a=""+o?.location,s=/iPad|iPhone|iPod/.test(navigator.userAgent),c=s&&"undefined"==typeof SharedWorker,u=(()=>{const e=navigator.userAgent.match(/Firefox[/\s](\d+\.\d+)/);return Array.isArray(e)&&e.length>=2?+e[1]:0})(),d=Boolean(n&&window.document.documentMode),f=!!navigator.sendBeacon},1117:(e,t,r)=>{r.d(t,{w:()=>o});var n=r(50);const i={agentIdentifier:"",ee:void 0};class o{constructor(e){try{if("object"!=typeof e)return(0,n.Z)("shared context requires an object as input");this.sharedContext={},Object.assign(this.sharedContext,i),Object.entries(e).forEach((e=>{let[t,r]=e;Object.keys(i).includes(t)&&(this.sharedContext[t]=r)}))}catch(e){(0,n.Z)("An error occured while setting SharedContext",e)}}}},8e3:(e,t,r)=>{r.d(t,{L:()=>d,R:()=>c});var n=r(2177),i=r(1284),o=r(4322),a=r(3325);const s={};function c(e,t){const r={staged:!1,priority:a.p[t]||0};u(e),s[e].get(t)||s[e].set(t,r)}function u(e){e&&(s[e]||(s[e]=new Map))}function d(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:"",t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:"feature";if(u(e),!e||!s[e].get(t))return a(t);s[e].get(t).staged=!0;const r=[...s[e]];function a(t){const r=e?n.ee.get(e):n.ee,a=o.X.handlers;if(r.backlog&&a){var s=r.backlog[t],c=a[t];if(c){for(var u=0;s&&u {let[t,r]=e;return r.staged}))&&(r.sort(((e,t)=>e[1].priority-t[1].priority)),r.forEach((e=>{let[t]=e;a(t)})))}function f(e,t){var r=e[1];(0,i.D)(t[r],(function(t,r){var n=e[0];if(r[0]===n){var i=r[1],o=e[3],a=e[2];i.apply(o,a)}}))}},2177:(e,t,r)=>{r.d(t,{c:()=>f,ee:()=>u});var n=r(8632),i=r(2210),o=r(1284),a=r(5763),s="nr@context";let c=(0,n.fP)();var u;function d(){}function f(e){return(0,i.X)(e,s,l)}function l(){return new d}function h(){u.aborted=!0,u.backlog={}}c.ee?u=c.ee:(u=function e(t,r){var n={},c={},f={},g=!1;try{g=16===r.length&&(0,a.OP)(r).isolatedBacklog}catch(e){}var p={on:b,addEventListener:b,removeEventListener:y,emit:v,get:x,listeners:w,context:m,buffer:A,abort:h,aborted:!1,isBuffering:E,debugId:r,backlog:g?{}:t&&"object"==typeof t.backlog?t.backlog:{}};return p;function m(e){return e&&e instanceof d?e:e?(0,i.X)(e,s,l):l()}function v(e,r,n,i,o){if(!1!==o&&(o=!0),!u.aborted||i){t&&o&&t.emit(e,r,n);for(var a=m(n),s=w(e),d=s.length,f=0;fn,p:()=>i});var n=r(2177).ee.get("handle");function i(e,t,r,i,o){o?(o.buffer([e],i),o.emit(e,t,r)):(n.buffer([e],i),n.emit(e,t,r))}},4322:(e,t,r)=>{r.d(t,{X:()=>o});var n=r(5546);o.on=a;var i=o.handlers={};function o(e,t,r,o){a(o||n.E,i,e,t,r)}function a(e,t,r,i,o){o||(o="feature"),e||(e=n.E);var a=t[o]=t[o]||{};(a[r]=a[r]||[]).push([e,i])}},3239:(e,t,r)=>{r.d(t,{bP:()=>s,iz:()=>c,m$:()=>a});var n=r(385);let i=!1,o=!1;try{const e={get passive(){return i=!0,!1},get signal(){return o=!0,!1}};n._A.addEventListener("test",null,e),n._A.removeEventListener("test",null,e)}catch(e){}function a(e,t){return i||o?{capture:!!e,passive:i,signal:t}:!!e}function s(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;window.addEventListener(e,t,a(r,n))}function c(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;document.addEventListener(e,t,a(r,n))}},4402:(e,t,r)=>{r.d(t,{Ht:()=>u,M:()=>c,Rl:()=>a,ky:()=>s});var n=r(385);const i="xxxxxxxx-xxxx-4xxx-yxxx-xxxxxxxxxxxx";function o(e,t){return e?15&e[t]:16*Math.random()|0}function a(){const e=n._A?.crypto||n._A?.msCrypto;let t,r=0;return e&&e.getRandomValues&&(t=e.getRandomValues(new Uint8Array(31))),i.split("").map((e=>"x"===e?o(t,++r).toString(16):"y"===e?(3&o()|8).toString(16):e)).join("")}function s(e){const t=n._A?.crypto||n._A?.msCrypto;let r,i=0;t&&t.getRandomValues&&(r=t.getRandomValues(new Uint8Array(31)));const a=[];for(var s=0;s {r.d(t,{Bq:()=>n,Hb:()=>o,oD:()=>i});const n="NRBA",i=144e5,o=18e5},7894:(e,t,r)=>{function n(){return Math.round(performance.now())}r.d(t,{z:()=>n})},7243:(e,t,r)=>{r.d(t,{e:()=>o});var n=r(385),i={};function o(e){if(e in i)return i[e];if(0===(e||"").indexOf("data:"))return{protocol:"data"};let t;var r=n._A?.location,o={};if(n.il)t=document.createElement("a"),t.href=e;else try{t=new URL(e,r.href)}catch(e){return o}o.port=t.port;var a=t.href.split("://");!o.port&&a[1]&&(o.port=a[1].split("/")[0].split("@").pop().split(":")[1]),o.port&&"0"!==o.port||(o.port="https"===a[0]?"443":"80"),o.hostname=t.hostname||r.hostname,o.pathname=t.pathname,o.protocol=a[0],"/"!==o.pathname.charAt(0)&&(o.pathname="/"+o.pathname);var s=!t.protocol||":"===t.protocol||t.protocol===r.protocol,c=t.hostname===r.hostname&&t.port===r.port;return o.sameOrigin=s&&(!t.hostname||c),"/"===o.pathname&&(i[e]=o),o}},50:(e,t,r)=>{function n(e,t){"function"==typeof console.warn&&(console.warn("New Relic: ".concat(e)),t&&console.warn(t))}r.d(t,{Z:()=>n})},2587:(e,t,r)=>{r.d(t,{N:()=>c,T:()=>u});var n=r(2177),i=r(5546),o=r(8e3),a=r(3325);const s={stn:[a.D.sessionTrace],err:[a.D.jserrors,a.D.metrics],ins:[a.D.pageAction],spa:[a.D.spa],sr:[a.D.sessionReplay,a.D.sessionTrace]};function c(e,t){const r=n.ee.get(t);e&&"object"==typeof e&&(Object.entries(e).forEach((e=>{let[t,n]=e;void 0===u[t]&&(s[t]?s[t].forEach((e=>{n?(0,i.p)("feat-"+t,[],void 0,e,r):(0,i.p)("block-"+t,[],void 0,e,r),(0,i.p)("rumresp-"+t,[Boolean(n)],void 0,e,r)})):n&&(0,i.p)("feat-"+t,[],void 0,void 0,r),u[t]=Boolean(n))})),Object.keys(s).forEach((e=>{void 0===u[e]&&(s[e]?.forEach((t=>(0,i.p)("rumresp-"+e,[!1],void 0,t,r))),u[e]=!1)})),(0,o.L)(t,a.D.pageViewEvent))}const u={}},2210:(e,t,r)=>{r.d(t,{X:()=>i});var n=Object.prototype.hasOwnProperty;function i(e,t,r){if(n.call(e,t))return e[t];var i=r();if(Object.defineProperty&&Object.keys)try{return Object.defineProperty(e,t,{value:i,writable:!0,enumerable:!1}),i}catch(e){}return e[t]=i,i}},1284:(e,t,r)=>{r.d(t,{D:()=>n});const n=(e,t)=>Object.entries(e||{}).map((e=>{let[r,n]=e;return t(r,n)}))},4351:(e,t,r)=>{r.d(t,{P:()=>o});var n=r(2177);const i=()=>{const e=new WeakSet;return(t,r)=>{if("object"==typeof r&&null!==r){if(e.has(r))return;e.add(r)}return r}};function o(e){try{return JSON.stringify(e,i())}catch(e){try{n.ee.emit("internal-error",[e])}catch(e){}}}},3960:(e,t,r)=>{r.d(t,{K:()=>a,b:()=>o});var n=r(3239);function i(){return"undefined"==typeof document||"complete"===document.readyState}function o(e,t){if(i())return e();(0,n.bP)("load",e,t)}function a(e){if(i())return e();(0,n.iz)("DOMContentLoaded",e)}},8632:(e,t,r)=>{r.d(t,{EZ:()=>u,Qy:()=>c,ce:()=>o,fP:()=>a,gG:()=>d,mF:()=>s});var n=r(7894),i=r(385);const o={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net"};function a(){return i._A.NREUM||(i._A.NREUM={}),void 0===i._A.newrelic&&(i._A.newrelic=i._A.NREUM),i._A.NREUM}function s(){let e=a();return e.o||(e.o={ST:i._A.setTimeout,SI:i._A.setImmediate,CT:i._A.clearTimeout,XHR:i._A.XMLHttpRequest,REQ:i._A.Request,EV:i._A.Event,PR:i._A.Promise,MO:i._A.MutationObserver,FETCH:i._A.fetch}),e}function c(e,t,r){let i=a();const o=i.initializedAgents||{},s=o[e]||{};return Object.keys(s).length||(s.initializedAt={ms:(0,n.z)(),date:new Date}),i.initializedAgents={...o,[e]:{...s,[r]:t}},i}function u(e,t){a()[e]=t}function d(){return function(){let e=a();const t=e.info||{};e.info={beacon:o.beacon,errorBeacon:o.errorBeacon,...t}}(),function(){let e=a();const t=e.init||{};e.init={...t}}(),s(),function(){let e=a();const t=e.loader_config||{};e.loader_config={...t}}(),a()}},7956:(e,t,r)=>{r.d(t,{N:()=>i});var n=r(3239);function i(e){let t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],r=arguments.length>2?arguments[2]:void 0,i=arguments.length>3?arguments[3]:void 0;return void(0,n.iz)("visibilitychange",(function(){if(t)return void("hidden"==document.visibilityState&&e());e(document.visibilityState)}),r,i)}},1214:(e,t,r)=>{r.d(t,{em:()=>v,u5:()=>N,QU:()=>S,_L:()=>I,Gm:()=>L,Lg:()=>M,gy:()=>U,BV:()=>Q,Kf:()=>ee});var n=r(2177);const i="nr@original";var o=Object.prototype.hasOwnProperty,a=!1;function s(e,t){return e||(e=n.ee),r.inPlace=function(e,t,n,i,o){n||(n="");var a,s,c,u="-"===n.charAt(0);for(c=0;c 2?n-2:0),o=2;o {r(A[T],e,w),r(E[T],e,w)})),r(l._A,"fetch",y),t.on(y+"end",(function(e,r){var n=this;if(r){var i=r.headers.get("content-length");null!==i&&(n.rxSize=i),t.emit(y+"done",[null,r],n)}else t.emit(y+"done",[e],n)})),t}const O={},j=["pushState","replaceState"];function S(e){const t=function(e){return(e||n.ee).get("history")}(e);return!l.il||O[t.debugId]++||(O[t.debugId]=1,s(t).inPlace(window.history,j,"-")),t}var P=r(3239);const C={},R=["appendChild","insertBefore","replaceChild"];function I(e){const t=function(e){return(e||n.ee).get("jsonp")}(e);if(!l.il||C[t.debugId])return t;C[t.debugId]=!0;var r=s(t),i=/[?&](?:callback|cb)=([^&#]+)/,o=/(.*)\.([^.]+)/,a=/^(\w+)(\.|$)(.*)$/;function c(e,t){var r=e.match(a),n=r[1],i=r[3];return i?c(i,t[n]):t[n]}return r.inPlace(Node.prototype,R,"dom-"),t.on("dom-start",(function(e){!function(e){if(!e||"string"!=typeof e.nodeName||"script"!==e.nodeName.toLowerCase())return;if("function"!=typeof e.addEventListener)return;var n=(a=e.src,s=a.match(i),s?s[1]:null);var a,s;if(!n)return;var u=function(e){var t=e.match(o);if(t&&t.length>=3)return{key:t[2],parent:c(t[1],window)};return{key:e,parent:window}}(n);if("function"!=typeof u.parent[u.key])return;var d={};function f(){t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}function l(){t.emit("jsonp-error",[],d),t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}r.inPlace(u.parent,[u.key],"cb-",d),e.addEventListener("load",f,(0,P.m$)(!1)),e.addEventListener("error",l,(0,P.m$)(!1)),t.emit("new-jsonp",[e.src],d)}(e[0])})),t}var k=r(5763);const H={};function L(e){const t=function(e){return(e||n.ee).get("mutation")}(e);if(!l.il||H[t.debugId])return t;H[t.debugId]=!0;var r=s(t),i=k.Yu.MO;return i&&(window.MutationObserver=function(e){return this instanceof i?new i(r(e,"fn-")):i.apply(this,arguments)},MutationObserver.prototype=i.prototype),t}const z={};function M(e){const t=function(e){return(e||n.ee).get("promise")}(e);if(z[t.debugId])return t;z[t.debugId]=!0;var r=n.c,o=s(t),a=k.Yu.PR;return a&&function(){function e(r){var n=t.context(),i=o(r,"executor-",n,null,!1);const s=Reflect.construct(a,[i],e);return t.context(s).getCtx=function(){return n},s}l._A.Promise=e,Object.defineProperty(e,"name",{value:"Promise"}),e.toString=function(){return a.toString()},Object.setPrototypeOf(e,a),["all","race"].forEach((function(r){const n=a[r];e[r]=function(e){let i=!1;[...e||[]].forEach((e=>{this.resolve(e).then(a("all"===r),a(!1))}));const o=n.apply(this,arguments);return o;function a(e){return function(){t.emit("propagate",[null,!i],o,!1,!1),i=i||!e}}}})),["resolve","reject"].forEach((function(r){const n=a[r];e[r]=function(e){const r=n.apply(this,arguments);return e!==r&&t.emit("propagate",[e,!0],r,!1,!1),r}})),e.prototype=a.prototype;const n=a.prototype.then;a.prototype.then=function(){var e=this,i=r(e);i.promise=e;for(var a=arguments.length,s=new Array(a),c=0;c e())),t};function m(e,t){i.inPlace(t,["onreadystatechange"],"fn-",E)}function b(){var e=this,t=r.context(e);e.readyState>3&&!t.resolved&&(t.resolved=!0,r.emit("xhr-resolved",[],e)),i.inPlace(e,f,"fn-",E)}if(function(e,t){for(var r in e)t[r]=e[r]}(o,p),p.prototype=o.prototype,i.inPlace(p.prototype,J,"-xhr-",E),r.on("send-xhr-start",(function(e,t){m(e,t),function(e){h.push(e),a&&(y?y.then(A):u?u(A):(w=-w,x.data=w))}(t)})),r.on("open-xhr-start",m),a){var y=c&&c.resolve();if(!u&&!c){var w=1,x=document.createTextNode(w);new a(A).observe(x,{characterData:!0})}}else t.on("fn-end",(function(e){e[0]&&e[0].type===d||A()}));function A(){for(var e=0;e {r.d(t,{t:()=>n});const n=r(3325).D.ajax},6660:(e,t,r)=>{r.d(t,{A:()=>i,t:()=>n});const n=r(3325).D.jserrors,i="nr@seenError"},3081:(e,t,r)=>{r.d(t,{gF:()=>o,mY:()=>i,t9:()=>n,vz:()=>s,xS:()=>a});const n=r(3325).D.metrics,i="sm",o="cm",a="storeSupportabilityMetrics",s="storeEventMetrics"},4649:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageAction},7633:(e,t,r)=>{r.d(t,{Dz:()=>i,OJ:()=>a,qw:()=>o,t9:()=>n});const n=r(3325).D.pageViewEvent,i="firstbyte",o="domcontent",a="windowload"},9251:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageViewTiming},3614:(e,t,r)=>{r.d(t,{BST_RESOURCE:()=>i,END:()=>s,FEATURE_NAME:()=>n,FN_END:()=>u,FN_START:()=>c,PUSH_STATE:()=>d,RESOURCE:()=>o,START:()=>a});const n=r(3325).D.sessionTrace,i="bstResource",o="resource",a="-start",s="-end",c="fn"+a,u="fn"+s,d="pushState"},7836:(e,t,r)=>{r.d(t,{BODY:()=>A,CB_END:()=>E,CB_START:()=>u,END:()=>x,FEATURE_NAME:()=>i,FETCH:()=>_,FETCH_BODY:()=>v,FETCH_DONE:()=>m,FETCH_START:()=>p,FN_END:()=>c,FN_START:()=>s,INTERACTION:()=>l,INTERACTION_API:()=>d,INTERACTION_EVENTS:()=>o,JSONP_END:()=>b,JSONP_NODE:()=>g,JS_TIME:()=>T,MAX_TIMER_BUDGET:()=>a,REMAINING:()=>f,SPA_NODE:()=>h,START:()=>w,originalSetTimeout:()=>y});var n=r(5763);const i=r(3325).D.spa,o=["click","submit","keypress","keydown","keyup","change"],a=999,s="fn-start",c="fn-end",u="cb-start",d="api-ixn-",f="remaining",l="interaction",h="spaNode",g="jsonpNode",p="fetch-start",m="fetch-done",v="fetch-body-",b="jsonp-end",y=n.Yu.ST,w="-start",x="-end",A="-body",E="cb"+x,T="jsTime",_="fetch"},5938:(e,t,r)=>{r.d(t,{W:()=>o});var n=r(5763),i=r(2177);class o{constructor(e,t,r){this.agentIdentifier=e,this.aggregator=t,this.ee=i.ee.get(e,(0,n.OP)(this.agentIdentifier).isolatedBacklog),this.featureName=r,this.blocked=!1}}},9144:(e,t,r)=>{r.d(t,{j:()=>m});var n=r(3325),i=r(5763),o=r(5546),a=r(2177),s=r(7894),c=r(8e3),u=r(3960),d=r(385),f=r(50),l=r(3081),h=r(8632);function g(){const e=(0,h.gG)();["setErrorHandler","finished","addToTrace","inlineHit","addRelease","addPageAction","setCurrentRouteName","setPageViewName","setCustomAttribute","interaction","noticeError","setUserId"].forEach((t=>{e[t]=function(){for(var r=arguments.length,n=new Array(r),i=0;i 1?r-1:0),i=1;i {e.exposed&&e.api[t]&&o.push(e.api[t](...n))})),o.length>1?o:o[0]}(t,...n)}}))}var p=r(2587);function m(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{},m=arguments.length>2?arguments[2]:void 0,v=arguments.length>3?arguments[3]:void 0,{init:b,info:y,loader_config:w,runtime:x={loaderType:m},exposed:A=!0}=t;const E=(0,h.gG)();y||(b=E.init,y=E.info,w=E.loader_config),(0,i.Dg)(e,b||{}),(0,i.GE)(e,w||{}),(0,i.sU)(e,x),y.jsAttributes??={},d.v6&&(y.jsAttributes.isWorker=!0),(0,i.CX)(e,y),g();const T=function(e,t){t||(0,c.R)(e,"api");const h={};var g=a.ee.get(e),p=g.get("tracer"),m="api-",v=m+"ixn-";function b(t,r,n,o){const a=(0,i.C5)(e);return null===r?delete a.jsAttributes[t]:(0,i.CX)(e,{...a,jsAttributes:{...a.jsAttributes,[t]:r}}),x(m,n,!0,o||null===r?"session":void 0)(t,r)}function y(){}["setErrorHandler","finished","addToTrace","inlineHit","addRelease"].forEach((e=>h[e]=x(m,e,!0,"api"))),h.addPageAction=x(m,"addPageAction",!0,n.D.pageAction),h.setCurrentRouteName=x(m,"routeName",!0,n.D.spa),h.setPageViewName=function(t,r){if("string"==typeof t)return"/"!==t.charAt(0)&&(t="/"+t),(0,i.OP)(e).customTransaction=(r||"http://custom.transaction")+t,x(m,"setPageViewName",!0)()},h.setCustomAttribute=function(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2];if("string"==typeof e){if(["string","number"].includes(typeof t)||null===t)return b(e,t,"setCustomAttribute",r);(0,f.Z)("Failed to execute setCustomAttribute.\nNon-null value must be a string or number type, but a type of was provided."))}else(0,f.Z)("Failed to execute setCustomAttribute.\nName must be a string type, but a type of was provided."))},h.setUserId=function(e){if("string"==typeof e||null===e)return b("enduser.id",e,"setUserId",!0);(0,f.Z)("Failed to execute setUserId.\nNon-null value must be a string type, but a type of was provided."))},h.interaction=function(){return(new y).get()};var w=y.prototype={createTracer:function(e,t){var r={},i=this,a="function"==typeof t;return(0,o.p)(v+"tracer",[(0,s.z)(),e,r],i,n.D.spa,g),function(){if(p.emit((a?"":"no-")+"fn-start",[(0,s.z)(),i,a],r),a)try{return t.apply(this,arguments)}catch(e){throw p.emit("fn-err",[arguments,this,"string"==typeof e?new Error(e):e],r),e}finally{p.emit("fn-end",[(0,s.z)()],r)}}}};function x(e,t,r,i){return function(){return(0,o.p)(l.xS,["API/"+t+"/called"],void 0,n.D.metrics,g),i&&(0,o.p)(e+t,[(0,s.z)(),...arguments],r?null:this,i,g),r?void 0:this}}function A(){r.e(439).then(r.bind(r,7438)).then((t=>{let{setAPI:r}=t;r(e),(0,c.L)(e,"api")})).catch((()=>(0,f.Z)("Downloading runtime APIs failed...")))}return["actionText","setName","setAttribute","save","ignore","onEnd","getContext","end","get"].forEach((e=>{w[e]=x(v,e,void 0,n.D.spa)})),h.noticeError=function(e,t){"string"==typeof e&&(e=new Error(e)),(0,o.p)(l.xS,["API/noticeError/called"],void 0,n.D.metrics,g),(0,o.p)("err",[e,(0,s.z)(),!1,t],void 0,n.D.jserrors,g)},d.il?(0,u.b)((()=>A()),!0):A(),h}(e,v);return(0,h.Qy)(e,T,"api"),(0,h.Qy)(e,A,"exposed"),(0,h.EZ)("activatedFeatures",p.T),T}},3325:(e,t,r)=>{r.d(t,{D:()=>n,p:()=>i});const n={ajax:"ajax",jserrors:"jserrors",metrics:"metrics",pageAction:"page_action",pageViewEvent:"page_view_event",pageViewTiming:"page_view_timing",sessionReplay:"session_replay",sessionTrace:"session_trace",spa:"spa"},i={[n.pageViewEvent]:1,[n.pageViewTiming]:2,[n.metrics]:3,[n.jserrors]:4,[n.ajax]:5,[n.sessionTrace]:6,[n.pageAction]:7,[n.spa]:8,[n.sessionReplay]:9}}},n={};function i(e){var t=n[e];if(void 0!==t)return t.exports;var o=n[e]={exports:{}};return r[e](o,o.exports,i),o.exports}i.m=r,i.d=(e,t)=>{for(var r in t)i.o(t,r)&&!i.o(e,r)&&Object.defineProperty(e,r,{enumerable:!0,get:t[r]})},i.f={},i.e=e=>Promise.all(Object.keys(i.f).reduce(((t,r)=>(i.f[r](e,t),t)),[])),i.u=e=>(({78:"page_action-aggregate",147:"metrics-aggregate",242:"session-manager",317:"jserrors-aggregate",348:"page_view_timing-aggregate",412:"lazy-feature-loader",439:"async-api",538:"recorder",590:"session_replay-aggregate",675:"compressor",733:"session_trace-aggregate",786:"page_view_event-aggregate",873:"spa-aggregate",898:"ajax-aggregate"}[e]||e)+"."+{78:"ac76d497",147:"3dc53903",148:"1a20d5fe",242:"2a64278a",317:"49e41428",348:"bd6de33a",412:"2f55ce66",439:"30bd804e",538:"1b18459f",590:"cf0efb30",675:"ae9f91a8",733:"83105561",786:"06482edd",860:"03a8b7a5",873:"e6b09d52",898:"998ef92b"}[e]+"-1.236.0.min.js"),i.o=(e,t)=>Object.prototype.hasOwnProperty.call(e,t),e={},t="NRBA:",i.l=(r,n,o,a)=>{if(e[r])e[r].push(n);else{var s,c;if(void 0!==o)for(var u=document.getElementsByTagName("script"),d=0;d {s.onerror=s.onload=null,clearTimeout(h);var i=e[r];if(delete e[r],s.parentNode&&s.parentNode.removeChild(s),i&&i.forEach((e=>e(n))),t)return t(n)},h=setTimeout(l.bind(null,void 0,{type:"timeout",target:s}),12e4);s.onerror=l.bind(null,s.onerror),s.onload=l.bind(null,s.onload),c&&document.head.appendChild(s)}},i.r=e=>{"undefined"!=typeof Symbol&&Symbol.toStringTag&&Object.defineProperty(e,Symbol.toStringTag,{value:"Module"}),Object.defineProperty(e,"__esModule",{value:!0})},i.j=364,i.p="https://js-agent.newrelic.com/",(()=>{var e={364:0,953:0};i.f.j=(t,r)=>{var n=i.o(e,t)?e[t]:void 0;if(0!==n)if(n)r.push(n[2]);else{var o=new Promise(((r,i)=>n=e[t]=[r,i]));r.push(n[2]=o);var a=i.p+i.u(t),s=new Error;i.l(a,(r=>{if(i.o(e,t)&&(0!==(n=e[t])&&(e[t]=void 0),n)){var o=r&&("load"===r.type?"missing":r.type),a=r&&r.target&&r.target.src;s.message="Loading chunk "+t+" failed.\n("+o+": "+a+")",s.name="ChunkLoadError",s.type=o,s.request=a,n[1](s)}}),"chunk-"+t,t)}};var t=(t,r)=>{var n,o,[a,s,c]=r,u=0;if(a.some((t=>0!==e[t]))){for(n in s)i.o(s,n)&&(i.m[n]=s[n]);if(c)c(i)}for(t&&t(r);u {i.r(o);var e=i(3325),t=i(5763);const r=Object.values(e.D);function n(e){const n={};return r.forEach((r=>{n[r]=function(e,r){return!1!==(0,t.Mt)(r,"".concat(e,".enabled"))}(r,e)})),n}var a=i(9144);var s=i(5546),c=i(385),u=i(8e3),d=i(5938),f=i(3960),l=i(50);class h extends d.W{constructor(e,t,r){let n=!(arguments.length>3&&void 0!==arguments[3])||arguments[3];super(e,t,r),this.auto=n,this.abortHandler,this.featAggregate,this.onAggregateImported,n&&(0,u.R)(e,r)}importAggregator(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{};if(this.featAggregate||!this.auto)return;const r=c.il&&!0===(0,t.Mt)(this.agentIdentifier,"privacy.cookies_enabled");let n;this.onAggregateImported=new Promise((e=>{n=e}));const o=async()=>{let t;try{if(r){const{setupAgentSession:e}=await Promise.all([i.e(860),i.e(242)]).then(i.bind(i,3228));t=e(this.agentIdentifier)}}catch(e){(0,l.Z)("A problem occurred when starting up session manager. This page will not start or extend any session.",e)}try{if(!this.shouldImportAgg(this.featureName,t))return void(0,u.L)(this.agentIdentifier,this.featureName);const{lazyFeatureLoader:r}=await i.e(412).then(i.bind(i,8582)),{Aggregate:o}=await r(this.featureName,"aggregate");this.featAggregate=new o(this.agentIdentifier,this.aggregator,e),n(!0)}catch(e){(0,l.Z)("Downloading and initializing ".concat(this.featureName," failed..."),e),this.abortHandler?.(),n(!1)}};c.il?(0,f.b)((()=>o()),!0):o()}shouldImportAgg(r,n){return r!==e.D.sessionReplay||!1!==(0,t.Mt)(this.agentIdentifier,"session_trace.enabled")&&(!!n?.isNew||!!n?.state.sessionReplay)}}var g=i(7633),p=i(7894);class m extends h{static featureName=g.t9;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];if(super(r,n,g.t9,i),("undefined"==typeof PerformanceNavigationTiming||c.Tt)&&"undefined"!=typeof PerformanceTiming){const n=(0,t.OP)(r);n[g.Dz]=Math.max(Date.now()-n.offset,0),(0,f.K)((()=>n[g.qw]=Math.max((0,p.z)()-n[g.Dz],0))),(0,f.b)((()=>{const t=(0,p.z)();n[g.OJ]=Math.max(t-n[g.Dz],0),(0,s.p)("timing",["load",t],void 0,e.D.pageViewTiming,this.ee)}))}this.importAggregator()}}var v=i(1117),b=i(1284);class y extends v.w{constructor(e){super(e),this.aggregatedData={}}store(e,t,r,n,i){var o=this.getBucket(e,t,r,i);return o.metrics=function(e,t){t||(t={count:0});return t.count+=1,(0,b.D)(e,(function(e,r){t[e]=w(r,t[e])})),t}(n,o.metrics),o}merge(e,t,r,n,i){var o=this.getBucket(e,t,n,i);if(o.metrics){var a=o.metrics;a.count+=r.count,(0,b.D)(r,(function(e,t){if("count"!==e){var n=a[e],i=r[e];i&&!i.c?a[e]=w(i.t,n):a[e]=function(e,t){if(!t)return e;t.c||(t=x(t.t));return t.min=Math.min(e.min,t.min),t.max=Math.max(e.max,t.max),t.t+=e.t,t.sos+=e.sos,t.c+=e.c,t}(i,a[e])}}))}else o.metrics=r}storeMetric(e,t,r,n){var i=this.getBucket(e,t,r);return i.stats=w(n,i.stats),i}getBucket(e,t,r,n){this.aggregatedData[e]||(this.aggregatedData[e]={});var i=this.aggregatedData[e][t];return i||(i=this.aggregatedData[e][t]={params:r||{}},n&&(i.custom=n)),i}get(e,t){return t?this.aggregatedData[e]&&this.aggregatedData[e][t]:this.aggregatedData[e]}take(e){for(var t={},r="",n=!1,i=0;i t.max&&(t.max=e),e 2&&void 0!==arguments[2])||arguments[2];super(e,r,j.t,n),c.il&&((0,t.OP)(e).initHidden=Boolean("hidden"===document.visibilityState),(0,N.N)((()=>(0,s.p)("docHidden",[(0,p.z)()],void 0,j.t,this.ee)),!0),(0,O.bP)("pagehide",(()=>(0,s.p)("winPagehide",[(0,p.z)()],void 0,j.t,this.ee))),this.importAggregator())}}var P=i(3081);class C extends h{static featureName=P.t9;constructor(e,t){let r=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(e,t,P.t9,r),this.importAggregator()}}var R,I=i(2210),k=i(1214),H=i(2177),L={};try{R=localStorage.getItem("__nr_flags").split(","),console&&"function"==typeof console.log&&(L.console=!0,-1!==R.indexOf("dev")&&(L.dev=!0),-1!==R.indexOf("nr_dev")&&(L.nrDev=!0))}catch(e){}function z(e){try{L.console&&z(e)}catch(e){}}L.nrDev&&H.ee.on("internal-error",(function(e){z(e.stack)})),L.dev&&H.ee.on("fn-err",(function(e,t,r){z(r.stack)})),L.dev&&(z("NR AGENT IN DEVELOPMENT MODE"),z("flags: "+(0,b.D)(L,(function(e,t){return e})).join(", ")));var M=i(6660);class B extends h{static featureName=M.t;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(r,n,M.t,i),this.skipNext=0;try{this.removeOnAbort=new AbortController}catch(e){}const o=this;o.ee.on("fn-start",(function(e,t,r){o.abortHandler&&(o.skipNext+=1)})),o.ee.on("fn-err",(function(t,r,n){o.abortHandler&&!n[M.A]&&((0,I.X)(n,M.A,(function(){return!0})),this.thrown=!0,(0,s.p)("err",[n,(0,p.z)()],void 0,e.D.jserrors,o.ee))})),o.ee.on("fn-end",(function(){o.abortHandler&&!this.thrown&&o.skipNext>0&&(o.skipNext-=1)})),o.ee.on("internal-error",(function(t){(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,o.ee)})),this.origOnerror=c._A.onerror,c._A.onerror=this.onerrorHandler.bind(this),c._A.addEventListener("unhandledrejection",(t=>{const r=function(e){let t="Unhandled Promise Rejection: ";if(e instanceof Error)try{return e.message=t+e.message,e}catch(t){return e}if(void 0===e)return new Error(t);try{return new Error(t+(0,D.P)(e))}catch(e){return new Error(t)}}(t.reason);(0,s.p)("err",[r,(0,p.z)(),!1,{unhandledPromiseRejection:1}],void 0,e.D.jserrors,this.ee)}),(0,O.m$)(!1,this.removeOnAbort?.signal)),(0,k.gy)(this.ee),(0,k.BV)(this.ee),(0,k.em)(this.ee),(0,t.OP)(r).xhrWrappable&&(0,k.Kf)(this.ee),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}onerrorHandler(t,r,n,i,o){"function"==typeof this.origOnerror&&this.origOnerror(...arguments);try{this.skipNext?this.skipNext-=1:(0,s.p)("err",[o||new F(t,r,n),(0,p.z)()],void 0,e.D.jserrors,this.ee)}catch(t){try{(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,this.ee)}catch(e){}}return!1}}function F(e,t,r){this.message=e||"Uncaught error with no additional information",this.sourceURL=t,this.line=r}let U=1;const q="nr@id";function G(e){const t=typeof e;return!e||"object"!==t&&"function"!==t?-1:e===c._A?0:(0,I.X)(e,q,(function(){return U++}))}function V(e){if("string"==typeof e&&e.length)return e.length;if("object"==typeof e){if("undefined"!=typeof ArrayBuffer&&e instanceof ArrayBuffer&&e.byteLength)return e.byteLength;if("undefined"!=typeof Blob&&e instanceof Blob&&e.size)return e.size;if(!("undefined"!=typeof FormData&&e instanceof FormData))try{return(0,D.P)(e).length}catch(e){return}}}var X=i(7243);class W{constructor(e){this.agentIdentifier=e,this.generateTracePayload=this.generateTracePayload.bind(this),this.shouldGenerateTrace=this.shouldGenerateTrace.bind(this)}generateTracePayload(e){if(!this.shouldGenerateTrace(e))return null;var r=(0,t.DL)(this.agentIdentifier);if(!r)return null;var n=(r.accountID||"").toString()||null,i=(r.agentID||"").toString()||null,o=(r.trustKey||"").toString()||null;if(!n||!i)return null;var a=(0,_.M)(),s=(0,_.Ht)(),c=Date.now(),u={spanId:a,traceId:s,timestamp:c};return(e.sameOrigin||this.isAllowedOrigin(e)&&this.useTraceContextHeadersForCors())&&(u.traceContextParentHeader=this.generateTraceContextParentHeader(a,s),u.traceContextStateHeader=this.generateTraceContextStateHeader(a,c,n,i,o)),(e.sameOrigin&&!this.excludeNewrelicHeader()||!e.sameOrigin&&this.isAllowedOrigin(e)&&this.useNewrelicHeaderForCors())&&(u.newrelicHeader=this.generateTraceHeader(a,s,c,n,i,o)),u}generateTraceContextParentHeader(e,t){return"00-"+t+"-"+e+"-01"}generateTraceContextStateHeader(e,t,r,n,i){return i+"@nr=0-1-"+r+"-"+n+"-"+e+"----"+t}generateTraceHeader(e,t,r,n,i,o){if(!("function"==typeof c._A?.btoa))return null;var a={v:[0,1],d:{ty:"Browser",ac:n,ap:i,id:e,tr:t,ti:r}};return o&&n!==o&&(a.d.tk=o),btoa((0,D.P)(a))}shouldGenerateTrace(e){return this.isDtEnabled()&&this.isAllowedOrigin(e)}isAllowedOrigin(e){var r=!1,n={};if((0,t.Mt)(this.agentIdentifier,"distributed_tracing")&&(n=(0,t.P_)(this.agentIdentifier).distributed_tracing),e.sameOrigin)r=!0;else if(n.allowed_origins instanceof Array)for(var i=0;i 2&&void 0!==arguments[2])||arguments[2];super(r,n,Z.t,i),(0,t.OP)(r).xhrWrappable&&(this.dt=new W(r),this.handler=(e,t,r,n)=>(0,s.p)(e,t,r,n,this.ee),(0,k.u5)(this.ee),(0,k.Kf)(this.ee),function(r,n,i,o){function a(e){var t=this;t.totalCbs=0,t.called=0,t.cbTime=0,t.end=E,t.ended=!1,t.xhrGuids={},t.lastSize=null,t.loadCaptureCalled=!1,t.params=this.params||{},t.metrics=this.metrics||{},e.addEventListener("load",(function(r){_(t,e)}),(0,O.m$)(!1)),c.IF||e.addEventListener("progress",(function(e){t.lastSize=e.loaded}),(0,O.m$)(!1))}function s(e){this.params={method:e[0]},T(this,e[1]),this.metrics={}}function u(e,n){var i=(0,t.DL)(r);i.xpid&&this.sameOrigin&&n.setRequestHeader("X-NewRelic-ID",i.xpid);var a=o.generateTracePayload(this.parsedOrigin);if(a){var s=!1;a.newrelicHeader&&(n.setRequestHeader("newrelic",a.newrelicHeader),s=!0),a.traceContextParentHeader&&(n.setRequestHeader("traceparent",a.traceContextParentHeader),a.traceContextStateHeader&&n.setRequestHeader("tracestate",a.traceContextStateHeader),s=!0),s&&(this.dt=a)}}function d(e,t){var r=this.metrics,i=e[0],o=this;if(r&&i){var a=V(i);a&&(r.txSize=a)}this.startTime=(0,p.z)(),this.listener=function(e){try{"abort"!==e.type||o.loadCaptureCalled||(o.params.aborted=!0),("load"!==e.type||o.called===o.totalCbs&&(o.onloadCalled||"function"!=typeof t.onload)&&"function"==typeof o.end)&&o.end(t)}catch(e){try{n.emit("internal-error",[e])}catch(e){}}};for(var s=0;s 1?e[1]=i:e.push(i)}else e[0]&&e[0].headers&&s(e[0].headers,n)&&(this.dt=n);function s(e,t){var r=!1;return t.newrelicHeader&&(e.set("newrelic",t.newrelicHeader),r=!0),t.traceContextParentHeader&&(e.set("traceparent",t.traceContextParentHeader),t.traceContextStateHeader&&e.set("tracestate",t.traceContextStateHeader),r=!0),r}}function x(e,t){this.params={},this.metrics={},this.startTime=(0,p.z)(),this.dt=t,e.length>=1&&(this.target=e[0]),e.length>=2&&(this.opts=e[1]);var r,n=this.opts||{},i=this.target;"string"==typeof i?r=i:"object"==typeof i&&i instanceof Y?r=i.url:c._A?.URL&&"object"==typeof i&&i instanceof URL&&(r=i.href),T(this,r);var o=(""+(i&&i instanceof Y&&i.method||n.method||"GET")).toUpperCase();this.params.method=o,this.txSize=V(n.body)||0}function A(t,r){var n;this.endTime=(0,p.z)(),this.params||(this.params={}),this.params.status=r?r.status:0,"string"==typeof this.rxSize&&this.rxSize.length>0&&(n=+this.rxSize);var o={txSize:this.txSize,rxSize:n,duration:(0,p.z)()-this.startTime};i("xhr",[this.params,o,this.startTime,this.endTime,"fetch"],this,e.D.ajax)}function E(t){var r=this.params,n=this.metrics;if(!this.ended){this.ended=!0;for(var o=0;o 2&&void 0!==arguments[2])||arguments[2];super(e,t,we.t,r),this.importAggregator()}}new class{constructor(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:(0,_.ky)(16);c._A?(this.agentIdentifier=t,this.sharedAggregator=new y({agentIdentifier:this.agentIdentifier}),this.features={},this.desiredFeatures=new Set(e.features||[]),this.desiredFeatures.add(m),Object.assign(this,(0,a.j)(this.agentIdentifier,e,e.loaderType||"agent")),this.start()):(0,l.Z)("Failed to initial the agent. Could not determine the runtime environment.")}get config(){return{info:(0,t.C5)(this.agentIdentifier),init:(0,t.P_)(this.agentIdentifier),loader_config:(0,t.DL)(this.agentIdentifier),runtime:(0,t.OP)(this.agentIdentifier)}}start(){const t="features";try{const r=n(this.agentIdentifier),i=[...this.desiredFeatures];i.sort(((t,r)=>e.p[t.featureName]-e.p[r.featureName])),i.forEach((t=>{if(r[t.featureName]||t.featureName===e.D.pageViewEvent){const n=function(t){switch(t){case e.D.ajax:return[e.D.jserrors];case e.D.sessionTrace:return[e.D.ajax,e.D.pageViewEvent];case e.D.sessionReplay:return[e.D.sessionTrace];case e.D.pageViewTiming:return[e.D.pageViewEvent];default:return[]}}(t.featureName);n.every((e=>r[e]))||(0,l.Z)("".concat(t.featureName," is enabled but one or more dependent features has been disabled (").concat((0,D.P)(n),"). This may cause unintended consequences or missing data...")),this.features[t.featureName]=new t(this.agentIdentifier,this.sharedAggregator)}})),(0,T.Qy)(this.agentIdentifier,this.features,t)}catch(e){(0,l.Z)("Failed to initialize all enabled instrument classes (agent aborted) -",e);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,T.fP)();return delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.[t],delete this.sharedAggregator,r.ee?.abort(),delete r.ee?.get(this.agentIdentifier),!1}}}({features:[J,m,S,class extends h{static featureName=oe;constructor(t,r){if(super(t,r,oe,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;const n=this.ee;let i;(0,k.QU)(n),this.eventsEE=(0,k.em)(n),this.eventsEE.on(se,(function(e,t){this.bstStart=(0,p.z)()})),this.eventsEE.on(ae,(function(t,r){(0,s.p)("bst",[t[0],r,this.bstStart,(0,p.z)()],void 0,e.D.sessionTrace,n)})),n.on(ce+ne,(function(e){this.time=(0,p.z)(),this.startPath=location.pathname+location.hash})),n.on(ce+ie,(function(t){(0,s.p)("bstHist",[location.pathname+location.hash,this.startPath,this.time],void 0,e.D.sessionTrace,n)}));try{i=new PerformanceObserver((t=>{const r=t.getEntries();(0,s.p)(te,[r],void 0,e.D.sessionTrace,n)})),i.observe({type:re,buffered:!0})}catch(e){}this.importAggregator({resourceObserver:i})}},C,xe,B,class extends h{static featureName=de;constructor(e,r){if(super(e,r,de,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;if(!(0,t.OP)(e).xhrWrappable)return;try{this.removeOnAbort=new AbortController}catch(e){}let n,i=0;const o=this.ee.get("tracer"),a=(0,k._L)(this.ee),s=(0,k.Lg)(this.ee),u=(0,k.BV)(this.ee),d=(0,k.Kf)(this.ee),f=this.ee.get("events"),l=(0,k.u5)(this.ee),h=(0,k.QU)(this.ee),g=(0,k.Gm)(this.ee);function m(e,t){h.emit("newURL",[""+window.location,t])}function v(){i++,n=window.location.hash,this[ve]=(0,p.z)()}function b(){i--,window.location.hash!==n&&m(0,!0);var e=(0,p.z)();this[pe]=~~this[pe]+e-this[ve],this[ye]=e}function y(e,t){e.on(t,(function(){this[t]=(0,p.z)()}))}this.ee.on(ve,v),s.on(be,v),a.on(be,v),this.ee.on(ye,b),s.on(ge,b),a.on(ge,b),this.ee.buffer([ve,ye,"xhr-resolved"],this.featureName),f.buffer([ve],this.featureName),u.buffer(["setTimeout"+le,"clearTimeout"+fe,ve],this.featureName),d.buffer([ve,"new-xhr","send-xhr"+fe],this.featureName),l.buffer([me+fe,me+"-done",me+he+fe,me+he+le],this.featureName),h.buffer(["newURL"],this.featureName),g.buffer([ve],this.featureName),s.buffer(["propagate",be,ge,"executor-err","resolve"+fe],this.featureName),o.buffer([ve,"no-"+ve],this.featureName),a.buffer(["new-jsonp","cb-start","jsonp-error","jsonp-end"],this.featureName),y(l,me+fe),y(l,me+"-done"),y(a,"new-jsonp"),y(a,"jsonp-end"),y(a,"cb-start"),h.on("pushState-end",m),h.on("replaceState-end",m),window.addEventListener("hashchange",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("load",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("popstate",(function(){m(0,i>1)}),(0,O.m$)(!0,this.removeOnAbort?.signal)),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}],loaderType:"spa"})})(),window.NRBA=o})(); window.jQuery || document.write(' ') CKEDITOR_BASEPATH='https://f1000research.com/js/vendor/ckeditor/' window.reactTheme = 'research'; window.MathJax = { CommonHTML: { linebreaks: { automatic: true } }, 'HTML-CSS': { linebreaks: { automatic: true } }, SVG: { linebreaks: { automatic: true } }, AuthorInit: function() { MathJax.Hub.Register.MessageHook('End Process', function () { let timeout = false; // holder for timeout id const delay = 250; // delay after event is "complete" to run callback const reflowMath = function() { const dispFormulas = document.querySelectorAll('.disp-formula.panel'); if (!dispFormulas) { return; } for (const dispFormula of dispFormulas) { const child = dispFormula.querySelector('.MathJax_Preview').nextSibling.firstChild; const isMultiline = MathJax.Hub.getAllJax(dispFormula)[0].root.isMultiline; if (dispFormula.offsetWidth < child.offsetWidth || isMultiline) { MathJax.Hub.Queue(['Rerender', MathJax.Hub, dispFormula]); } } }; window.addEventListener('resize', function() { clearTimeout(timeout); // clear the timeout timeout = setTimeout(reflowMath, delay); // start timing for event "completion" }); }); }, }; if (window.location.hash == '#_=_'){ window.location = window.location.href.split('#')[0] } !function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function() {n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', "PixelInitialized", {}); (function(h,o,t,j,a,r){ h.hj=h.hj||function(){(h.hj.q=h.hj.q||[]).push(arguments)}; h._hjSettings={hjid:2318163,hjsv:6}; a=o.getElementsByTagName('head')[0]; r=o.createElement('script');r.async=1; r.src=t+h._hjSettings.hjid+j+h._hjSettings.hjsv; a.appendChild(r); })(window,document,'https://static.hotjar.com/c/hotjar-','.js?sv='); search file_upload Submit your research search menu close search Browse Gateways & Collections How to Publish Submit your Research My Submissions Article Guidelines Article Guidelines (New Versions) Open Data, Software and Code Guidelines Open Data and Accessible Source Materials Guidelines (HSS) Open Data, Software and Code Guidelines (PSE) Prepublication Checks Production Process Posters and Slides Guidelines Document Guidelines Article Processing Charges Peer Review Finding Article Reviewers About How it Works For Reviewers Our Advisors Policies Glossary FAQs For Developers Newsroom Contact My Research Submissions Content and Tracking Alerts My Details Sign In file_upload Submit your research { "@context": "https://schema.org", "@type": "ScholarlyArticle", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://f1000research.com/articles/14-15" }, "headline": "Concurrent stunting among under-five children in Egypt", "datePublished": "2025-01-03T08:55:35", "dateModified": "2025-05-20T16:03:33", "author": [ { "@type": "Person", "name": "Nagwa Farag Elmighrabi" }, { "@type": "Person", "name": "Catharine A. K. Fleming" }, { "@type": "Person", "name": "Kingsley E. Agho" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background Globally, stunting remains a significant public health challenge, particularly in low- and middle-income countries. In Egypt, it affects approximately 33% of children under five and contributes to a 2–3% reduction in the country’s gross domestic product. Therefore, this study examined the trends in the prevalence of stunting and its associated factors among children under five and 0-59 months in Egypt. Methods This survey used combined data from the 2005, 2008, and 2014 Egypt Demographic and Health Surveys (EDHS), with a total sample of 39,857 children aged 0-59 months. A multilevel logistic regression that adjusts for sampling weights and clustering was performed to analyse the factors associated with stunting among children in Egypt. Results The prevalence of stunting was 24.8% in children aged 0-23 months, 24.3% in children aged 24-59 months, and 24.5 % in children aged 0-59 months. After controlling for potential confounders, the common factors associated with stunting in three age groups were mothers with primary education and mothers who did not have an antenatal care (ANC) visit during pregnancy. Maternal short stature (height < 155 cm) was associated with an increased risk of stunting in three age groups compared to mothers taller than 160 cm. Conclusion A coordinated approach across health, WASH, education, and social protection is essential to address stunting in Egypt. Interventions should target high-risk groups, particularly those with low socioeconomic status, focusing on healthcare access, parental education, and infant feeding practices. While short maternal height increases risk, interventions must also tackle broader factors like food security and sanitation. A nutrition monitoring framework integrated into health systems will enable data collection, evidence-based actions, and progress tracking. Effective implementation requires cost-effective, scalable solutions, community involvement, and resource prioritisation to ensure sustainability and equity. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-15/v3", "name": "Concurrent stunting among under-five children in Egypt" } } ] } Home Browse Concurrent stunting among under-five children in Egypt ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Elmighrabi NF, Fleming CAK and Agho KE. Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.12688/f1000research.159168.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] Nagwa Farag Elmighrabi https://orcid.org/0000-0002-0482-4352 1,2 , Catharine A. K. Fleming 2,3 , Kingsley E. Agho 2-4 Nagwa Farag Elmighrabi https://orcid.org/0000-0002-0482-4352 1,2 , Catharine A. K. Fleming 2,3 , Kingsley E. Agho 2-4 PUBLISHED 20 May 2025 Author details Author details 1 Department of Nutrition, Faculty of Public Health, University of Benghazi Faculty of Medicine, Benghazi, Benghazi district, Libya 2 School of Health sciences, Western Sydney University - Campbelltown Campus, Campbelltown, New South Wales, 2560, Australia 3 Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, South Penrith, New South Wales, 2750, Australia 4 Faculty of Health Sciences, University of Johannesburg, Johannesburg, 2094, South Africa Nagwa Farag Elmighrabi Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Software, Validation, Visualization, Writing – Original Draft Preparation Catharine A. K. Fleming Roles: Conceptualization, Investigation, Project Administration, Supervision, Validation, Writing – Review & Editing Kingsley E. Agho Roles: Conceptualization, Investigation, Methodology, Project Administration, Software, Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Global Public Health gateway. Abstract Background Globally, stunting remains a significant public health challenge, particularly in low- and middle-income countries. In Egypt, it affects approximately 33% of children under five and contributes to a 2–3% reduction in the country’s gross domestic product. Therefore, this study examined the trends in the prevalence of stunting and its associated factors among children under five and 0-59 months in Egypt. Methods This survey used combined data from the 2005, 2008, and 2014 Egypt Demographic and Health Surveys (EDHS), with a total sample of 39,857 children aged 0-59 months. A multilevel logistic regression that adjusts for sampling weights and clustering was performed to analyse the factors associated with stunting among children in Egypt. Results The prevalence of stunting was 24.8% in children aged 0-23 months, 24.3% in children aged 24-59 months, and 24.5 % in children aged 0-59 months. After controlling for potential confounders, the common factors associated with stunting in three age groups were mothers with primary education and mothers who did not have an antenatal care (ANC) visit during pregnancy. Maternal short stature (height < 155 cm) was associated with an increased risk of stunting in three age groups compared to mothers taller than 160 cm. Conclusion A coordinated approach across health, WASH, education, and social protection is essential to address stunting in Egypt. Interventions should target high-risk groups, particularly those with low socioeconomic status, focusing on healthcare access, parental education, and infant feeding practices. While short maternal height increases risk, interventions must also tackle broader factors like food security and sanitation. A nutrition monitoring framework integrated into health systems will enable data collection, evidence-based actions, and progress tracking. Effective implementation requires cost-effective, scalable solutions, community involvement, and resource prioritisation to ensure sustainability and equity. READ ALL READ LESS Keywords Undernutrition, childhood, 0-59 months, Growth defect, North Africa Corresponding Author(s) Nagwa Farag Elmighrabi ( [email protected] ) Close Corresponding author: Nagwa Farag Elmighrabi Competing interests: No competing interests were disclosed. Grant information: This article is supported by Western Sydney University The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Elmighrabi NF et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Elmighrabi NF, Fleming CAK and Agho KE. Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.12688/f1000research.159168.3 ) First published: 03 Jan 2025, 14 :15 ( https://doi.org/10.12688/f1000research.159168.1 ) Latest published: 20 May 2025, 14 :15 ( https://doi.org/10.12688/f1000research.159168.3 ) Revised Amendments from Version 2 The most important updates include the identification of inadequate use of vitamin A supplements as a factor associated with stunting, as presented in the results in the final table. Relevant results throughout the manuscript have been reviewed and updated accordingly. Furthermore, additional discussion has been included to explain the rise in stunting observed in Egypt in 2008, as well as the finding that children from middle-income households were less likely to be stunted. The most important updates include the identification of inadequate use of vitamin A supplements as a factor associated with stunting, as presented in the results in the final table. Relevant results throughout the manuscript have been reviewed and updated accordingly. Furthermore, additional discussion has been included to explain the rise in stunting observed in Egypt in 2008, as well as the finding that children from middle-income households were less likely to be stunted. See the authors' detailed response to the review by Godana Arero Dassie See the authors' detailed response to the review by Arlette Suzy Setiawan READ REVIEWER RESPONSES Introduction Undernutrition is a significant predictor of poor growth and morbidity in infants and young children. 1 Globally, stunting (low height for age) affects 150 million children under the age of five, a substantial portion of the world’s young population. 1 Previous studies have shown that stunting can result in delayed cognitive development, poor school performance, and ultimately lower future earning potential, perpetuating poverty. 2 , 3 The consequences, of stunting particularly in low- and middle-income countries, are far-reaching, leading to impaired growth, reduced educational attainment, delayed school enrolment, and a 20% reduction in adult income. 4 – 6 Reducing undernutrition among young children is one of the targets of the Sustainable Development Goal aimed at eradicating extreme poverty and zero hunger. It is also an important strategy to reduce child mortality, the fourth SDG. 7 In Egypt, approximately one-third of children under the age of five are affected by stunting. 8 , 9 With one in every five children in Egypt stunted, the country ranks among those with the second highest rates of stunting in the North African region. 9 – 11 In 2013, the economic and social cost of child undernutrition in Egypt was substantial, estimated to be 20.3 billion Egyptian Pounds, equivalent to about 2% of the Egyptian GDP. 12 Therefore, addressing undernutrition is important not only for public health, but also for enhancing the country long-term economic growth and social stability. Economic growth is an effective instrument for poverty alleviation and improving public health. 13 – 15 In response to the need for improved undernutrition in Egypt, several initiatives and programs were developed to address this issue, especially among vulnerable populations such as children and women. 16 These initiatives include the National Nutrition Strategy (2017-2030), Food Subsidy Programs, akamol and Karama Programs, the Scaling Up Nutrition (SUN) Movement, Micronutrient Supplementation, and collaborations with international organisations. 16 Undernutrition problem still prevalent and the challenges are further exacerbated by high unemployment rates, poverty, inequality, civil unrest, and climate change-induced natural disasters, all threatening food security and individuals’ nutritional status. 17 – 20 There have been several past studies assessing child stunting in Egypt. 10 , 21 , 22 For instance, one study examined the prevalence and factors associated with stunting among pre-school children (6-24 months) in Minia city in Upper Egypt and found that low birth weight of children, short stature of the mothers (≤160 cm) and low maternal education were associated with stunting 21 and similarly, a study conducted in Sohag, Egypt on stunting in schoolchildren found low maternal body mass index and familial short stature was the key drivers of stunting. 22 A population based cross-sectional studies conducted in Upper and Lower Egypt found that stunting peaked at 12–23 months. 10 However, these studies were limited in scope as it covered a smaller section in Egypt, children aged, 6-23 months 21 and 4-12 years (school age) in just two schools in one governorate. 22 Another past study assessed a cross-country study by Pritchett and Summers 13 used time series data and instrumental variables to demonstrate that as national income increases, population health tends to improve, and conversely, wealthier countries tend to have better health outcomes. Despite significant efforts to address the problem of stunting in Egypt, several factors may contribute to the current situation. Factors include the lack of up-to-date nutritional data, inadequate training for healthcare professionals, a focus on treatment over prevention, and limited studies on ecological factors associated with nutritional issues. 23 Therefore, this study aimed to investigate stunting among children aged 0-23, 24-59 and 0-59 months in Egypt and explore associated factors by pooling the 2005, 2008, and 2014 EDHS. The study will contribute to the growing body of evidence that informs national government institutions, public health researchers, and policymakers working to address the underlying factors associated with child stunting in Egypt. It stands out from previous research on stunting among children in Egypt due to its unique focus on combining data sets from 2005 to 2014. The study utilises population-based national representative data and provides age-specific results by examining the prevalence of stunting in three age groups: 0-23 months, 24-59 months, and 0-59 months across the three-survey data. Method Data source Analysis utilised data from the EDHS conducted in 2005, 2008, and 2014. The surveys were implemented by El-Zanaty and Associates on behalf of the Ministry of Health and Population and the National Population Council, as part of the global MEASURE DHS project funded by the United States Agency for International Development (USAID). The 2005, 2008, and 2014 EDHS received primary funding from USAID/Cairo, with additional support from UNICEF and the United Nations Population Fund (UNFPA). The datasets were downloaded from www.dhsprogram.com after completing the registration process. Study area Administratively, Egypt is divided into 26 governorates and Luxor City. The four Urban Governorates (Cairo, Alexandria, Port Said, and Suez) have no rural population. Each of the other 22 governorates is subdivided into urban and rural areas. Nine of these governorates are located in the Nile Delta (Lower Egypt), eight are located in the Nile Valley (Upper Egypt), and the remaining five Frontier Governorates are located on the eastern and western boundaries of Egypt. 24 Sample selection This study analysed data from the EDHS for 2005 (n=13,599), 2008 (n=10,590), and 2014 (n=15,668), focusing on children aged 0-59 months. The sample design was multistage sampling design enabled the estimation of key population and health indicators, including fertility and mortality rates, for Egypt, six major regions, and individual governorates. The sample size was disproportionately distributed throughout these areas to provide for regional and governorate-level estimates. The EDHS sample was chosen using a three-stage approach. Initially, primary sampling units (PSUs), which included shiakhas/towns in urban areas and villages in rural areas, were chosen from a list drawn from the 1996 census and then updated to August 2004 for the 2005 survey and to 2006 for both the 2008 and 2014 surveys. The units were geographically stratified, with smaller units merging to form larger units with a population of at least 5,000. During the second stage, complete maps of the selected primary sampling units (PSUs) were used to divide them into groups of about 5,000 people. A fast enumeration was used to assess household quantities, followed by a quality assurance verification in 10% of the regions. A systematic random sample of households was eventually selected. The survey covered all ever-married women aged 15 to 49 who lived or were present in the sampling households the night before the interview. Outcome variable The outcome variable for this study was stunting, which was determined by the height-for-age Z-score (HAZ). Children whose height-for-age is less than -2 standard deviations from the corresponding reference median (Z score ≤ -2) were categorised as stunted. Stunting is an indicator of linear growth retardation and reflects cumulative growth deficits in a child. The HAZ is calculated based on the 2006 WHO growth reference, which compares a child’s height to the median height of a healthy child in the same age group or reference population. 25 It is expressed in terms of the number of standard deviations (SD) above or below the median height. 25 Potential covariates The UNICEF conceptual framework of the determinants of nutritional status for mother and child health 26 guided the selection of covariate variables, with adjustments based on a previous study conducted in 35 low- and middle-income countries. 27 The covariates were categorised into three major categories. Basic factors include governance, resources, and norms area of residence (urban/rural), region (Urban governates, Urban (lower Egypt), Rural (Lower Egypt), Urban (Upper Egypt), Rural (Upper Egypt) and Frontier Governates). Underlying factors include socioeconomic factors (household wealth quantile, child’s sex, child’s age, maternal age, father age, maternal age at childbirth, age at first cohabitation/married, mother and father level of education, mother work in the last 12 months, father occupation, maternal marital status, religion, household members, number of children < 5 and combined birth rank and birth interval), mother’s health (mother height, maternal body mass index (BMI), maternal autonomy (money, care and movement), health care services factors (combined Place of birth and mode of delivery, delivery assistants, number of ANC visits and postnatal checkup, recent vitamin A supplement, ever had vaccination) and household environmental factors (sources of drinking water, stool disposal, and toilet facility and access to media). Immediate factors include child health (perceived child size at birth, diarrhoea, fever and cough) and breastfeeding practices (early initiation of breastfeeding and duration of breastfeeding). Multiple previous studies have consistently highlighted the relationship between these factors and child anthropometric failure. Previous studies have identified a significant association between child anthropometric failures and factors such as household wealth index, 11 , 28 – 32 child age and gender, 11 , 31 , 33 maternal nutritional health, 11 , 21 , 29 , 31 , 32 , 34 maternal reproductive care, 28 , 35 family desired birth spacing, 11 , 31 and household environment 28 – 33 When considering household income and expenses, the “Household Wealth Quantile” serves as a quantitative indicator of a household’s financial status. The Principal Components Analysis (PCA) approach establishes the quantitative representation of household assets. A score was assigned to every authorised household member once this calculation was performed, in order to ascertain their position in the population. This study classified wealth into five categories at the national level: poorest, poorer, middle, fourth, and richest. The lowest 40% of households consisted of the poorest and poorest households, followed by the middle-class households comprising the next 20%, and the top 40% constituted the fourth and richest households. 27 Some covariate factors (combined Place of birth and mode of delivery, combined birth rank and birth interval) were grouped together due to the significant associations between them, as identified and applied in previous research studies. 36 , 37 Statistical analysis In our analysis, we examined factors associated with stunting from each EDHS 2005,2008 and 2014 surveys to determine the strength of the association of each characteristic in relation to the likelihood of stunting in Egypt. The outcome variable for the final logistic regression models is the presence or absence of stunting (Y = 1 = stunted, 0 = not stunted). For each survey, frequency was used to describe the characteristics of the study population and to estimate the prevalence of stunting. The chi-square test was used for categorical variables. Univariate analyses were used to examine distributions and normality of continuous predictors. Bivariate analyses were performed using Pearson’s chi-square, to test differences in frequencies of categorical variables and t-tests for differences in means of continuous variables. Variables found to be significant at the p < 0.05 were included in the final multivariable analysis models. All statistical analyses were carried out using STATA/MP Version.17.0 (Stata Corp, College Station, TX, USA), ( https://blog.stata.com/2021/04/20/stata-17-released/ ), and adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) obtained from the adjusted multivariate regression were used to measure the factors associated with child stunting. The prevalence of stunting was estimated in each survey. A total prevalence estimate (unweighted by year of the survey) was also generated for each year. Results Characteristics of the sample The current study involved 39,857 children aged under five years: 13,599 from the 2005 EDHS, 10,590 from the 2008 EDHS and 15668 from the 2014 EDHS. The basic characteristics of the samples in three surveys are displayed in Table S1 (Extended Data). More than one half of the children in each survey lived in rural areas (64%, 63% and 69% in 2005 EDHS, 2008 EDHS and 2014 EDHS respectively). Across the three surveys, the minority of children were from the poorest households, and the ratio of males to girls was almost the same. More than one half of the mothers were aged between 25 and 34 years, while the majority of fathers were aged 18-34 years across the three surveys. Other variables which were in the majority across the three surveys included: married mothers, parents with secondary education, non-working mothers, fathers working in non-agricultural sector, mothers who had money, movement and healthcare autonomy, who were Muslim, who had BMI > 25 who listened to the radio, watched the television and never read any newspaper or magazine, who attended more than 8 ANC clinics, who were delivered by health professionals, who put their babies to the breast within one hour of delivery and who breastfed their babies for more than 12 months; households with members between 5 and 10, having between 2 and 3 children being aged under 5 years, having access to protected water source, with safe stool disposal and improved toilet facility; and children who were not given vitamin A supplement medication and who had not contracted diarrhoea, fever and cough in the two weeks prior to the survey. Prevalence of stunting The difference in the prevalence of stunting among children aged 0-23 months in Egypt, based on surveys conducted in 2005, 2008, and 2014 is illustrated in Figure 1 . Compared to 2005, the prevalence of stunting among young children in Egypt has significantly decreased from 27.6% to 20.8% in 2014 with overall prevalence 24.8 %. For older children 24-59 months, the difference in the stunting rates in Egypt is shown in Figure 2 . The prevalence of stunting among children aged 24-59 months in Egypt was a slightly decreased from 22.5% in 2005 to 21.9% in 2014, with an overall prevalence of 24.3%. Nonetheless, the occurrence of stunting in the same age group experienced a substantial rise from 22.5% in 2005 to 30.4% in 2008. The variation in stunting rates among children aged 0-59 months in Egypt, as observed in surveys conducted in 2005, 2008, and 2014, are illustrated in Figure 3 . The prevalence of child stunting in Egypt slightly declined from 24.6% in 2005 to 21.5% in 2014 but remained high at 24.5% overall. However, the prevalence of stunting among the same age group significantly increased from 24.6% in 2005 to 28.9% in 2008. Stunting is prevalent among children under five in Egypt with 1 in each 4 children expected to be stunted. Figure 1. Prevalence and 95% CIs of stunting among children aged (0–23) in Egypt. Figure 2. Prevalence and 95% CIs of stunting among children aged (24–59) in Egypt. Figure 3. Prevalence and 95% CIs of stunting among children aged (0–59) in Egypt. Prevalence of stunting by factors Table 1 presents the prevalence of stunting among Egyptian children aged 0-23 months, 24-59 months, and 0-59 months, in relation to the fundamental, underlying, and immediate variables. Stunted children across all three age groups (0-23 months, 24-59 months, and 0-59 months) were more prevalent among those residing in rural upper Egypt, hailing from low-income families, having mothers under 18 years of age, being the fourth child in birth order, having mothers with limited media exposure (minimal listening and viewing), being born at home via non-cesarean delivery, lacking maternal ANC visits, and having mothers who are illiterate. For detailed information regarding the prevalence of stunting within certain age groups (0-23, 24-59, and 0-59 months) based on the three primary categorical factors, refer to supplementary Table S2 (Extended Data). Table 1. Prevalence of stunting among children (0-23, 24-59 and 0-59 months) in Egypt by the basic, underlying and immediate factors. Variables Children (0-23 months) stunting +ve prevalence Children (24-59 months) stunting +ve prevalence Children (0-59 months) stunting +ve prevalence Basic factors Area of residence Urban 25.7 [24.1,27.5] 22.7 [21.1,24.4] 24.0 [22.6,25.3] Rural 24.4 [23.1,25.7] 25.1 [23.8,26.5] * 24.8 [23.7,25.9] Region Urban Governates 23.0 [20.6,25.6] 19.8 [17.5,22.2] 21.1 [19.3,23.1] Urban (lower Egypt) 29.1 [25.5,33.0] 23.6 [20.6,26.8] 25.8 [23.3,28.6] Rural (Lower Egypt) 21.8 [19.9,23.7] 21.7 [19.9,23.7] 21.7 [20.1,23.4] Urban (Upper Egypt) 26.0 [23.0,29.2] 25.6 [22.7,28.9] 25.8[23.1,28.6] Rural (Upper Egypt) 27.3 [25.5,29.1] *** 28.9 [27.1,30.8] *** 28.2 [26.7,29.9] *** Frontier Governates 25.4 [21.7,29.5] 16.7 [13.1,20.9] 20.2 [17.2,23.7] Underlying factors Socioeconomic factors Wealth Index Richest 25.1 [23.1,27.2] 22.0 [20.1,24.0] 23.3 [21.8,24.9] Fourth 24.0 [22.1,26.0] 22.4 [20.7,24.3] 23.1 [21.7,24.6] Middle 22.1 [20.2,24.1] 21.3 [19.5,23.2] 21.6 [20.1,23.2] Second 26.3 [24.3,28.5] 26.0 [24.0,28.1] 26.1 [24.5,27.9] Poorest 27.4 [25.3,29.7] ** 30.4 [28.6,32.4] *** 29.2 [27.8,30.8] *** Sex of baby Boy 27.9 [26.5,29.3] *** 24.9 [23.6,26.1] 26.1 [25.1,27.2] *** Girl 21.6 [20.4,22.9] 23.7[22.5,24.9] 22.8 [21.9,23.8] Child age (months) 0-5 21.5 [19.6,23.6] 21.5 [19.6,23.6] 6-11 22.3 [20.7,24.0] 22.3 [20.7,24.0] 12-17 24.3 [22.6,26.1] 24.3 [22.6,26.1] 18-23 31.0 [29.1,32.9] *** 31.0 [29.1,32.9] *** 24-29 26.9 [25.1,28.7] 26.9 [25.1,28.7] 30-35 27.8 [25.9,29.7] *** 27.8 [25.9,29.7] 36-41 25.6 [23.7,27.6] 25.6 [23.7,27.6] 42-47 24.0 [22.2,25.9] 24.0 [22.2,25.9] 48-53 18.9 [17.3,20.7] 18.9 [17.3,20.7] 54-59 21.7 [19.9,23.7] 21.7 [19.9,23.7] Mother's age (years) 15-24 26.0 [24.5,27.6] * 25.9 [24.1,27.8] 26.0 [24.7,27.3] ** 25-34 23.8 [22.6,25.1] 24.1 [22.9,25.3] 24.0 [23.0,25.0] 35-49 25.5 [23.1,28.0] 23.3 [21.7,25.0] 23.9 [22.5,25.4] Father’s age (years) 18-34 25.0 [23.8,26.3] 25.6 [24.2,27.0] ** 25.3 [24.3,26.4] 35-44 24.2 [22.8,25.7] 23.3 [22.1,24.5] 23.6 [22.6,24.7] 45+ 25.8 [22.9,29.0] ** 22.6 [20.7,24.6] 23.5 [21.9,25.2] Maternal age at childbirth (years) Less than 20 28.2 [25.6,31.0] 26.5 [24.2,28.9] 27.2 [25.3,29.1] ** 20-29 24.7 [23.6,25.9] 24.1 [22.9,25.3] 24.4 [23.4,25.3] 30-39 23.2 [21.5,25.0] 23.9 [22.4,25.6] 23.6 [22.4,24.9] 40+ 29.8 [23.9,36.6] ** 22.0 [17.8,27.0] 25.0 [21.3,29.1] Mother's marital status Married 24.7 [23.7,25.7] 24.4 [23.3,25.4] * 24.5 [23.6,25.4] Not married 38.6 [29.2,49.1] ** 19.5 [15.5,24.3] 25.2 [21.2,29.7] Age at first cohabitation/married 18 years 24.2 [23.0,25.3] 23.1 [22.0,24.3] 23.6 [22.6,24.5] Maternal education Higher 21.6 [19.4,24.0] 22.3 [20.2,24.7] 22.0 [20.3,23.8] Secondary 23.7 [22.4,25.0] 22.0 [20.8,23.2] 22.7 [21.7,23.7] Primary 29.3 [26.4,32.3] *** 27.0 [24.5,29.7] 27.9 [25.8,30.1] No education 27.6 [25.6,29.6] 28.4 [26.7,30.1] *** 28.1 [26.6,29.6] *** Father education Higher 22.3 [20.2,24.5] 21.2 [19.3,23.3] 21.7 [20.1,23.3] Secondary 24.1 [22.8,25.4] 23.1 [21.9,24.4] 23.5 [22.5,24.6] Primary 29.0 [26.7,31.3] *** 26.8 [24.8,28.9] 27.6 [26.1,29.3] *** No education 26.2 [23.9,28.6] 28.1 [26.1,30.3] *** 27.4 [25.7,29.2] Worked in the last 12 months Non-working 24.6 [23.5,25.7] 24.1 [23.0,25.2] 24.3 [23.4,25.2] * Working 26.5 [24.1,29.1] 25.5 [23.5,27.6] 25.9 [24.2,27.6] Husband's occupation Non agriculture 24.7 [23.6,25.8] 23.7 [22.6,24.8] 24.1 [23.2,25.0] Agriculture 25.4 [23.2,27.7] 27.6 [25.6,29.7] *** 26.7 [25.0,28.4] ** Not working 24.6 [19.5,30.7] 25.1 [20.0,31.1] 24.9 [21.0,29.4] Religion Muslim 24.8 [23.8,25.9] 24.1 [23.1,25.2] 24.4 [23.5,25.3] Christian 25.6 [21.5,30.1] 28.0 [24.4,31.9] ** 27.0 [24.2,30.2] Household members 2-4 24.1 [22.7,25.5] 22.7 [21.3,24.2] 23.3 [22.2,24.5] 5-10 25.0 [23.7,26.3] 24.7 [23.5,25.9] 24.8 [23.8,25.8] >10 27.8 [24.3,31.7] 27.7 [24.3,31.5] ** 27.8 [24.7,31.0] ** Number of children under 5 None 23.9 [22.5,25.4] 22.6 [21.3,23.9] 23.1 [22.1,24.2] 1 23.0 [19.5,26.9] 24.3 [20.4,28.6] 23.6 [20.8,26.6] 2-3 children 25.5 [24.2,26.9] 24.9 [23.7,26.2] 25.2 [24.1,26.3] 4+ 26.2 [22.3,30.6] 29.9 [25.5,34.7] *** 28.4 [24.9,32.2] ** Combined birth rank and birth interval 1st birth 24.5 [23.0,26.0] 22.7 [21.3,24.1] 23.4 [22.3,24.6] 2nd/3 rd /interval >2 23.7 [22.4,25.0] 23.6 [22.4,24.9] 23.6 [22.6,24.7] 2nd/3 rd /interval 2 26.8 [24.0,29.7] ** 27.0 [24.8,29.3] *** 26.9 [25.1,28.8] 4th birth/interval <2 26.6 [20.9,33.2] 33.1 [28.6,38.1] 30.7 [26.8,34.9] *** Literacy Cannot read 28.4 [26.5,30.3] *** 28.8 [27.2,30.5] *** 28.6 [27.3,30.1] *** Read par 23.6 [22.5,24.8] 22.3 [21.2,23.5] 22.9 [21.9,23.8] Mother health and autonomy Mother's height (cm) >160 22.2 [20.9,23.7] 21.1 [19.8,22.6] 21.6 [20.5,22.7] 155-159 24.6 [23.1,26.1] 24.8 [23.4,26.3] 24.7 [23.6,25.9] 150-154 28.2 [26.1,30.3] 28.5 [26.7,30.4] 28.4 [26.9,29.9] 145-149 36.3 [32.2,40.6] 32.3 [28.8,36.1] 34.0 [31.1,37.0] <145 42.1 [31.2,53.9] *** 46.3 [37.1,55.8] *** 44.5 [36.9,52.4] *** Maternal BMI (kg/m 2 ) ≤18.5 23.4 [21.9,24.9] 24.9 [23.4,26.5] 24.3 [23.0,25.6] 19-25 26.6 [25.0,28.2] ** 28.5 [26.8,30.2] *** 27.6 [26.3,29.0] *** 25+ 26.2 [24.2,28.3] 20.3 [18.7,22.0] 22.6 [21.1,24.1] Women has money autonomy Yes 24.3 [23.2,25.6] 24.5 [23.3,25.7] 24.4 [23.4,25.4] Husband 25.5 [24.0,27.2] 24.1 [22.5,25.8] 24.7 [23.4,26.1] Women have health care autonomy Yes 24.7 [23.7,25.8] 24.5 [23.5,25.7] 24.6 [23.7,25.6] Husband 24.6 [22.5,26.7] 22.9 [21.1,25.0] 23.6 [22.1,25.3] Women have movement autonomy Yes 24.4 [23.3,25.5] 24.5 [23.4,25.7] 24.4 [23.5,25.4] Husband 25.7 [23.8,27.7] 24.0 [22.3,25.7] 24.7 [23.3,26.2] Environmental factors Source of drinking water Protected 25.1 [24.0,26.2] 24.1 [23.1,25.1] 24.5 [23.6,25.4] Unprotected 22.2 [19.6,25.1] 26.6 [23.5,29.9] 24.6 [22.4,26.9] Stool disposal Safe 25.5 [24.3,26.7] ** 25.3 [24.1,26.5] ** 25.4 [24.4,26.4] *** Unsafe 22.7 [20.9,24.5] 22.2 [20.5,23.9] 22.3 [20.9,23.8] Type of toilet Improved 25.5 [24.4,26.6] ** 24.5 [23.4,25.6] 24.9 [24.0,25.9] ** Unimproved 21.6 [19.6,23.8] 23.1 [20.9,25.4] 22.4 [20.7,24.3] Listening to the radio At least 24.4 [23.0, 25.8] 22.6 [21.3,23.9] 23.3 [22.3,24.4] Less than 27.0 [23.3,25.8] ** 29.0 [26.3,32.0] *** 28.2 [26.0,30.5] *** Never 24.8 [23.5,26.3] 24.9 [23.6,26.4] 24.9 [23.7,26.1] Watching TV At least 24.8 [23.8,25.9] 24.0 [23.0,25.1] 24.3 [23.5,25.2] Less than 20.9 [15.5,27.5] 28.8 [23.7,34.5] 25.8 [21.9,30.2] Never 27.2 [22.4,32.7] *** 31.0 [26.7,35.7] *** 29.5 [25.9,33.3] *** Frequency of reading magazine or newspaper At least 22.8 [20.3, 25.5] 18.7 [16.6,22.9] 20.3 [18.6,22.2] Less than 22.8 [20.7,25.0] 21.0 [19.2,22.9] 21.8 [20.3,23.3] Never 25.4 [24.3,26.6] 25.6 [24.5,26.8] *** 25.5 [24.6,26.5] *** Health care services Place and mode of delivery Cesarean & health facility 22.3 [20.9,23.9] 21.6 [20.1,23.2] 21.9 [20.7,23.2] Non-Cesarean &home delivery 24.8 [23.4,26.2] 24.1 [22.8,25.4] 24.4 [23.3,25.5] Non-Cesarean & health facility 29.0 [27.0,31.2] *** 27.6 [25.9,29.5] *** 28.2 [26.6,29.8] *** Antenatal clinic visits 8+ 22.7 [21.3,24.2] 22.4 [20.9,23.9] 22.5 [21.4,23.7] 4-7 visits 24.8 [23.1,26.6] 23.0 [21.5,24.6] 23.8 [22.5,25.1] 1-3 visits 23.2 [20.4,26.3] 25.4 [23.0,28.0] 24.5 [22.5,26.6] None 30.5 [28.4,32.8] *** 29.1 [27.4,30.9] *** 29.6 [28.1,31.2] *** Delivery assistance Health professional 24.0 [23.0,25.1] 23.3 [22.2,24.4] 23.6 [22.7,24.5] Traditional 29.3 [26.9,31.9] *** 28.6 [26.6,30.7] 28.9 [27.2,30.6] Other 22.8 [17.9,28.5] 24.7 [20.5,29.5] 24.0 [20.5,27.7] No one 43.4 [30.1,57.8] 29.1 [21.6,38.0] *** 33.8 [26.4,42.1] *** Postnatal checkup No PNC 26.8 [25.4,28.3] *** 24.3 [23.1,25.4] 25.1 [24.1,26.2] ** 0-2 days 23.3 [21.8,25.0] 25.2 [23.2,27.2] 24.2 [22.7,25.6] Delayed 20.6 [18.5,22.8] 22.0 [19.5,24.8] 21.2 [19.5,23.0] Recent vitamin A Yes 24.2 [22.1,26.3] 22.8 [20.0,25.8] 23.7 [21.9,25.5] No 24.9 [23.8,26.0] 24.5 [23.4,25.6] 24.7 [23.8,25.6] Ever had vaccination No 24.9 [23.7,26.1] 23.9 [22.8,25.1] 24.4 [23.4,25.4] Yes 24.7 [23.1,26.3] 24.7 [23.3,26.3] 24.7 [23.5,26.0] Immediate factors Child health Size of baby Average 27.2 [25.6,28.8] *** 23.5 [22.0,25.1] 25.0 [23.7,26.3] Small 23.3 [22.1,24.6] 24.9 [23.6,26.2] 24.2 [23.1,25.3] Large 23.4 [18.9,28.6] 22.9 [19.8,26.3] 23.0 [20.4,25.8] Diarrhoea last two weeks No 25.1 [24.0,26.2] 23.9 [22.9,25.0] 24.4 [23.5,25.3] Yes 23.9 [22.1,25.7] 27.9 [25.3,30.6] ** 25.3 [23.7,27.0] Fever No 25.0 [23.9,26.1] 24.1 [23.1,25.2] 24.4 [23.5,25.4] Yes 24.4 [22.7,26.1] 25.1 [23.3,27.1] 24.8 [23.4,26.2] Cough No 25.1 [24.0,26.2] 23.9 [22.9,25.0] 24.4 [23.5,25.3] Yes 23.9 [22.1,25.7] 27.9 [25.3,30.6] ** 25.3 [23.7,27.0] Breastfeeding practices Early initiation of breast feeding After 1 hr 24.2 [23.0,25.5] - - Withing 1 hr 25.8 [24.3,27.3] - - Duration of breast feeding Up to 12 months 22.3 [21.1,23.6] 24.9 [22.4,27.5] 22.8 [21.7,24.0] >12 months 27.8 [26.3,29.3] *** 24.2 [23.1,25.3] 25.1 [24.1,26.2] *** * P< 0.05; ** p<0.01; *** p<0.001. Multivariable analysis Table S3 (Extended Data) and Table 2 show the univariate and multivariate analyses of stunting determinants among Egyptian children aged 0–23, 24-59, and 0–59 months. For children across the three age groups, the odds of stunting were significantly lower in 2014 compared to 2005, with adjusted odds ratios (aOR) of 0.64 (95% CI: 0.54–0.76) for the 0-23 months group, 0.78 (95% CI: 0.64–1.00) for the 24-59 months group, and 0.71 (95% CI: 0.59–0.84) for the 0-59 months group. Table 2. Adjusted Odds Ratios for Determinants of Stunting among Children aged (0-23, 24-59 and 0-59 months) in Egypt. Children 0-23 months Children 24-59 months Children 0-59 months) Characteristics a OR P value a OR P value a OR P value Year 2005 1 1 1 2008 0.98 [0.95, 1.13] 0.742 1.22 [1.02, 1.46] 0.030 1.05 [0.91, 1.21] 0.537 2014 0.64 [0.54, 0.76] <0.001 0.78 [0.64, 1.00] 0.047 0.71 [0.59, 0.84] <0.001 Basic factors Region Urban Governates 1 1 1 Urban (Lower Egypt) 1.41 [1.11, 1.78] 0.005 1.25 [1.00, 1.57] 0.058 1.31[1.09, 1.58] 0.004 Rural (Lower Egypt) 1.00 [0.81, 1.24] 0.991 1.07 [0.87, 1.32] 0.512 1.05 [0.89, 1.25] 0.533 Urban (Upper Egypt) 1.09 [0.87, 1.36] 0.465 1.28 [1.00, 1.63] 0.042 1.17 [0.96, 1.43] 0.112 Rural (Upper Egypt) 1.12 [0.91, 1.39] 0.282 1.30 [1.05, 1.61] 0.018 1.22 [1.02, 1.44] 0.027 Frontier Governates 1.01 [0.76, 1.32] 0.967 .75 [0.53, 1.06] 0.098 0.82 [0.66, 1.03] 0.089 Underlying factors Socioeconomic factors Wealth Index Richest 1 1 1 Fourth 0.86 [0.72, 1.01] 0.069 0.90 [0.77, 1.03] 0.144 0.87 [0.78, 0.98] 0.022 Middle 0.82 [0.67, 1.00] 0.050 0.80 [0.66, 0.96] 0.014 0.84 [0.72, 0.97] 0.015 Second 0.90 [0.72, 1.11] 0.313 0.91 [0.74, 1.10] 0.329 0.93 [0.79, 1.09] 0.360 Poorest 0.80 [0.64, 1.01] 0.059 0.95 [0.78, 1.17] 0.639 0.93 [0.79, 1.09] 0.364 Sex of baby Boy 1 1 Girl 0.71 [0.64, 0.78] <0.001 0.83 [0.78, 0.89] <0.001 Child age (months) 0-5 1 1 6-11 1.10 [0.94, 1.29] 0.238 1.08 [0.92, 1.26] 0.365 12-17 1.08 [0.88, 1.32] 0.481 1.25 [1.07, 1.47] 0.005 18-23 1.52 [1.23, 1.90] <0.001 1.78 [1.52, 2.09] <0.001 24-29 1 1.44 [1.23, 1.69] <0.001 30-35 1.06 [0.93, 1.21] 0.369 1.49[1.26, 1.77] <0.001 36-41 .93 [0.82, 1.06] 0.264 1.30 [1.12, 1.53] 0.001 42-47 .85[0.75, 0.98] 0.019 1.20 [1.01, 1.41] 0.33 48-53 .62 [0.53, 0.71] <0.001 0.88 [0.74, 1.05] 0.161 54-59 .74 [0.63, 0.85] <0.001 1.02 [0.85, 1.22] 0.838 Mother's age (years) 15-24 1 25-34 0.88 [0.79, 0.98] 0.017 35-49 0.90 [0.76, 1.08] 0.250 Father’s age (years) 18-34 1 35-44 0.88 [0.80, 0.97] 0.008 45+ 0.79 [0.68, 0.92] 0.002 Mother's marital status Married 1 1 Not married 1.76 [1.15, 2.70] 0.010 0.74 [0.54, 1.00] 0.047 Age at first cohabitation/married 18 years Maternal education Higher 1 1 1 Secondary 1.07 [0.90, 1.26] 0.429 1.02 [0.90, 1.16] 0.727 1.02 [0.90, 1.16] 0.736 Primary 1.37 [1.20, 1.72] 0.005 1.21 [1.02, 1.44] 0.028 1.21 [1.02, 1.44] 0.029 No education 1.12 [0.91, 1.37] 0.289 1.09 [0.93, 1.28] 0.281 1.09 [0.93, 1.28] 0.282 Father education Higher 1 1 Secondary 1.00 [0.87, 1.14] 0.945 1.05 [0.93, 1.17] 0.442 Primary 1.21 [1.02, 1.43] 0.030 1.24 [1.08, 1.43] 0.003 No education 1.16 [0.98, 1.37] 0.089 1.12 [0.96, 1.30] 0.140 Worked in the last 12 months Non-working 1 1 Working 1.19 [1.06, 1.34] 0.003 1.18 [1.07, 1.29] 0.001 Combined birth order and birth interval 1st birth 1 1 1 2nd/3 rd /interval >2 097 [0.86, 1.10] 0.681 1.10 [0.99, 1.22] 0.084 0.98[0.91, 1.05] 0.498 2nd/3 rd /interval 2 1.00 [0.81, 1.24] 0.997 1.19 [1.01, 1.41] 0.035 0.98 [0.87, 1.11] 0.746 4th birth/interval 160 1 1 1 155-159 1.09 [0.98, 1.21] 0.127 1.20 [1.09, 1.32] <0.001 1.17 [1.08, 1.26] <0.001 150-154 1.32 [1.15, 1.51] <0.001 1.38[1.22, 1.57] <0.001 1.38 [1.26, 1.52] <0.001 145-149 1.90 [1.53, 2.35] <0.001 1.62 [1.34, 1.97] <0.001 1.79 1.54, 2.09] <0.001 <145 2.51 [1.59, 3.95] <0.001 3.28 [2.10, 5.15] <0.001 3.11 [2.24, 4.33] <0.001 Maternal BMI (kg/m 2 ) ≤18.5 1 1 19-25 0.98 [0.86, 1.12] 0.734 0.98 [0.90, 1.08] 0.720 25+ 0.69 [0.57, 0.84] <0.001 0.74 [0.64, 0.86] <0.001 Environmental factors Source of drinking water Protected 1 Unprotected 1.22 [1.03, 1.46] 0.025 Listening to the radio At least 1 1 1 Less than 1.15 [0.96, 1.37] 0.132 1.27 [1.09, 1.48] 0.002 1.22 [1.08, 1.38] 0.001 Never 1.25 [1.12, 1.40] <0.001 1.03 [0.93, 1.14] 0.607 1.14 [1.06, 1.24] 0.001 Frequency of reading magazine or newspaper At least 1 1 Less than 1.11 [0.92, 1.34] 0.267 Never 1.31 [1.09, 1.56] 0.004 Health care services Place and mode of delivery Caesarean & health facility 1 Non-Caesarean &home delivery 1.03 [0.91, 1.17] 0.593 Non-Caesarean & health facility 1.18 [1.02, 1.37] 0.029 Antenatal clinic visits 8+ 1 1 1 4-7 visits 1.07 [0.94, 1.21] 0.303 0.97 [0.87, 1.09] 0.605 1.01 [0.93, 1.10] 0.814 1-3 visits 0.91 [0.75, 1.10] 0.322 1.02 [0.88, 1.19] 0.788 0.98 [0.86, 1.11] 0.714 None 1.25[1.08, 1.45] 0.003 1.17 [1.03, 1.32] 0.011 1.21 [1.10, 1.34] 12 months 1.24 [1.06, 1.45] 0.009 Children living in rural Upper Egypt and urban Lower Egypt were significantly more likely to be stunted than those from other geographical regions, while those from middle-income households were significantly less likely to be stunted than those from the richest households. For the three age categories, children whose mothers only had primary school were considerably more likely to be stunted than those whose mothers had secondary education or above. For all three age groups, children whose mothers were less than 155 cm tall had a significantly higher risk of stunting than those whose mothers were taller than 160 cm. In all age categories, children whose mothers did not visit any ANC clinic had significantly higher odds of stunting than those whose mothers visited at least 8 ANC clinics. For all three age groups, children whose mothers did not listen to radio had a considerably increased risk of stunting. Among children aged 0-23 months, the likelihood of stunting was significantly less among girls than boys. The odds of stunting were significantly higher among children aged 18-23 months compared to those aged 0-5 months. For 0-23 months groups, the likelihood of a child being stunted was significantly higher among those whose mothers were not married compared to those whose mothers were married. For children aged 0-23 months, the risk of stunting was significantly higher among children who were delivered through a non-caesarean section and at home than children who were delivered through a caesarean section at a health facility. Children who received vitamin A supplements were more likely to be stunted than children who did not. Among children in the 0-23 months age group, the likelihood of stunting was significantly higher in those who were breastfed for more than 12 months compared to children who were breastfed for up to 12 months. Among children aged 24-59 months, the likelihood of stunting was significantly less among older children. The odds of stunting were significantly lower in children whose fathers were older than 45 years compared to those fathers were aged 18-34 years. Children whose mothers had only primary education were significantly more prone to stunting than those whose mothers were educated to higher levels than secondary. The odds of stunting were significantly higher among those whose fathers were educated to primary level, compared to those whose fathers had higher levels than secondary. Children whose mothers worked were significantly more likely to be stunted than their counterparts whose mothers did not work. children whose mothers had a BMI of more than 25 kg/m 2 were significantly less likely to be stunted compared to those whose mothers had a BMI of 18.5 kg/m 2 or less. Children who were from households with unprotected source of drinking water were significantly more likely to be stunted compared to their counterparts from households with protected source of drinking water. Among children aged 0-59 months, the likelihood of stunting was significantly less among girls than boys. The odds of stunting were significantly higher among children aged 6 months until 41 months compared to other ages. The odds of stunting were significantly higher among those whose fathers were educated to primary level, compared to those whose fathers had higher levels than secondary. Children whose mothers worked were significantly more likely to be stunted than their counterparts whose mothers did not work. For the 24-59 months and the 0-59 months groups, children whose mothers had a BMI of more than 25 kg/m 2 were significantly less likely to be stunted compared to those whose mothers had a BMI of 18.5 kg/m 2 or less. Those who did not receive vitamin A supplements were more likely to be stunted than those who did. Discussion The current study determined the prevalence of stunting and associated risk factors with stunting among children aged (0-23, 24-59 and 0-59 months) in Egypt. Findings from the study demonstrate that stunting is a significant concern in Egypt, with a prevalence rate of 24.5%. Although, the EDHS data analysed did show a fluctuating pattern of prevalence for stunting among children under five in Egypt. It was 24.6% in 2005, rose to 28.9% in 2008, and then declined to 21.5% in 2014. The common factors among the three age groups were the survey year, region, wealth index, child age, mother education level and height, birth order, listening to media and ANC. While factors such as mother’s age, marital status, and duration of breastfeeding were associated only with children aged 0-23 months, paternal education level, mother had BMI >25, and mother’s employment in the last 12 months were factors associated with children aged 0-59 months but not with children aged 0-23 months. Child gender and those who do not adequately use vitamin A supplements were associated with stunting among children aged 0-23 and 0-59 months. 38 Study findings suggest stunting in Egypt has decreased slightly over the last decade, with a significant increase in 2008. The surge in global food prices in 2007 and 2008 led to significant increases in food costs in Egypt. This escalation reduced access to nutritious foods, particularly among low-income families, contributing to higher rates of child malnutrition and stunting. 38 This could be one of the key factors behind the increase in undernutrition in Egypt during 2008. However, stunting in Egypt has decreased slightly over the last decade and the declining in stunting can potentially be attributed to the government’s endeavours in addressing undernutrition. The Egyptian government implemented the Agenda for Action Policy Paper (2017-2025) which was prepared for the main purpose of defining a feasible and practical ‘roadmap’ that would transform government-led nutrition policies and programs and mobilise harmonise multi-sector, as well as a multi-stakeholder, support to scaling-up of nutrition actions. 39 Central to this process was the formulation of an updated National Nutrition Policy and Strategy which was aligned to important national and global commitments, such as the Egypt Vision 2030, and the Sustainable Development Goals’ “Agenda for action” in 2023, The National Agenda for Sustainable Development Egypt’s Updated Vision 2030 was published with number of strategies, government plans and programs for Egypt to achieve the SDGs by 2030. 40 Although various efforts have been made, 39 stunting remains a significant issue in Egypt, and several factors may contribute to its persistence. For example, the lack of regular data collection is a critical challenge as the last EDHS was conducted in 2014, nearly a decade ago. 41 The lack of updated, monitoring and assessment data hampers the ability to clearly understand and detect problems earlier, as well as to assess the effectiveness of existing policies. This makes it challenging to identify issues promptly and implement effective preventive measures. Therefore, it is crucial to advocate for and invest in the comprehensive and consistent collection of nationally representative data as an integral part of new policies. Furthermore, other factors that can exacerbate undernutrition or hinder Egypt’s efforts to address the issue include the widespread levels of inequality and poverty. Poverty in Egypt affected a substantial portion of the population in 2015, with 27.8% living in poverty and an additional 28.7% at risk of becoming impoverished. 18 In a study carried out in 2020, it was emphasized that Egypt faces deep-rooted inequalities in multiple domains, including income, wealth, education, gender, employment, and health. These disparities have persisted and even worsened over time. 42 Children from lower socioeconomic background have less access to quality healthcare, nutritious food, safe living conditions, and educational opportunities, which leads to poorer health outcomes. 18 Poor child health as a result of poverty and inequality has a lasting impact, including lower educational attainment, lower earning capacity, and an increased risk of chronic health disorders in adulthood, continuing a cycle of poverty and poor health throughout generations. 18 , 42 Furthermore, the study discovered that stunting is more common among children living in rural areas of Upper Egypt, which represents > 30 % of the population when compared to the other five regions. Poverty plays a major role in this trend as approximately 43 % of the population in rural Upper Egypt live below the poverty line that represents the highest percentage in the country. There are significant challenges in this area, such as a low level of education, especially among individuals whose fathers also had limited education. Limited access to healthcare, diverse foods, and nutritional knowledge, due to educational, economic, geographic, and gender disparities, worsens the risk of undernutrition among vulnerable populations. 18 A recent report states that over half of the population in Egypt’s rural Upper Egypt is currently facing challenges in meeting their basic needs, including both food and non-food essentials. According to the results of the Household Income and Expenditure Survey, there has been a decline in poverty rates in rural Upper Egypt as the percentage dropped from 56.7% in 2015 to 51.94% in 2018. 43 Despite this, the rural area of Upper Egypt region continues to uphold its reputation as the most economically underdeveloped in Egypt. Presently, the current national poverty rate is recorded at 32.5%. In urban governorates, the percentage stands at 26.73%, whereas in urban Lower Egypt, it amounts to 14.31%. In the rural regions of Lower Egypt, the percentage amounts to 27.29%. The African continent, along with other developing nations, is experiencing the destructive consequences of the interconnected issues of undernutrition and poverty. 44 Poverty is the main cause of undernutrition, its presence in early life can worsen the cycle of poverty and result in severe and long-lasting health consequences. 44 Analysis of the current study indicated that children from the middle wealth households were less prone to being stunted, compared to their counterparts from the richest households, which does not reflect findings from a systematic review conducted in sub-Saharan Africa and Bangladesh. 29 , 45 A study in India indicated that the greatest opportunity for reducing stunting was higher among low to middle wealth quintiles than higher wealth quintiles; however, the decline in prevalence associated with wealth was not consistent throughout the nation. 46 A sub-analysis by cross-tabulating household income with place of residence revealed that 81% of middle-income households were in rural areas, while only 19% resided in urban areas. These findings could also be attributed to the fact that middle-income families may provide more balanced, home-cooked meals, while affluent households may depend more on processed or convenience foods, which are not always nutritionally optimal. Wealthier families may initiate formula feeding earlier, whereas middle-income households may adhere more closely to recommended breastfeeding practices. Additionally, middle-income parents may be more involved in child-rearing, while affluent families may delegate childcare to carers who may not consistently follow ideal feeding and care practices. 46 , 47 Furthermore, the study findings explored that the increased odds of stunting were associated with mothers who had a low level of education and who worked in the last 12 months. This finding may be attributed to the fact that mothers with a higher education level are more knowledgeable about the advantages of exclusive breastfeeding during the first six months, as well as appropriate nutrition and early feeding practices. 48 , 49 Mothers of high education attainment may comprehend the significance of timely, frequent, and diverse complementary nutrition, which allows them to make more informed decisions regarding their child’s health status. 49 In addition, mothers who are educated are more likely to practise good hygiene and are more aware of the importance of regular check-ups and preventive care for their children, as well as healthcare services. 50 , 51 Education should be considered as an essential issue regarding child stunting for Egypt, like many other developing countries as several studies have reported a better education level as a strong determinant of better health outcomes. 52 – 54 In consonance with findings from several previous studies such as those from Nigeria, 55 Pakistan, 56 Indonesia and Bangladesh, 57 and from systematic review studies. 28 , 29 , 58 Mothers who have recently entered the workforce may find it challenging to dedicate sufficient time and energy to their children’s care. The return to work for mothers often has a negative impact on consistent breastfeeding. Exclusive breastfeeding rates are higher among mothers who are not employed than those who are employed. 59 While some studies suggest that maternal employment can positively impact child health due to increased family income, 60 this dynamic must be considered within the cultural context. In Arab countries like Egypt, the working mother often faces unique challenges. A mother is typically expected to balance her job with family commitments 61 such as childcare, cleaning, and cooking, while the partner primarily focuses on providing for the family’s external needs. When a mother works, this often leads to an overwhelming burden on her health, as she must juggle multiple roles simultaneously. 61 The cultural nuance of this situation underscores the importance of understanding cultural and social factors that influence the well-being of both the mother and child. The study analysis found that the duration of breastfeeding > 12 months was more prevalent among children aged 0-23 and 0-59 months and more associated with children aged 0-23 months Similarly, in Pakistan, a study by Syeda et al. revealed that three-year-old children had a significantly higher risk of stunting compared to two-year-old children who were breastfed during their second year, even after accounting for other factors related to mother, child and health care services. The study also found that the three-year-old children who received breastfeeding until this age exhibited an elevated susceptibility to severe stunting when compared to their two-year-old counterparts. 62 Furthermore, a cohort study conducted in Sudan found that stunting and wasting were more common among children who received prolonged breastfeeding compared to their well-nourished peers. The variance in height gains at 6 months was slight between children who were breastfed and those who were fully weaned. However, there was a significant decrease in weight gain observed among children who were breastfed, particularly between the ages of 6 and 12 months. 63 Several studies conducted in different countries, including Ghana, 64 , 65 Sub-Saharan African countries, 66 and rural Senegal, 67 had demonstrated a positive correlation between the duration of breastfeeding and the occurrence of stunting, wasting, and underweight. Furthermore, these studies have observed that this correlation strengthens as children grow older. Various factors mentioned by the forementioned studies that may be accountable for the found association, such as the findings of the study conducted in Sudan by Fawzi et al. which found an association between prolonged breastfeeding and stunting and wasting were greater among children of disadvantaged or illiterate mothers compared to those of educated, wealthier mothers. The inverse association is hypothesized to stem from inadequate complementary feeding in breast-fed children relative to weaned children, particularly in families with low incomes. 63 The interpretation of the findings needs to be done so with caution as both the current study and those mentioned above have not considered the dietary quality and energy intake received from oral intake alongside the measure of breastfeeding duration as dietary diversity was not included in the 2005 DHS data. Further investigation is needed to determine the interplay between diet quality, breastfeeding duration, and anthropometric outcomes for children aged over 12 months in Egypt. Additionally, the study analysis that inadequate use of vitamin A supplement was associated with stunting in both children aged 0-23 and 0-59 months. Vitamin A is essential for healthy vision, immune system function, and for child growth and development. 68 The micronutrients deficiency is especially concerning in children, as it may impair growth, immune function, and overall health, thus increasing the risk of undernutrition. 68 The lack of knowledge regarding the significance of vitamin A and its sources in low socioeconomic communities is a contributing factor affecting vitamin A consumption. 10 A similar result was found by study conduct in Brazil as it found that the probability of children experiencing stunting and anemia decreased by 8% and 31% due to vitamin A supplementation, the intake of vitamin A supplements reduces the risk of stunting. 69 The likelihood of a child being stunted was found to be higher in those whose mothers had limited or no ANC visits during pregnancy. This was consistent with findings from Ethiopia 35 and Zambia. 30 Routine ANC is a vital health service for expectant mothers that aims to identify potential obstetric complications, provide guidance on healthy lifestyle choices, pregnancy, and childbirth. 70 Through regular ANC visits, healthcare providers can detect high-risk pregnancies early, thereby reducing the risk of maternal mortality and closely monitoring the progress of the fetus. The World Health Organisation (WHO) stated that ANC is crucial in reducing pregnancy and childbirth complications, stillbirths, and perinatal deaths through evidence-based actions. Moreover, WHO stated that ANC provides a significant chance to engage with and support women, their families, and communities during a crucial stage in a woman’s life. 71 The study analysis also revealed that boys were significantly more prone to being stunted than girls, which is in consonance with findings from past studies that show that overall, boys tend to be at greater risk of stunting than girls, 72 especially in Sub-Saharan Africa and in lower socioeconomic group. 73 This finding may be attributed to the fact that research has consistently shown that boys are more prone to common childhood illnesses like lower respiratory infections, diarrheal disease, and malaria compared to girls. 74 , 75 Additionally, boys tend to experience higher rates of wasting, and underweight, 72 , 76 which suggest that boys are more vulnerable to environmental stressors and have higher rates of infectious morbidity and mortality. 77 – 82 In some societies or regions, the health and well-being of younger females may be prioritised by social values and practices, which may lead to superior nutrition and care for them in comparison to older girls or boys. As a result, some researchers and policymakers recommend targeting interventions towards boys 83 , 84 or reevaluating the focus on girls and women in nutrition research. 72 , 76 , 85 , 86 Analysis of the current study corroborates this finding, by showing that the odds of stunting among children 0-59 months were significantly higher among children aged 18-41 months. Past studies have revealed that the odds of stunting were higher in older children than in younger ones. For instance, in Myanmar, older children (24-35 months) are more likely to be stunted than those under 6 months 87 and South Ari District, Southern Ethiopia: a community-based cross-sectional study found that children in the age group of 24–59 months were more prone to stunting than others. 88 Another cross sectional study targeted four North African countries found the higher prevalence of stunting was among children aged 24-59 months. 11 This is most likely due to the cumulative effect of foetal and early childhood development delays. Children who remain stunted after two years have missed the critical window of opportunity to reverse the impacts of poor growth and development, which occurs within the first 1,000 days following conception until age two. 89 Stunting after two years raises the probability of poor long-term cognitive, educational, and productive results. In contrast, a cross-sectional study of 94 low- and middle-income countries on patterns in child stunting by age observed that Stunting prevalence was higher for younger children until around age 28 months. 90 Research indicates that genetics has a more significant impact on growth patterns after the age of two, implying that environmental factors have a greater influence on the growth of younger children compared to older children. 91 One possible explanation for this phenomenon is that as children mature, their immune system becomes more robust, enabling them to better resist pathogens and reducing the impact of environmental stressors on their growth. 68 The analysis revealed that shorter mothers were more likely to have stunted children. The finding suggests that a mother’s height is a significant factor in determining her child’s birth length, with taller mothers more likely to have longer children and shorter mothers more likely to have shorter children. This indicates a strong genetic link between maternal height and child length. 92 However, it is also important to note that external factors, such as adequate nutrition, play a crucial role in a child’s growth and development. Ensuring proper nutritional intake is essential to support healthy growth and prevent delays in development, as highlighted by a past. 92 , 93 This finding was consistent with those of other previous studies from Indonesia, 94 south Asia 95 and Bangladesh. 96 Furthermore, Children of mothers with a BMI greater than 25 were found to be less likely to suffer from stunting compared to their counterparts. While some studies have highlighted the prevalent coexistence of stunting and maternal overweight, 34 , 45 , 97 the risk of child stunting and overweight in the mother-child pair appear to be strongly related to other specific maternal characteristics rather than her BMI. These include shorter maternal height, younger maternal age at birth, lower levels of education, and the household’s economic status, as indicated by the wealth index and the number of household members. 98 These factors play a critical role in determining the nutritional health and overall well-being of both mother and child. 34 , 98 To address the prevalence of child stunting in Egypt, multisectoral actions are recommended: 1) implement targeted interventions focusing on boys and children born to short mothers, who are at higher risk of stunting; 2) ensure universal access to ANC for all pregnant women, prioritising those with limited or no previous ANC visits; 3) provide nutrition counselling and education to mothers, emphasising the importance of adequate feeding practices during pregnancy and early childhood; 4) rural focused initiatives: develop and implement context-specific initiatives addressing the unique challenges faced by rural populations in Upper Egypt; 5) foster collaboration between the healthcare, education, WASH, and social protection sectors to address the multifaceted determinants of child stunting; 6) establish a robust monitoring and evaluation system to track progress, identify areas for improvement, and adjust policies accordingly. Although this study has several strengths, including the use of a large sample size, pooling three large population-based dataset which enhances statistical power and allows for comparisons across different studies, it also provides detailed insights into changes in the prevalence of undernutrition and its associated factors among children under five in Egypt. By focusing on specific geographic areas and age groups (0-23 months, 24-59 months, and 0-59 months), a more comprehensive understanding of the distinct challenges and circumstances that contribute to undernutrition will enable for more impactful interventions. The utilisation of a population-based design and a significant pooled sample size ensure that the collected data correctly reflect the total population within the designated area. This strategy enhanced the validity and reliability of results by minimising selection bias and facilitating more precise calculations of prevalence and connections. However, this study was not without its limitations. MICS surveys primarily focus on cross-sectional data collection, limiting the ability to establish causal relationships or understand the dynamic factors contributing to undernutrition. Furthermore, cross-sectional statistics rely on self-reported data, which can be influenced by recall or social desirability biases, leading to inaccuracies. Ultimately, it is important to consider the possibility of unaccounted confounding variables affecting the results of the study. As an example, it should be noted that the study findings regarding breastfeeding and Vitamin A supplement could have been clearer if dietary intake variables for the Infant and young child feeding indicators were included. However, due to the unavailability of data about dietary intake in the EDHS 2005, this was not possible. Conclusions Child stunting is a significant public health challenge in Egypt, necessitating focused interventions based on critical risk factors. Addressing the root causes of stunting in Egypt requires a multisectoral approach involving collaboration across health, WASH, education, and social protection sectors. Effective interventions should be designed to target vulnerable groups, including children born to mothers with short stature, while also considering broader determinants such as socioeconomic conditions and environmental influences. To reduce stunting rates, interventions must be accessible and tailored to families with low socioeconomic status. These should include expanding access to quality healthcare services, enhancing parental education on child nutrition and early development, and promoting optimal infant and young child feeding practices. Additionally, strengthening food security programs and improving household access to safe water and sanitation can contribute to better nutritional outcomes. A structured nutrition monitoring framework is essential to track progress and guide policy decisions. Implementing routine data collection on key nutritional indicators will enable early detection of at-risk populations, facilitate timely interventions, and support the continuous improvement of child health programs. Ethical statement EDHS ethical clearance was obtained from the Inner-City Fund (ICF) International, and permission to use the data was obtained from ICF International for this study. This study used existing EDHS data sets and did not involve interaction with the participants. A re-analysis was performed with the participants’ original consent. Thus, no further consent was obtained from the participants. Data availability statement The used data is national representative data. The data are available in the public domain and can be accessed through the prescribed registration on the official DHS program website ( https://dhsprogram.com/ ) (accessed on 25 Oct 2024). The data are available in the public domain and can be accessed through the prescribed registration on the official DHS program website ( https://dhsprogram.com/ ). Extended data Figshare repository: Concurrent stunting among under-five children in Egypt. (DOI. 10.6084/m9.figshare.28030355.v1 ). 99 This project contains the following underlying information: • Table S1. Distribution of Determinants of Child Nutritional Health: EDHS for the Years 2005, 2008, and 2014; • Table S2. Prevalence of stunting among children (0-23, 24-59 and 0-59 months) in Egypt by the basic, underlying and immediate factors; • Table S3. Unadjusted Odds Ratios for Determinants of Stunting among Children aged (0-23, 24-59 and 0-59 months) in Egypt. Materials are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgements This paper forms part of the first author’s doctoral dissertation at the School of Health Sciences, Western Sydney University. References 1. United Nations Children’s Fund, World Health Organization & International Bank for Reconstruction, Development/The World Bank: Levels and Trends in Child Malnutrition: UNICEF/WHO/The World Bank Group Joint Child Malnutrition Estimates: Key Findings of the 2021 Edition. World Health Organization; 2021. 2. De Sanctis V, Soliman A, Alaaraj N, et al. : Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood. Acta Biomed. 2021; 92 (1): e2021168. PubMed Abstract | Publisher Full Text 3. Alam MA, Richard SA, Fahim SM, et al. : Impact of early-onset persistent stunting on cognitive development at 5 years of age: Results from a multi-country cohort study. PLoS One. 2020; 15 (1): e0227839. PubMed Abstract | Publisher Full Text | Free Full Text 4. Adair LS, Fall CHD, Osmond C, et al. : Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet. 2013; 382 (9891): 525–534. PubMed Abstract | Publisher Full Text | Free Full Text 5. Grantham-McGregor S, Cheung YB, Cueto S, et al. : Developmental potential in the first 5 years for children in developing countries. Lancet. 2007; 369 (9555): 60–70. PubMed Abstract | Publisher Full Text | Free Full Text 6. Walker SP, Chang SM, Powell CA, et al. : Effects of early childhood psychosocial stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican children: prospective cohort study. Lancet. 2005; 366 (9499): 1804–1807. PubMed Abstract | Publisher Full Text 7. UNICEF: Goal 2: Zero Hunger. Sustainable Developemnt Goals. 8. Food and Agriculture Organization: The double burden of malnutrition: Case studies from six developing countries.Food & Nutrition Paper, editor. Food and Agriculture (FAO) Nutr Paper. Rome, Italy: FAO; 2006; Vol. 84 . : pp. 1–334. 9. Ministry of Health and Population. 2015 Egypt Health Issues Survey (EHIS): In collaboration with: El Zanaty and Associates, USAID, UNFPA and UNICEF.October 2015. 10. Kavle J, Mehanna S, Saleh G, et al. : Examining factors associated with stunting in Lower Egypt in comparison to Upper Egypt. Bridging the gap between cultural beliefs and feasible feeding practices through Trials for Improved Practices, Washington DC.2014. 11. Elmighrabi NF, Fleming CAK, Agho KE: Factors Associated with Childhood Stunting in Four North African Countries: Evidence from Multiple Indicator Cluster Surveys, 2014-2019. Nutrients. 2024; 16 (4): 473. PubMed Abstract | Publisher Full Text | Free Full Text 12. The Egyptian Cabinet Information and Decision Support Center: The cost of hunger in Egypt implications of child undernutrition on the social and economic development of Egypt.2013. 13. Pritchett L, Summers LH: Wealthier is Healthier. World Bank Publications; 1993; pp. 841–868. 14. Smith LC, Haddad L: How potent is economic growth in reducing undernutrition? What are the pathways of impact? New cross-country evidence. Econ. Dev. Cult. Chang. 2002; 51 (1): 55–76. Publisher Full Text 15. Vollmer S, Harttgen K, Subramanyam MA, et al. : Association between economic growth and early childhood undernutrition: evidence from 121 Demographic and Health Surveys from 36 low-income and middle-income countries. Lancet Glob. Health. 2014; 2 (4): e225–e234. PubMed Abstract | Publisher Full Text 16. Herbst CH, Elshalakani A, Kakietek J, et al. : Scaling up nutrition in the Arab Republic of Egypt: investing in a healthy future. Washington, DC: The World Bank; 2020. 17. World Bank Group: Poverty has Fallen in the Maghreb, but Inequality Persists 2016.[cited 10 Sep 2024]. Reference Source 18. World Bank Blogs: Understanding Poverty and Inequality in Egypt. Washington: © World Bank; 2019. 19. Cho R: How Climate Change Impacts the Economy. State of the Planet. Columbia Climate School 2019. Reference Source 20. Where we work: Libya: World Food Programme: Saving lives changing lives.2022 [cited 5 Sep 2024]. Reference Source 21. Seedhom AE, Mohammed ES, Mahfouz EM: Determinants of stunting among preschool children, Minia, Egypt. Int. Public Health Forum. 2014; 1 (2): 6–9. 22. Hamed A, Hegab A, Roshdy E: Prevalence and factors associated with stunting among school children in Egypt. East Mediterr. Health J. 2020; 26 (7): 787–793. PubMed Abstract | Publisher Full Text 23. Musaiger AO, Hassan AS, Obeid O: The paradox of nutrition-related diseases in the Arab countries: the need for action. Int. J. Environ. Res. Public Health. 2011; 8 (9): 3637–3671. PubMed Abstract | Publisher Full Text | Free Full Text 24. El-Zanaty F, Way A: Egypt Demographic and Health Survey 2005. Cairo, Egypt: Ministry of Health and Population, National Population Council, El-Zanaty and Associates, and ORC Macro; 2006. 25. De Onis M: WHO Child Growth Standards Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. Methods and development. 2006. 26. UNICEF: UNICEF Conceptual Framework on Maternal and Child Nutrition. Contract No.: July 23. 27. Li Z, Kim R, Vollmer S, et al. : Factors associated with child stunting, wasting, and underweight in 35 low-and middle-income countries. JAMA Netw. Open. 2020; 3 (4): e203386-e. PubMed Abstract | Publisher Full Text | Free Full Text 28. Beal T, Tumilowicz A, Sutrisna A, et al. : A review of child stunting determinants in Indonesia. Matern. Child Nutr. 2018; 14 (4): e12617. PubMed Abstract | Publisher Full Text | Free Full Text 29. Akombi BJ, Agho KE, Hall JJ, et al. : Stunting, wasting and underweight in sub-Saharan Africa: a systematic review. Int. J. Environ. Res. Public Health. 2017; 14 (8): 863. PubMed Abstract | Publisher Full Text | Free Full Text 30. Mzumara B, Bwembya P, Halwiindi H, et al. : Factors associated with stunting among children aged 6-23 months in Zambian: evidence from the 2007 Zambia demographic and health survey. Int. J. Adv. Nutr. Health Sci. 2015; 3 (1): 116–131. 31. Elmighrabi NF, Fleming CAK, Agho KE: Wasting and Underweight in Northern African Children: Findings from Multiple-Indicator Cluster Surveys, 2014-2018. Nutrients. 2023; 15 (14): 3207. PubMed Abstract | Publisher Full Text | Free Full Text 32. Elmighrabi NF, Fleming CAK, Dhami MV, et al. : Childhood undernutrition in North Africa: systematic review and meta-analysis of observational studies. Glob. Health Action. 2023; 16 (1): 2240158. Publisher Full Text 33. El Taguri A, Betilmal I, Mahmud SM, et al. : Risk factors for stunting among under-fives in Libya. Public Health Nutr. 2009; 12 (8): 1141–1149. PubMed Abstract | Publisher Full Text 34. Blankenship JL, Gwavuya S, Palaniappan U, et al. : High double burden of child stunting and maternal overweight in the Republic of the Marshall Islands. Matern. Child Nutr. 2020; 16 . Publisher Full Text 35. Abeway S, Gebremichael B, Murugan R, et al. : Stunting and its determinants among children aged 6–59 months in Northern Ethiopia: A cross-sectional study. Int. J. Nutr. Metab. 2018; 2018 (1): 1–8. Publisher Full Text 36. Ghimire PR, Agho KE, Ezeh OK, et al. : Under-Five Mortality and Associated Factors: Evidence from the Nepal Demographic and Health Survey (2001 - 2016). Int. J. Environ. Res. Public Health. 2019; 16 (7): 1241. PubMed Abstract | Publisher Full Text | Free Full Text 37. Agho KE, Ogeleka P, Ogbo FA, et al. : Trends and Predictors of Prelacteal Feeding Practices in Nigeria (2003-2013). Nutrients. 2016; 8 (8): 462. PubMed Abstract | Publisher Full Text | Free Full Text 38. Climate Diplomacy: Food Price Shocks in Egypt. Climate Diplomacy; Accessed April 3, 2025. Reference Source 39. Ministry of Health and Population, National Nutrition Institute, UNICEF: Nutrition agenda for action policy paper on scaling up nutrition interventions in Egypt.2017. 40. Ministry of Planning and Economic Developent: The National agenda for sustainable development Egypt’s updated vision 2030.2023. 41. Elmighrabi NF, Fleming CAK, Dhami MV, et al. : A systematic review and meta-analysis of the prevalence of childhood undernutrition in North Africa. PLoS One. 2023; 18 (4): e0283685. PubMed Abstract | Publisher Full Text 42. Ghafar AA: Causes and consequences of inequality in Egypt. Muslim World. 2021; 111 (1): 5–26. Publisher Full Text 43. CAPMAS: The Central Agency for Public Mobilization and Statistics. Egypt in figures, formal report March 2018.2018. 44. Adeyeye SAO, Adebayo-Oyetoro AO, Tiamiyu HK: Poverty and malnutrition in Africa: a conceptual analysis. Nutr. Food Sci. 2017; 47 : 754–764. Publisher Full Text 45. Sarma H, Khan JR, Asaduzzaman M, et al. : Factors influencing the prevalence of stunting among children aged below five years in Bangladesh. Food Nutr. Bull. 2017; 38 (3): 291–301. PubMed Abstract | Publisher Full Text 46. Kishore S, Thomas T, Sachdev H, et al. : Modeling the potential impacts of improved monthly income on child stunting in India: a subnational geospatial perspective. BMJ Open. 2022; 12 (4): e055098. PubMed Abstract | Publisher Full Text | Free Full Text 47. Global Nutrition Report: Inequalities in the Global Burden of Malnutrition. Global Nutrition Report; 2020. Accessed April 3, 2025. 48. Neves PA, Barros AJ, Gatica-Domínguez G, et al. : Maternal education and equity in breastfeeding: trends and patterns in 81 low- and middle-income countries between 2000 and 2019. Int. J. Equity Health. 2021; 20 : 1–3. 49. Liaqat P, Rizvi MA, Qayyum A, et al. : Maternal education and complementary feeding. Pak. J. Nutr. 2006; 5 (6): 563–568. Publisher Full Text 50. Bain LE, Awah PK, Geraldine N, et al. : Malnutrition in Sub–Saharan Africa: burden, causes and prospects. Pan Afr. Med. J. 2013; 15 (1): 120. PubMed Abstract | Publisher Full Text | Free Full Text 51. Rachmi CN, Agho KE, Li M, et al. : Stunting, underweight and overweight in children aged 2.0–4.9 years in Indonesia: prevalence trends and associated risk factors. PLoS One. 2016; 11 (5): e0154756. PubMed Abstract | Publisher Full Text | Free Full Text 52. Ipa M, Widawati M, Laksono AD, et al. : Variation of preventive practices and its association with malaria infection in eastern Indonesia: Findings from community-based survey. PLoS One. 2020; 15 (5): e0232909. PubMed Abstract | Publisher Full Text | Free Full Text 53. Andayani Q, Laksono AD: Neonatal death incidence in healthcare Facility in Indonesia: does antenatal care matter? Indian J. Forensic Med. Toxicol. 2021; 15 (1): 1265. 54. Wulandari RD, Laksono AD: Determinants of knowledge of pregnancy danger signs in Indonesia. PLoS One. 2020; 15 (5): e0232550. PubMed Abstract | Publisher Full Text | Free Full Text 55. Lawal SA, Okunlola DA, Adegboye OA, et al. : Mother’s education and nutritional status as correlates of child stunting, wasting, underweight, and overweight in Nigeria: Evidence from 2018 Demographic and Health Survey. Nutr. Health. 2023; 30 : 821–830. Publisher Full Text 56. Fatima S, Manzoor I, Joya AM, et al. : Stunting and associated factors in children of less than five years: A hospital-based study. Pak. J. Med. Sci. 2020; 36 (3): 581–585. PubMed Abstract | Publisher Full Text 57. Semba RD, de Pee S , Sun K, et al. : Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study. Lancet. 2008; 371 (9609): 322–328. PubMed Abstract | Publisher Full Text 58. Tahangnacca M, Amiruddin R, Syam A: Model of stunting determinants: A systematic review. Enferm. Clin. 2020; 30 : 241–245. Publisher Full Text 59. Murtagh LMA: Working mothers, breastfeeding, and the law. Am. J. Public Health. 2011; 101 (2): 217–223. PubMed Abstract | Publisher Full Text | Free Full Text 60. Blau F, Grossberg D: Maternal labor supply and children’s cognitive development. Rev. Econ. Stat. 1992; 77 : 231–249. 61. Moghadam VM: Women, work and family in the Arab region: Toward economic citizenship. Doha International Family Institute Journal. 2015; 2013 (7). Publisher Full Text 62. Syeda B, Agho K, Wilson L, et al. : Relationship between breastfeeding duration and undernutrition conditions among children aged 0–3 Years in Pakistan. Int. J. Pediatr. Adolesc. Med. 2021; 8 (1): 10–17. PubMed Abstract | Publisher Full Text | Free Full Text 63. Fawzi WW, Herrera MG, Nestel P, et al. : A longitudinal study of prolonged breastfeeding in relation to child undernutrition. Int. J. Epidemiol. 1998; 27 (2): 255–260. PubMed Abstract | Publisher Full Text 64. Sawudatu Z: Does prolonged breast-feeding enhance nutritional status; evidence from Ghana. University of Ghana; 2001. (Doctoral dissertation). 65. Nubé M, Asenso-Okyere WK: Large differences in nutritional status between fully weaned and partially breast fed children beyond the age of 12 months. Eur. J. Clin. Nutr. 1996; 50 (3): 171–177. PubMed Abstract 66. Simondon KB, Simondon F: Mothers prolong breastfeeding of undernourished children in rural Senegal. Int. J. Epidemiol. 1998; 27 (3): 490–494. 67. Caulfield LE, Bentley ME, Ahmed S: Is prolonged breastfeeding associated with malnutrition? Evidence from nineteen demographic and health surveys. Int. J. Epidemiol. 1996; 25 (4): 693–703. PubMed Abstract | Publisher Full Text 68. Maggini S, Pierre A, Calder PC: Immune function and micronutrient requirements change over the life course. Nutrients. 2018; 10 (10): 1531. PubMed Abstract | Publisher Full Text | Free Full Text 69. Silva-Neto LG, dos Santos Neto JE , de Menezes Toledo Florêncio TM : Association between vitamin A supplementation and stunting and anemia in socially vulnerable Brazilian children. Eur. J. Nutr. 2024; 23 : 1–8. 70. Downe S, Finlayson K, Tunçalp O, et al. : Provision and uptake of routine antenatal services: a qualitative evidence synthesis. Cochrane Database Syst. Rev. 2019; 2019 (6). Publisher Full Text 71. World Health Organisation recommendations on antenatal care for a positive pregnancy experience. 20 Avenue Appia, 1211 Geneva 27, Switzerland: World Health Organization; 2016. 72. Thurstans S, Opondo C, Seal A, et al. : Boys are more likely to be undernourished than girls: a systematic review and meta-analysis of sex differences in undernutrition. BMJ Glob. Health. 2020; 5 (12): e004030. PubMed Abstract | Publisher Full Text | Free Full Text 73. Wamani H, Åstrøm AN, Peterson S, et al. : Boys are more stunted than girls in sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys. BMC Pediatr. 2007; 7 : 1–10. Publisher Full Text 74. Sawyer CC: Child mortality estimation: estimating sex differences in childhood mortality since the 1970s.2012. 75. Costa JC, da Silva IC , Victora CG: Gender bias in under-five mortality in low/middle-income countries. BMJ Glob. Health. 2017; 2 (2): e000350. PubMed Abstract | Publisher Full Text | Free Full Text 76. Navarro D, Serrano M, Dolores M, et al. : Female eco-stability and severe malnutrition in children: Evidence from humanitarian aid interventions of Action Against Hunger in African, Asian and Latin American countries. Clin. Nutr. Hosp. Diet. 2017; 37 (4): 127–134. 77. Stinson S: Sex differences in environmental sensitivity during growth and development. Am. J. Phys. Anthropol. 1985; 28 (S6): 123–147. Publisher Full Text 78. Eriksson JG, Kajantie E, Osmond C, et al. : Boys live dangerously in the womb. Am. J. Hum. Biol. 2010; 22 (3): 330–335. PubMed Abstract | Publisher Full Text | Free Full Text 79. Kirchengast S, Hartmann B: The male disadvantage hypothesis reconsidered: is there really a weaker sex? An analysis of gender differences in newborn somatometrics and vital parameters. J. Life Sci. 2009; 1 (1): 63–71. Publisher Full Text 80. Drevenstedt GL, Crimmins EM, Vasunilashorn S, et al. : The rise and fall of excess male infant mortality. Proc. Natl. Acad. Sci. 2008; 105 (13): 5016–5021. PubMed Abstract | Publisher Full Text | Free Full Text 81. Stevenson DK, Verter J, Fanaroff AA, et al. : Sex differences in outcomes of very low birthweight infants: the newborn male disadvantage. Arch. Dis. Child Fetal Neonatal Ed. 2000; 83 (3): 182F–1185F. PubMed Abstract | Publisher Full Text | Free Full Text 82. Wells JC: Natural selection and sex differences in morbidity and mortality in early life. J. Theor. Biol. 2000; 202 (1): 65–76. PubMed Abstract | Publisher Full Text 83. Slemming W, Kagura J, Saloojee H, et al. : Early life risk exposure and stunting in urban South African 2-year old children. J. Dev. Orig. Health Dis. 2017; 8 (3): 301–310. PubMed Abstract | Publisher Full Text 84. Oyenubi A: Who benefits from the South African Child Support Grant?: The role of gender and birthweight. Dev. South. Afr. 2021; 38 (4): 539–563. Publisher Full Text 85. Khara T, Mwangome M, Ngari M, et al. : Children concurrently wasted and stunted: A meta-analysis of prevalence data of children 6–59 months from 84 countries. Matern. Child Nutr. 2018; 14 (2): e12516. PubMed Abstract | Publisher Full Text | Free Full Text 86. Mehta S, Mugusi FM, Bosch RJ, et al. : A randomized trial of multivitamin supplementation in children with tuberculosis in Tanzania. Nutr. J. 2011; 10 : 1–9. 87. WHO: Global nutrition targets 2025: low birth weight policy brief- external site opens in new window. Geneva: WHO; 2014. 88. Toma TM, Andargie KT, Alula RA, et al. : Factors associated with wasting and stunting among children aged 06–59 months in South Ari District, Southern Ethiopia: a community-based cross-sectional study. BMC Nutr. 2023; 9 (34): 34. PubMed Abstract | Publisher Full Text | Free Full Text 89. Fink G, Rockers PC: Childhood growth, schooling, and cognitive development: further evidence from the Young Lives study. Am. J. Clin. Nutr. 2014; 100 : 182–188. PubMed Abstract | Publisher Full Text 90. Karlsson O, Kim R, Moloney GM, et al. : Patterns in child stunting by age: A cross-sectional study of 94 low-and middle-income countries. Matern. Child Nutr. 2023; 19 (4): e13537. PubMed Abstract | Publisher Full Text | Free Full Text 91. Jelenkovic A, Sund R, Yokoyama Y, et al. : Genetic and environmental influences on human height from infancy through adulthood at different levels of parental education. Sci. Rep. 2020; 10 (1): 7974. PubMed Abstract | Publisher Full Text | Free Full Text 92. Addo OY, Stein AD, Fall CH, et al. : Consortium on Health Orientated Research in Transitional Societies (COHORTS) Group. Maternal height and child growth patterns. J. Pediatr. 2013; 163 (2): 549–554.e1. PubMed Abstract | Publisher Full Text | Free Full Text 93. Desmond C, Casale D: Catch-up growth in stunted children: Definitions and predictors. PLoS One. 2017; 12 (12): e0189135. PubMed Abstract | Publisher Full Text | Free Full Text 94. Ahmawati VE, Pamungkasari EP, Murti B: Determinants of stunting and child development in Jombang District. J. Matern. Child Health. 2018; 03 (1): 68–80. Publisher Full Text 95. Kim R, Mejía-Guevara I, Corsi DJ, et al. : Relative importance of 13 correlates of child stunting in South Asia: Insights from nationally representative data from Afghanistan, Bangladesh, India, Nepal, and Pakistan. Soc. Sci. Med. 2017; 187 : 144–154. PubMed Abstract | Publisher Full Text 96. Rahman MS, Howlader T, Masud MS, et al. : Association of low-birth weight with malnutrition in children under five years in Bangladesh: do mother’s education, socio-economic status, and birth interval matter? PLoS One. 2016; 11 (6): e0157814. PubMed Abstract | Publisher Full Text | Free Full Text 97. Pomati M, Mendoza-Quispe D, Anza-Ramirez C, et al. : Trends and patterns of the double burden of malnutrition (DBM) in Peru: a pooled analysis of 129,159 mother–child dyads. Int. J. Obes. 2021; 45 (3): 609–618. PubMed Abstract | Publisher Full Text | Free Full Text 98. Rachmah Q, Mahmudiono T, Loh SP: Predictor of Obese Mothers and Stunted Children in the Same Roof: A Population-Based Study in the Urban Poor Setting Indonesia. Front. Nutr. 2021; 8 : 710588. PubMed Abstract | Publisher Full Text | Free Full Text 99. Elmighrabi N: Supplementary materials. Dataset. figshare. 2024. Publisher Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 03 Jan 2025 ADD YOUR COMMENT Comment Author details Author details 1 Department of Nutrition, Faculty of Public Health, University of Benghazi Faculty of Medicine, Benghazi, Benghazi district, Libya 2 School of Health sciences, Western Sydney University - Campbelltown Campus, Campbelltown, New South Wales, 2560, Australia 3 Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, South Penrith, New South Wales, 2750, Australia 4 Faculty of Health Sciences, University of Johannesburg, Johannesburg, 2094, South Africa Nagwa Farag Elmighrabi Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Software, Validation, Visualization, Writing – Original Draft Preparation Catharine A. K. Fleming Roles: Conceptualization, Investigation, Project Administration, Supervision, Validation, Writing – Review & Editing Kingsley E. Agho Roles: Conceptualization, Investigation, Methodology, Project Administration, Software, Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This article is supported by Western Sydney University The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (3) version 3 Revised Published: 20 May 2025, 14:15 https://doi.org/10.12688/f1000research.159168.3 version 2 Revised Published: 17 Mar 2025, 14:15 https://doi.org/10.12688/f1000research.159168.2 version 1 Published: 03 Jan 2025, 14:15 https://doi.org/10.12688/f1000research.159168.1 Copyright © 2025 Elmighrabi NF et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Elmighrabi NF, Fleming CAK and Agho KE. Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.12688/f1000research.159168.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 3 VERSION 3 PUBLISHED 20 May 2025 Revised Views 0 Cite How to cite this report: Marume A. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r440926 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-440926 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 14 Jan 2026 Anesu Marume , University of Zimbabwe, Harare, Zimbabwe Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.180883.r440926 General Comments The manuscript addresses an important public health issue; however, substantial revisions are required to improve clarity, methodological transparency, and internal consistency. In several sections, the English language requires careful editing to improve readability and precision. Additionally, results ... Continue reading READ ALL General Comments The manuscript addresses an important public health issue; however, substantial revisions are required to improve clarity, methodological transparency, and internal consistency. In several sections, the English language requires careful editing to improve readability and precision. Additionally, results are often presented without appropriate statistical evidence, limiting their interpretability and policy relevance. Specific Comments Abstract - Methods The statement “A multilevel regression that adjusts for…” is unclear and grammatically awkward. Please clarify whether the multilevel regression explicitly adjusts for sampling weights or merely accounts for the survey design. Similar grammatical and clarity issues are present throughout the manuscript and require systematic editing. Abstract – Results The rationale for stratifying prevalence estimates by age group is unclear. If stunting prevalence is relatively uniform across age categories, it would be more appropriate to present an overall prevalence for the study population rather than disaggregating by age without a clear justification. The abstract should prioritise statistically significant findings with clear implications for policy or intervention. Results should be accompanied by appropriate measures of association (e.g., odds ratios with 95% confidence intervals and/or p-values). Statements indicating an “association” without statistical evidence are not sufficiently justified. Language and Clarity Several sentences in the abstract are grammatically incorrect or unclear. For example, phrases such as “mothers who did not have antenatal care visits during pregnancy” require rephrasing for clarity and correctness. Abstract - Conclusion The abstract conclusion does not align with the results presented in the abstract. Conclusions should be strictly based on findings reported in the abstract; currently, there is a disconnect between the presented results and the concluding statements. Introduction Inconsistencies are evident in the framing of the burden of stunting. For example, the first paragraph refers to “one-third,” while the second paragraph refers to “one-fifth.” These figures must be reconciled and accurately referenced. Paragraph 5, line 2: Please specify the age group being referred to; otherwise, there is a disconnect between the first and second sentences. Several statistics cited are outdated (e.g. from 2014) but are presented as if current. While historical context is valuable, the authors should incorporate more recent statistics and studies to support their arguments. The final paragraph of the introduction contains a weak and potentially incorrect justification for combining datasets. Pooling data across years does not inherently strengthen an analysis unless temporal effects are explicitly modelled (e.g., through time trends, spatial–temporal analysis, or inclusion of survey year as a variable). Assuming that determinants of stunting remained constant between 2005 and 2014 may, in fact, weaken the study’s validity. Methods Study Population / Sample Selection The sample described reflects the overall EDHS sample rather than the analytic sample used in this study. The authors should clearly describe how the study sample was derived from the EDHS, including inclusion and exclusion criteria. Much of the current information is already published elsewhere and does not add value. Outcome Variable The authors must explain how unrealistic or implausible height-for-age z-scores (HAZ) were handled. This can be included in this section or in a separate data management subsection. Clarification is needed on how data from EDHS 2005 (conducted prior to the 2006 WHO Child Growth Standards) were handled. If recoding or recalculation was performed, this process should be explicitly described. The WHO standards should be correctly referred to as growth standards, not growth references. Covariates The description of the wealth index suggests it was constructed by the authors; however, this variable is already generated within DHS datasets. This should be clearly stated. The final sentence under “potential covariates” is confusing and should be revised. If variables were grouped as “other” because they did not align with the UNICEF framework, this should be stated clearly and justified. Results Descriptive characteristics of the study sample should be presented in a single table (e.g. Table 1) rather than as an extensive narrative. This would also eliminate the need for Figures 1–3, which merely replicate prevalence estimates and add limited value. A data management section is missing from the methodology, making it difficult to assess the reported sample size. The authors should clearly describe how missing data were handled; it is unlikely that no missingness existed across all variables. The section on the prevalence of stunting by factors substantially overlaps with the “Characteristics of the sample” section. These could be combined into a single results subsection with an appropriately structured table (including a total column), allowing the text to focus on key findings. In Table 1, child age appears both as a row and as a column; this is redundant and should be corrected. Additionally, the use of very small age categories may unnecessarily complicate the model and should be justified. The footnote in Table 1 is unclear; stating “CI = p-value” is incorrect and should be corrected. Claims of statistical significance must be supported by appropriate evidence (adjusted odds ratios with 95% confidence intervals and/or p-values). Discussion Results are repeatedly restated in the discussion without sufficient interpretation. The discussion should focus on explaining findings rather than duplicating results. The second paragraph of the discussion consists of a single sentence and lacks a logical connection to the surrounding paragraphs. The argument should be expanded and better integrated into the overall discussion. Is the work clearly and accurately presented and does it cite the current literature? No Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Public Health Nutrition I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Marume A. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r440926 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-440926 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Hossain MA. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r440929 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-440929 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 08 Jan 2026 Md. Alamgir Hossain , International Centre for Diarrhoeal Disease Research, Dhaka, Dhaka Division, Bangladesh Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.180883.r440929 This is a very good study; however, the data set is older. If possible, see the trends as well with the 2005, 2008, 2014, or maybe 2018 and 2022 (if the data set are availabale. Otherwise, it seems the older ... Continue reading READ ALL This is a very good study; however, the data set is older. If possible, see the trends as well with the 2005, 2008, 2014, or maybe 2018 and 2022 (if the data set are availabale. Otherwise, it seems the older result, which may not have implications for taking action. The results in abstract are very brief. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Epidemiology, Social behavior and public health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Hossain MA. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r440929 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-440929 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Harwanto F. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r427076 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-427076 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 10 Nov 2025 Fatria Harwanto , Sriwijaya University, Palembang and Indralaya, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.180883.r427076 In summary, the article “Concurrent stunting among under-five children in Egypt” is a well-designed and relevant study that adds meaningful insight into the problem of child stunting in Egypt. The authors make good use of large, nationally representative data from ... Continue reading READ ALL In summary, the article “Concurrent stunting among under-five children in Egypt” is a well-designed and relevant study that adds meaningful insight into the problem of child stunting in Egypt. The authors make good use of large, nationally representative data from multiple Demographic and Health Surveys (EDHS 2005–2014) and apply an appropriate analytical approach to explore the social and biological factors linked to stunting. The work is technically sound and clearly structured, showing careful attention to data analysis and presentation. That said, several points could be improved to make the paper clearer and more convincing. The term “concurrent stunting” should be explained more clearly, as it may be interpreted in different ways. The authors should also remind readers that, because the study design is cross-sectional, the findings describe associations rather than cause-and-effect relationships . Some aspects of the statistical section, such as model validation or testing for multicollinearity, could be described in more detail to strengthen the technical transparency. The discussion around the relationship between vitamin A supplementation and higher odds of stunting also needs a more careful explanation, as this could be due to reverse causality (children who are already undernourished are more likely to receive supplements). Finally, the paper would be stronger if the authors included more recent references (after 2020) and expanded their discussion of environmental and social influences, particularly water and sanitation (WASH), maternal education, and economic inequality. With these improvements, the article would make a valuable and credible contribution to the evidence base on child nutrition in Egypt and could serve as an important reference for policymakers and researchers working to reduce stunting and improve child health. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: public health nutrition, nutritional epidemiology, and biomedical aspects of maternal and child nutrition. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Harwanto F. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r427076 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-427076 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Sumarmi S. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r420417 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-420417 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 10 Nov 2025 Sri Sumarmi , Universitas Airlangga, Surabaya, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.180883.r420417 Tittle may be added: "Concurrent stunting and its associated factors among children under five in Egypt: Pooled analysis from EDHS 2005-2014" Abstract: prevalence of stunting in each age group represents prevalence in what year? or it is the ... Continue reading READ ALL Tittle may be added: "Concurrent stunting and its associated factors among children under five in Egypt: Pooled analysis from EDHS 2005-2014" Abstract: prevalence of stunting in each age group represents prevalence in what year? or it is the mean value pooled data? Pooled data is data from multiple sources that have been combined for analysis. Methods: In the methods section, author did not explain clearly what actually the study sample is its individual data or aggregate data (cluster/area). Consider the outcome variable is Z score, the unit analysis is individual data (maternal-child paired data) It is better to make a figure (chart flow) to describe clearly how you did the sample selection. Potential Covariate: The covariates in this study were selected using UNICEF framework of maternal and child malnutrition. Please ensure that authors make a proper variable grouping as basic factors, underlying factors and immediate factors. Socio economic is categorize as basic factor or as root causal, rather than underlying factors as mentioned in this study. (Please check The UNICEF conceptual framework of undernutrition is shown. Source: ( Improving Child Nutrition: The achievable imperative for global progress - UNICEF DATA , 2013. p. 4.) Maternal Nutrition is an important factor affecting child stunting, as well as antenatal care (ANC). Iron folic acid (IFA) is the crucial program for pregnant women over the world. In this study does not include this data. I suggest adding the data of IFA consumption during pregnancy include in multivariate analysis. In the other side, sensitive aspect of stunting such as Water Sanitation and Hygiene (WASH) were not complete in this analysis except water supply, without consider household sanitation and hygiene behavior among household member, particularly mothers' behavior. The category of short stature mother less than 160 cm? please elaborate why authors use the cut off 160 cm for short stature mother. Is it originally category in EDHS or you grouping with certain consideration? WHO does not specify a single fixed height threshold for short stature in adult women. WHO use <145 cm, in one of publication, but in the other report use <150 cm as cut off point to identify shorth stature mother. Conclusion can be generated after the additional data include in multivariate analysis Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: maternal and child nutrition; micronutrient I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Sumarmi S. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r420417 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-420417 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Astuti Y. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r396491 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-396491 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 30 Sep 2025 Yuly Astuti , National Research and Innovation Agency, Jakarta, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.180883.r396491 This is an important study, and the authors have clearly put in a significant amount of work. The manuscript addresses stunting as a critical public health issue in Egypt and utilizes a robust dataset. While previous reviewer comments have led ... Continue reading READ ALL This is an important study, and the authors have clearly put in a significant amount of work. The manuscript addresses stunting as a critical public health issue in Egypt and utilizes a robust dataset. While previous reviewer comments have led to improvements, there are still several areas that require further attention to enhance clarity, precision, and overall scientific rigor before indexing. The detailed comments for each section are as follows. INTRODUCTION : 1. "Undernutrition is a significant predictor of poor growth and morbidity in infants and young children. Globally, stunting (low height for age) affects 150 million children under the age of five, a substantial portion of the world’s young population." --> These two sentences are good starting points, but they would be stronger if directly linked to show the relationship between undernutrition and stunting. Currently, they feel a bit disconnected. --> Clearly state that stunting is a form of chronic undernutrition . For example: "Undernutrition is a significant predictor of poor growth and morbidity in infants and young children. Among its manifestations, stunting (defined as low height for age) is a particularly widespread form of chronic undernutrition , affecting 150 million children under the age of five globally, a substantial portion of the world’s young population." This immediately clarifies the hierarchy. 2. The introduction mentions "stunting (low height for age)" and its consequences. --> While "low height for age" is the definition, it's vital to explicitly state its chronic nature and the critical period during which it develops. This differentiates it from acute malnutrition (wasting) and explains why it has long-term, often irreversible, consequences. You briefly touch on this regarding age stratification, but it should be clearly stated here. --> After defining stunting, add a sentence emphasizing: "Stunting is fundamentally caused by prolonged periods of insufficient nutrient intake and/or recurrent infections, primarily during the crucial 1,000 First Days of Life (from conception to two years of age) . This chronic nature means its adverse effects on physical and cognitive development are largely irreversible after a child reaches two years old, though its impacts continue through the first five years of life and into adulthood." 3. Consistency in Acronyms and Terminology --> There is an inconsistency in using "Sustainable Development Goal" (singular) and "Sustainable Development Goals" (plural), as well as "SDG" and "SDGs." Consistency is key for professional writing. 4. "It stands out from previous research on stunting among children in Egypt due to its unique focus on combining data sets from 2005 to 2014. The study utilises population-based national representative data and provides age-specific results by examining the prevalence of stunting in three age groups: 0-23 months, 24-59 months, and 0-59 months across the three-survey data." --> This is a strong statement of your study's contribution. Ensure the language is precise. "Utilises" is often preferred over "utilizes" in British English (common in F1000Research). --> This section is good. Just ensure minor grammatical refinements are made during the overall language edit. 4. I found several instances of minor grammatical errors, awkward phrasing, and capitalization issues in the Introduction (and likely throughout the manuscript, as indicated in your initial comments). This affects readability and professionalism. For examples: - " The consequences, of stunting particularly in low- and middle-income countries, are far-reaching, leading to impaired growth, reduced educational attainment, delayed school enrolment, and a 20% reduction in adult income." --> The comma after "consequences" is unnecessary. - "Therefore, addressing undernutrition is important not only for public health, but also for enhancing the country long-term economic growth and social stability." --> "country long-term" should be "country's long-term." You have acknowledged the need for English editing in your author responses. A thorough review by a native English speaker or a professional editing service is highly recommended to correct these issues, ensure smooth transitions, and enhance the overall readability and conciseness of the text. Pay close attention to: article usage (a, an, the), subject-verb agreement, punctuation, and consistent capitalization. METHODS: The Methods section generally provides the necessary information about your data source, study area, sample selection, outcome variable, covariates, and statistical analysis. However, some parts could be explained more simply, and there are a number of grammatical errors and awkward sentences that make it harder to read and understand. 1. "Data Source" Sub-section: "Analysis utilised data from the EDHS conducted in 2005, 2008, and 2014. The surveys were implemented by El-Zanaty and Associates on behalf of the Ministry of Health and Population and the National Population Council, as part of the global MEASURE DHS project funded by the United States Agency for International Development (USAID)." --> The first sentence is clear. However, the next sentence about who implemented the surveys and the funding is quite long and a bit formal --> Suggestion for Improvement: Try to break down long sentences or simplify phrasing. For example: "This study used data from the Egyptian Demographic and Health Surveys (EDHS) conducted in 2005, 2008, and 2014. These surveys were carried out by El-Zanaty and Associates for the Ministry of Health and Population and the National Population Council. They were part of the worldwide MEASURE DHS project, funded mainly by the United States Agency for International Development (USAID)." 2. "Study Area" Sub-section: "Administratively, Egypt is divided into 26 governorates and Luxor City. The four Urban Governorates (Cairo, Alexandria, Port Said, and Suez) have no rural population. Each of the other 22 governorates is subdivided into urban and rural areas. Nine of these governorates are located in the Nile Delta (Lower Egypt), eight are located in the Nile Valley (Upper Egypt), and the remaining five Frontier Governorates are located on the eastern and western boundaries of Egypt." --> This description is quite detailed, which is good for context. However, some phrasing could be smoother. --> Suggestion for Improvement: "Egypt is divided into 26 governorates, plus Luxor City. Four of these, known as Urban Governorates (Cairo, Alexandria, Port Said, and Suez), do not have rural areas. The other 22 governorates are split into urban and rural parts. Nine are in the Nile Delta (Lower Egypt), eight in the Nile Valley (Upper Egypt), and the last five are 'Frontier Governorates' on the eastern and western borders." 3. "Sample Selection" Sub-section: "This study analysed data from the EDHS for 2005 (n=13,599), 2008 (n=10,590), and 2014 (n=15,668) focusing on children aged 0-59 months. The sample design was multistage sampling design enabled the estimation of key population and health indicators, including fertility and mortality rates, for Egypt, six major regions, and individual governorates." --> The second sentence is grammatically incorrect and very hard to follow. As previously noted, the detailed theoretical justification for choosing the specific age groups (0-23 months, 24-59 months, and 0-59 months) is currently only in your author response. This crucial explanation must be explicitly incorporated into this 'Sample Selection' sub-section within the main manuscript body to enhance methodological transparency and rationale. 4. "Outcome Variable" Sub-section: "The outcome variable for this study was stunting, which was determined by the height-for-age Z-score (HAZ). Children whose height-for-age is less than -2 standard deviations from the corresponding reference median (Z score≤−2) were categorised as stunted." --> No major changes needed for clarity. Just ensure consistent formatting for Z-scores (e.g., Z−score≤−2 instead of Z score≤−2). 5. "Potential Covariates" Sub-section: "The UNICEF conceptual framework of the determinants of nutritional status for mother and child health guided the selection of covariate variables, with adjustments based on a previous study conducted in 35 low- and middle-income countries." --> This sentence is quite long, difficult to follow. The lists of factors under "Basic factors," "Underlying factors," and "Immediate factors" are dense and lack clear separation for readability --> Use bullet points or a more structured list format for the factors within each category (Basic, Underlying, Immediate). This make the information much more understand. 6. "Statistical Analysis" Sub-section: "In our analysis, we examined factors associated with stunting from each EDHS 2005,2008 and 2014 surveys to determine the strength of the association of each characteristic in relation to the likelihood of stunting in Egypt." --> 2005,2008 should have a space. "In our analysis, we examined factors..." is fine, but "to determine the strength of the association of each characteristic in relation to the likelihood of stunting in Egypt" is a bit wordy --> Suggestion for Improvement: "For our analysis, we examined factors associated with stunting using data from each of the 2005, 2008, and 2014 EDHS, aiming to understand how each characteristic related to the likelihood of stunting in Egypt." "The outcome variable for the final logistic regression models is the presence or absence of stunting (Y=1= stunted, 0= not stunted)." --> As noted in the previous feedback, this phrasing can be improved . --> "The outcome variable for the final logistic regression models was the presence or absence of stunting, coded as 1 for stunted and 0 for not stunted." "All statistical analyses were carried out using STATA/MP Version.17.0 (Stata Corp, College Station, TX, USA), ( https://blog.stata.com/2021/04/20/stata-17-released/ ), and adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) obtained from the adjusted multivariate regression were used to measure the factors associated with child stunting." --> The URL for STATA is likely not needed in the main text; it's usually sufficient to just state the software and version. The sentence is also long. RESULTS: The narrative should summarize the most important findings from your tables (Table 1, Table S1, Table S2, Table S3) rather than simply restating every number. The detailed numbers belong in the tables themselves. Your narrative should guide the reader through the most salient patterns and statistically significant associations. Organize your results logically. You could group them by: - Overall prevalence and trends (as you've done); - Key findings from basic factors (e.g., region, wealth); - Key findings from underlying factors (e.g., maternal education, maternal height, ANC); - Key findings from immediate factors (e.g., breastfeeding, vitamin A); - Then, discuss specific age-group findings. Each sub-section (e.g., "Characteristics of the sample," "Prevalence of stunting," "Prevalence of stunting by factors," "Multivariable analysis") should begin with a clear introductory sentence stating what that section will present. While you mention statistical significance (e.g., p-values), ensure you emphasize the strength and direction of associations using Adjusted Odds Ratios (AORs) and their 95% Confidence Intervals (CIs). Do not just say something is "significantly associated"; explain how it's associated (e.g., "X was associated with a 1.5 times higher odds of stunting [AOR = 1.5, 95% CI: Y-Z]"). This is critical for interpreting the practical importance of your findings. Eliminate any repetitive phrases or sentences. For example, "The difference in the prevalence of stunting among children aged 0-23 months in Egypt... is illustrated in Figure 1." You can simply state: "Figure 1 illustrates the prevalence of stunting among children aged 0-23 months in Egypt." Your Figures 1, 2, and 3 are good. In the narrative, make sure you do not just state what the figures show, but interpret the key trends and changes over time, highlighting specific percentages and year-on-year differences that are most impactful. For the Results of Multivariate Logistic Regression Based on Age Stratification: Instead of jumping between age groups for each factor, consider: 1. Common Significant Factors Across All Age Groups (0-23, 24-59, 0-59 months): - Group these together first, clearly stating that these factors consistently influenced stunting across all three age cohorts. Example: Multivariate logistic regression revealed that several factors were consistently associated with stunting across all three age groups (0-23, 24-59, and 0-59 months) (Table 2). These included [list factors: e.g., survey year, region, maternal education, maternal height, ANC visits, media exposure]. For instance, children in 2014 had significantly lower odds of stunting compared to 2005 across all groups (e.g., 0-23 months: AOR=0.64, 95% CI: 0.54-0.76; 0-59 months: AOR=0.71, 95% CI: 0.59-0.84). - Explicitly mention the direction of association and provide AORs and CIs for each factor discussed. For example, for maternal primary education: Children whose mothers had only primary education were significantly more likely to be stunted than those whose mothers had secondary or higher education (e.g., 0-23 months: AOR=1.37, 95% CI: 1.20-1.72; 0-59 months: AOR=1.21, 95% CI: 1.02-1.44). Similarly, for maternal height: Mothers less than 155 cm tall had a significantly higher risk of having stunted children across all age groups compared to mothers taller than 160 cm (e.g., for 0-59 months, mothers <145 cm: AOR=3.11, 95% CI: 2.24-4.33). 2. Age-Specific Significant Factors: - Provide separate paragraphs to factors that were significant only for specific age groups. Example: - 0-23 months specific factors: Among children aged 0-23 months, significant associations were also observed with child gender, age (18-23 months), maternal marital status, place and mode of delivery, and duration of breastfeeding. Provide the AORs and CIs for each. - 24-59 months specific factors: For the 24-59 months group, additional significant factors included... (e.g., paternal age, maternal BMI > 25, maternal work status, unprotected drinking water source, frequency of reading magazine/newspaper). - 0-59 months specific factors (if any unique ones beyond the common): If there are factors significant only for the overall 0-59 months group that weren't common to all or specific to others, highlight them here. The Results section should only present findings. Avoid discussing why a finding occurred or its implications for policy; save that for the Discussion section. For example, avoid sentences like 'This is most likely due to...' or 'This finding may be attributed to the fact that...' These belong in the discussion." DISCUSSION: - Begin by briefly restating the most important findings that emerged from your results (e.g., overall prevalence, trends, and the strongest/most consistent associations from multivariate analysis across age groups). Avoid simply repeating numbers; focus on the insights . - Instead of discussing factors haphazardly, group related findings and discuss them thematically. For example, dedicate a paragraph or two to socioeconomic factors, then maternal factors, then environmental, and so on. This makes the argument easier to follow. - Your study found that boys were significantly more prone to stunting than girls. The discussion offers explanations for this, consistent with global literature. You also mention that 'in some societies or regions, the health and well-being of younger females may be prioritized by social values and practices, which may lead to superior nutrition and care for them in comparison to older girls or boys'. This is a very important point for the Egyptian context . --> elaborate on this socio-cultural aspect. Do cultural practices around feeding, care-seeking, or resource allocation differ significantly between urban and rural areas in Egypt, potentially influencing sex-based disparities in stunting? For example, are there specific traditional beliefs or gender roles in rural Upper Egypt (where stunting is high) that might lead to boys receiving less preferential feeding or healthcare than girls, or vice versa? Or perhaps, could the challenges of access to healthcare and diverse foods in rural areas (as you have mentioned) exacerbate any pre-existing biological or social vulnerabilities in boys more than girls in those settings? Are there specific cultural practices related to complementary feeding, introduction of solid foods, or healthcare-seeking for boys versus girls that might be relevant? For example, if boys are perceived as more robust, parents might delay seeking care for early signs of illness, or conversely, if boys are valued more for labor, their needs might be prioritized differently at different ages. If your data (even indirectly) or existing Egyptian qualitative research can support or refute such hypotheses, weave it into the discussion. You mention the Egyptian government's efforts (e.g., National Nutrition Strategy, Food Subsidy Programs) that likely contributed to the decline in stunting by 2014. --> The discussion of the 2008 rise and subsequent decline should lead to specific policy recommendations for preventing or mitigating future shocks (like economic crises or food price increases). CONCLUSION: The Conclusion section effectively reiterates the main problem (stunting as a public health challenge) and lists several recommended actions. To make it more impactful for a high-impact journal, it needs to be more concise, directly tied to your specific findings , and forward-looking. As emphasized before, a thorough professional English editing service is highly recommended for this manuscript. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: My expertise lies in maternal and child health, with a specific focus on the cultural and traditional influences on health outcomes, particularly concerning stunting I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Astuti Y. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r396491 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-396491 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: HIDAYANTI L. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r416860 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-416860 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 30 Sep 2025 LILIK HIDAYANTI , Siliwangi University, Tasikmalaya, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.180883.r416860 Dear Author(s) Congratulations on a work well done. Although the topic of stunting and its determinants is not a new area, but the study population and how this research provides a comprehensive understanding of the determinants of stunting ... Continue reading READ ALL Dear Author(s) Congratulations on a work well done. Although the topic of stunting and its determinants is not a new area, but the study population and how this research provides a comprehensive understanding of the determinants of stunting across three age groups are important findings. There are several things to considerer The data used is data from 2005, 2008, 2014. Is it still relevant to current conditions? Why don't you try to compare the determinants between the three years to predict changes in the determinants of stunting in Egypt? For maternal characteristics, data on weight gain during pregnancy, if available, would be better compared to BMI. Since the subject's age is 0-59 months, if there is data, in addition to presenting data on breastfeeding, it would be better to present data on providing complementary foods. What is your reason for using Pearson Chi Square, why don't you use Fisher Exact or Continuity Correction? For continuous variables, why do you use an independent t-test? You should first state that all continuous variables are normally distributed. Why did you use p<0.05 to determine which variables to include in a logistic regression model? Why not choose p<0.25, even though you're building a predictive model? It's also a good idea to consider changes in the OR during the modeling process to find the most appropriate model. Table 1 is very comprehensive but confusing to read. Please explain whether the data displayed is n(%) or cOR(95%CI). If the value is cOR, please specify the reference. In the results of logistic regression modeling, it is best to explain at the start of the modeling how many variables can be included in the model, and also how many times the modeling has been carried out to obtain the most appropriate model. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: public health nutrition I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT HIDAYANTI L. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r416860 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-416860 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 2 VERSION 2 PUBLISHED 17 Mar 2025 Revised Views 0 Cite How to cite this report: Setiawan AS. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.178689.r374387 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v2#referee-response-374387 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 02 Apr 2025 Arlette Suzy Setiawan , Universitas Padjadjaran, Bandung, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.178689.r374387 Dear Authors, This timely and important study investigates the prevalence and causes of stunting in Egyptian children under five years of age using nationally representative data from the 2005, 2008, and 2014 Egyptian Demographic and Health Surveys ... Continue reading READ ALL Dear Authors, This timely and important study investigates the prevalence and causes of stunting in Egyptian children under five years of age using nationally representative data from the 2005, 2008, and 2014 Egyptian Demographic and Health Surveys (EDHS). Aggregate data and age-specific analyses provide new insights into the current work. The work is methodologically sound and addresses an important public health question with clear policy importance. However, there are still some areas for improvement, especially in terms of language clarity, organization of data presentation, and interpretation of results. You will find detailed comments below that would help improve the article. Strengths: Substantive Methodology: The validity of the results is enhanced by multistage logistic regression and appropriate adjustments to the survey design. Large, representative sample: Combining data from three DHS surveys provides a comprehensive picture and improves the generalizability of the study. Unique contribution of age-stratified analysis: The stratification of results into three age groups—0–23 months, 24–59 months, and 0–59 months—provides a deeper understanding of the risk variables for stunting at different developmental stages. Policy implications: The paper, relevant to Egyptian legislators, makes a strong case for multisectoral interventions to combat stunting. Work points: A comprehensive revision of the English paper would help correct grammar, improve sentence structure, and enhance readability. Some statements are awkward or repetitive, such as: "Despite the Egyptian government's efforts to date, malnutrition remains a significant problem in Egypt." Presentation of results: Table 1 is difficult to read but still detailed. Consider visual representations (e.g., heatmaps or forest plots) or summaries of key results. The narrative results section repeats much of the material presented in the table. A more concise summary is recommended. Interpretation of results: The association between vitamin A supplementation and a higher risk of stunting in children aged 0-23 months should be carefully discussed as it may indicate a reverse causal relationship. The findings that children from middle-income families are at lower risk of stunting than those from the wealthiest families also require further discussion. or theory. The significant increase in stunting rates in 2008 requires more in-depth contextual analysis (e.g., political factors, economic situation). The discussion could be extended to consider how stunting patterns during the study period were influenced by Egypt’s political environment. Policy recommendations could be more specific and practical, such as: B. Expanding ANC work in communities, targeted maternal education initiatives, or improving access to water, sanitation, and hygiene services (WASH) in Upper Egypt. A section of the study specifically addresses limitations and will help highlight issues such as recall bias, missing covariates (e.g., dietary diversity), and lack of post-2014 data. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: stunting I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Setiawan AS. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.178689.r374387 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v2#referee-response-374387 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 21 Apr 2025 Nelmighrabi Elmighrabi , School of Health sciences, Western Sydney University - Campbelltown Campus, Campbelltown, 2560, Australia 21 Apr 2025 Author Response Dear Professor Arlette Suzy Setiawan, Thank you very much, Professor, for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality ... Continue reading Dear Professor Arlette Suzy Setiawan, Thank you very much, Professor, for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality of the manuscript. Below is our point-by-point response to each of your comments for consideration. Comment 1 A comprehensive revision of the English paper would help correct grammar, improve sentence structure, and enhance readability. Author's response: Thank you for your suggestion. We have revised the manuscript thoroughly to improve grammar, sentence structure, and overall readability. I hope the updated version meets the required standard grammar. Comment 2 Some statements are awkward or repetitive, such as: "Despite the Egyptian government's efforts to date, malnutrition remains a significant problem in Egypt." Authors' response: Thank you for your valuable feedback. We have addressed the awkward or repetitive sections to improve clarity and readability . Comment 3 Presentation of results: Table 1 is difficult to read but still detailed. Consider visual representations (e.g., heatmaps or forest plots) or summaries of key results. Authors' response: Thank you for your thoughtful suggestion. We acknowledge that Table 1 is detailed; however, we believe it is important to retain the table in its current format to provide a comprehensive view of the distribution of determinants across all survey years. The detailed presentation is necessary to allow readers and researchers to interpret the full scope of the data. To address readability concerns, we have added a brief summary of the key findings from Table 1 within the results section to guide interpretation and highlight the most relevant trends. Comment 4 The narrative results section repeats much of the material presented in the table. A more concise summary is recommended. We understand your point, but multiple risk factors contribute to stunting among children under five in Egypt, which could be one of the reasons why stunting is still prevalent even though Egypt is one of the oldest Arab countries and the cradle of multiple ancient civilisations. In the narrative results, we only reported the factors that showed a significant association with this issue. Comment 5 Interpretation of results: The association between vitamin A supplementation and a higher risk of stunting in children aged 0-23 months should be carefully discussed, as it may indicate a reverse causal relationship. Author's response: We apologise for this mistake and sincerely appreciate your insightful feedback. Inadequate use of vitamin A supplements was associated with stunting, as shown in the results in the last table. The results throughout the manuscript related to this issue have been reviewed and updated accordingly Comment 6 The findings that children from middle-income families are at lower risk of stunting than those from the wealthiest families also require further discussion. or theory. Authors response: This issue has been resolved by discussing the potential that could be behind this difference Comment 7 The significant increase in stunting rates in 2008 requires more in-depth contextual analysis (e.g., political factors, economic situation). Author's response: addressed by providing a more in-depth contextual analysis of why the significant increase in stunting rates among children under five in 2008. Comment 8 The discussion could be extended to consider how stunting patterns during the study period were influenced by Egypt’s political environment. Policy recommendations could be more specific and practical, such as: B. Expanding ANC work in communities, targeted maternal education initiatives, or improving access to water, sanitation, and hygiene services (WASH) in Upper Egypt. Author's response: We appreciate this valuable suggestion. We have updated the manuscript to include more specific and practical policy recommendations, such as fostering collaboration between the healthcare, education, WASH, and social protection sectors to address the multifaceted determinants of stunting among children under five. These revisions have been incorporated throughout the manuscript where appropriate. Dear Professor Arlette Suzy Setiawan, Thank you very much, Professor, for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality of the manuscript. Below is our point-by-point response to each of your comments for consideration. Comment 1 A comprehensive revision of the English paper would help correct grammar, improve sentence structure, and enhance readability. Author's response: Thank you for your suggestion. We have revised the manuscript thoroughly to improve grammar, sentence structure, and overall readability. I hope the updated version meets the required standard grammar. Comment 2 Some statements are awkward or repetitive, such as: "Despite the Egyptian government's efforts to date, malnutrition remains a significant problem in Egypt." Authors' response: Thank you for your valuable feedback. We have addressed the awkward or repetitive sections to improve clarity and readability . Comment 3 Presentation of results: Table 1 is difficult to read but still detailed. Consider visual representations (e.g., heatmaps or forest plots) or summaries of key results. Authors' response: Thank you for your thoughtful suggestion. We acknowledge that Table 1 is detailed; however, we believe it is important to retain the table in its current format to provide a comprehensive view of the distribution of determinants across all survey years. The detailed presentation is necessary to allow readers and researchers to interpret the full scope of the data. To address readability concerns, we have added a brief summary of the key findings from Table 1 within the results section to guide interpretation and highlight the most relevant trends. Comment 4 The narrative results section repeats much of the material presented in the table. A more concise summary is recommended. We understand your point, but multiple risk factors contribute to stunting among children under five in Egypt, which could be one of the reasons why stunting is still prevalent even though Egypt is one of the oldest Arab countries and the cradle of multiple ancient civilisations. In the narrative results, we only reported the factors that showed a significant association with this issue. Comment 5 Interpretation of results: The association between vitamin A supplementation and a higher risk of stunting in children aged 0-23 months should be carefully discussed, as it may indicate a reverse causal relationship. Author's response: We apologise for this mistake and sincerely appreciate your insightful feedback. Inadequate use of vitamin A supplements was associated with stunting, as shown in the results in the last table. The results throughout the manuscript related to this issue have been reviewed and updated accordingly Comment 6 The findings that children from middle-income families are at lower risk of stunting than those from the wealthiest families also require further discussion. or theory. Authors response: This issue has been resolved by discussing the potential that could be behind this difference Comment 7 The significant increase in stunting rates in 2008 requires more in-depth contextual analysis (e.g., political factors, economic situation). Author's response: addressed by providing a more in-depth contextual analysis of why the significant increase in stunting rates among children under five in 2008. Comment 8 The discussion could be extended to consider how stunting patterns during the study period were influenced by Egypt’s political environment. Policy recommendations could be more specific and practical, such as: B. Expanding ANC work in communities, targeted maternal education initiatives, or improving access to water, sanitation, and hygiene services (WASH) in Upper Egypt. Author's response: We appreciate this valuable suggestion. We have updated the manuscript to include more specific and practical policy recommendations, such as fostering collaboration between the healthcare, education, WASH, and social protection sectors to address the multifaceted determinants of stunting among children under five. These revisions have been incorporated throughout the manuscript where appropriate. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 21 Apr 2025 Nelmighrabi Elmighrabi , School of Health sciences, Western Sydney University - Campbelltown Campus, Campbelltown, 2560, Australia 21 Apr 2025 Author Response Dear Professor Arlette Suzy Setiawan, Thank you very much, Professor, for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality ... Continue reading Dear Professor Arlette Suzy Setiawan, Thank you very much, Professor, for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality of the manuscript. Below is our point-by-point response to each of your comments for consideration. Comment 1 A comprehensive revision of the English paper would help correct grammar, improve sentence structure, and enhance readability. Author's response: Thank you for your suggestion. We have revised the manuscript thoroughly to improve grammar, sentence structure, and overall readability. I hope the updated version meets the required standard grammar. Comment 2 Some statements are awkward or repetitive, such as: "Despite the Egyptian government's efforts to date, malnutrition remains a significant problem in Egypt." Authors' response: Thank you for your valuable feedback. We have addressed the awkward or repetitive sections to improve clarity and readability . Comment 3 Presentation of results: Table 1 is difficult to read but still detailed. Consider visual representations (e.g., heatmaps or forest plots) or summaries of key results. Authors' response: Thank you for your thoughtful suggestion. We acknowledge that Table 1 is detailed; however, we believe it is important to retain the table in its current format to provide a comprehensive view of the distribution of determinants across all survey years. The detailed presentation is necessary to allow readers and researchers to interpret the full scope of the data. To address readability concerns, we have added a brief summary of the key findings from Table 1 within the results section to guide interpretation and highlight the most relevant trends. Comment 4 The narrative results section repeats much of the material presented in the table. A more concise summary is recommended. We understand your point, but multiple risk factors contribute to stunting among children under five in Egypt, which could be one of the reasons why stunting is still prevalent even though Egypt is one of the oldest Arab countries and the cradle of multiple ancient civilisations. In the narrative results, we only reported the factors that showed a significant association with this issue. Comment 5 Interpretation of results: The association between vitamin A supplementation and a higher risk of stunting in children aged 0-23 months should be carefully discussed, as it may indicate a reverse causal relationship. Author's response: We apologise for this mistake and sincerely appreciate your insightful feedback. Inadequate use of vitamin A supplements was associated with stunting, as shown in the results in the last table. The results throughout the manuscript related to this issue have been reviewed and updated accordingly Comment 6 The findings that children from middle-income families are at lower risk of stunting than those from the wealthiest families also require further discussion. or theory. Authors response: This issue has been resolved by discussing the potential that could be behind this difference Comment 7 The significant increase in stunting rates in 2008 requires more in-depth contextual analysis (e.g., political factors, economic situation). Author's response: addressed by providing a more in-depth contextual analysis of why the significant increase in stunting rates among children under five in 2008. Comment 8 The discussion could be extended to consider how stunting patterns during the study period were influenced by Egypt’s political environment. Policy recommendations could be more specific and practical, such as: B. Expanding ANC work in communities, targeted maternal education initiatives, or improving access to water, sanitation, and hygiene services (WASH) in Upper Egypt. Author's response: We appreciate this valuable suggestion. We have updated the manuscript to include more specific and practical policy recommendations, such as fostering collaboration between the healthcare, education, WASH, and social protection sectors to address the multifaceted determinants of stunting among children under five. These revisions have been incorporated throughout the manuscript where appropriate. Dear Professor Arlette Suzy Setiawan, Thank you very much, Professor, for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality of the manuscript. Below is our point-by-point response to each of your comments for consideration. Comment 1 A comprehensive revision of the English paper would help correct grammar, improve sentence structure, and enhance readability. Author's response: Thank you for your suggestion. We have revised the manuscript thoroughly to improve grammar, sentence structure, and overall readability. I hope the updated version meets the required standard grammar. Comment 2 Some statements are awkward or repetitive, such as: "Despite the Egyptian government's efforts to date, malnutrition remains a significant problem in Egypt." Authors' response: Thank you for your valuable feedback. We have addressed the awkward or repetitive sections to improve clarity and readability . Comment 3 Presentation of results: Table 1 is difficult to read but still detailed. Consider visual representations (e.g., heatmaps or forest plots) or summaries of key results. Authors' response: Thank you for your thoughtful suggestion. We acknowledge that Table 1 is detailed; however, we believe it is important to retain the table in its current format to provide a comprehensive view of the distribution of determinants across all survey years. The detailed presentation is necessary to allow readers and researchers to interpret the full scope of the data. To address readability concerns, we have added a brief summary of the key findings from Table 1 within the results section to guide interpretation and highlight the most relevant trends. Comment 4 The narrative results section repeats much of the material presented in the table. A more concise summary is recommended. We understand your point, but multiple risk factors contribute to stunting among children under five in Egypt, which could be one of the reasons why stunting is still prevalent even though Egypt is one of the oldest Arab countries and the cradle of multiple ancient civilisations. In the narrative results, we only reported the factors that showed a significant association with this issue. Comment 5 Interpretation of results: The association between vitamin A supplementation and a higher risk of stunting in children aged 0-23 months should be carefully discussed, as it may indicate a reverse causal relationship. Author's response: We apologise for this mistake and sincerely appreciate your insightful feedback. Inadequate use of vitamin A supplements was associated with stunting, as shown in the results in the last table. The results throughout the manuscript related to this issue have been reviewed and updated accordingly Comment 6 The findings that children from middle-income families are at lower risk of stunting than those from the wealthiest families also require further discussion. or theory. Authors response: This issue has been resolved by discussing the potential that could be behind this difference Comment 7 The significant increase in stunting rates in 2008 requires more in-depth contextual analysis (e.g., political factors, economic situation). Author's response: addressed by providing a more in-depth contextual analysis of why the significant increase in stunting rates among children under five in 2008. Comment 8 The discussion could be extended to consider how stunting patterns during the study period were influenced by Egypt’s political environment. Policy recommendations could be more specific and practical, such as: B. Expanding ANC work in communities, targeted maternal education initiatives, or improving access to water, sanitation, and hygiene services (WASH) in Upper Egypt. Author's response: We appreciate this valuable suggestion. We have updated the manuscript to include more specific and practical policy recommendations, such as fostering collaboration between the healthcare, education, WASH, and social protection sectors to address the multifaceted determinants of stunting among children under five. These revisions have been incorporated throughout the manuscript where appropriate. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 03 Jan 2025 Views 0 Cite How to cite this report: Dassie GA. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.174857.r358467 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v1#referee-response-358467 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 27 Jan 2025 Godana Arero Dassie , Adama Hospital Medical College, Adama, Ethiopia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.174857.r358467 While emphasizing the importance of sectoral collaboration, risks overgeneralizing the complexity of addressing stunting. It does not adequately acknowledge the potential challenges in implementation, such as resource constraints, political will, and the difficulties of coordinating efforts across multiple sectors. ... Continue reading READ ALL While emphasizing the importance of sectoral collaboration, risks overgeneralizing the complexity of addressing stunting. It does not adequately acknowledge the potential challenges in implementation, such as resource constraints, political will, and the difficulties of coordinating efforts across multiple sectors. Please refer to the detailed assessment of the article here - https://f1000research.s3.amazonaws.com/linked/704364.Under_reviewing.docx Furthermore, focusing interventions on children born to short mothers could inadvertently stigmatize this group and may overlook other critical determinants of stunting, such as paternal influence or environmental factors. The broad scope of the recommendation, which suggests large-scale interventions, does not sufficiently consider the feasibility of such initiatives, including budget limitations, sector prioritization, and community-specific barriers that could hinder successful implementation. Lastly, while interventions for low-SES families are essential, the conclusion would benefit from greater specificity regarding the types of interventions proposed, such as cash transfers, community-based education, or food security measures, to ensure clarity and practical applicability in real-world settings. To address stunting in Egypt, a coordinated approach across health, WASH, education, and social protection is essential. Interventions should target high-risk groups, particularly those with low socioeconomic status, focusing on healthcare access, parental education, and infant feeding practices. While short maternal height increases risk, interventions must also tackle broader factors like food security and sanitation. A nutrition monitoring framework integrated into health systems will enable data collection, evidence-based actions, and progress tracking. Effective implementation requires cost-effective, scalable solutions, community involvement, and resource prioritization to ensure sustainability and equity. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: Nutrition I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Dassie GA. Reviewer Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.174857.r358467 ) The direct URL for this report is: https://f1000research.com/articles/14-15/v1#referee-response-358467 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 26 Feb 2025 Nelmighrabi Elmighrabi , School of Health sciences, Western Sydney University - Campbelltown Campus, Campbelltown, 2560, Australia 26 Feb 2025 Author Response Dear Associate Professor Godana Arero Dassie, Thank you for your valuable comments and feedback. The F1000Research journal has a 300-word limit for the abstract, which restricts the inclusion of detailed information. ... Continue reading Dear Associate Professor Godana Arero Dassie, Thank you for your valuable comments and feedback. The F1000Research journal has a 300-word limit for the abstract, which restricts the inclusion of detailed information. However, I agree with your point regarding maternal height in the conclusion, and I am happy to revise the conclusion accordingly. Dear Associate Professor Godana Arero Dassie, Thank you for your valuable comments and feedback. The F1000Research journal has a 300-word limit for the abstract, which restricts the inclusion of detailed information. However, I agree with your point regarding maternal height in the conclusion, and I am happy to revise the conclusion accordingly. Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 26 Apr 2025 Nelmighrabi Elmighrabi , School of Health sciences, Western Sydney University - Campbelltown Campus, Campbelltown, 2560, Australia 26 Apr 2025 Author Response Dear Associate Professor Godana Arero Dassie, Thank you very much for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality ... Continue reading Dear Associate Professor Godana Arero Dassie, Thank you very much for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality of the manuscript. Below is our point-by-point response to each of your comments for consideration: Comments 1: Use consistent wording based on your topic. Better to Be concise its multiple burdens of malnutrition Author's response: Thank you for the suggestion. We have kept the wording as 'undernutrition' for consistency throughout the manuscript Comment 2: First globally, then study area. Don’t write phrase like one-third and acronyms or abbreviation Authors response: We agree with the suggestion. The text has been revised accordingly global context is presented first, and informal phrases like 'one-third' and abbreviations have been avoided Comment 3:  0–23 months: Infants and young children (critical window for growth and development).  24–59 months: Preschool-aged children (toddler to early childhood phase).  0–59 months: All children under five years (captures the entire group). So, merge together in smart way Author's response: Targeting undernutrition by age groups (0–23, 24–59, and 0–59 months) allows for more precise and effective interventions. Optimal nutritional and developmental support during early childhood necessitates stage-specific interventions to mitigate potential long-term health risks. The cohort aged 0–23 months encompasses the critical “first 1,000 days”, a period during which adequate nutrition profoundly impacts neurological development, immune function, and somatic growth. Nutritional deficiencies during this phase may result in irreversible harm, necessitating interventions such as exclusive breastfeeding and appropriate complementary feeding. The period between 24 and 59 months of age is characterised by significant growth and development, leading to an elevated risk of infectious diseases due to increased physical activity and social interaction. In this age group, nutritional intake significantly impacts cognitive development, disease prevention, and readiness for school; therefore, consistent promotion of diverse diets and hygienic practices is crucial. The 0-59 month age group serves as a metric for population-level monitoring of child health and nutrition. It facilitates national and international initiatives to monitor advancements toward objectives such as the Sustainable Development Goals (SDGs) and to formulate comprehensive policy responses. Therefore, the study specifically targeted children aged 0–23 months, 24–59 months, and 0–59 months, considering the differing nutritional and developmental needs across these age groups Comment 4 Sure! Could you share the details of your current methods section or the main points you’d like to include? For example, the study design, sample size, population, data collection methods, analysis techniques, and tools used. This way, I can rewrite it comprehensively for you. Author's response: This survey used data from previously published national representative surveys, EDHS 2005, 2008 and 2014. Due to journal word limits for the abstract, detailed descriptions of data collection methods and analysis are not included in the abstract. More details about these three included surveys are provided in the manuscript's methods section. Comment 5 If you could share the exact text of the abstract or the results section you're working with, I can rewrite and enhance it for clarity, depth, and analytical rigor. Let me know if you'd like to emphasize specific aspects like statistical findings, key insights, or actionable conclusions! Authors' response: Thank you for your offer. We have kept the abstract concise while ensuring it accurately reflects the key findings. However, we have refined the results section for clarity and analytical depth, incorporating statistical insights where relevant. Please let us know if there are specific areas you believe need further enhancement Comment 6 Your conclusion is overstated. Rested over all your finding 1-3 sentences. I.e. reduce size and volume of text Author's response: Your insightful feedback is greatly appreciated. Resolved and updated as advised Comment 7 The conclusion, while emphasising the importance of sectoral collaboration, risks overgeneralizing the complexity of addressing stunting. It does not adequately acknowledge the potential challenges in implementation , such as resource constraints, political will, and the difficulties of coordinating efforts across multiple sectors. Furthermore, focusing interventions on children born to short mothers could inadvertently stigmatize this group and may overlook other critical determinants of stunting, such as paternal influence or environmental factors . The broad scope of the recommendation, which suggests large-scale interventions, does not sufficiently consider the feasibility of such initiatives, including budget limitations , sector prioritization , and community-specific barriers that could hinder successful implementation. Lastly, while interventions for low-SES families are essential, the conclusion would benefit from greater specificity regarding the types of interventions proposed, such as cash transfers , community-based education , or food security measures , to ensure clarity and practical applicability in real-world settings. Authors response: Thank you for this insightful comment. Conclusion has been updated as advised Comment 8 Revise the rest of your paper in a similar context. Author's response: Revised and updated accordingly. We sincerely appreciate your valuable feedback and remain willing to make additional revisions to further improve our paper, if required. Dear Associate Professor Godana Arero Dassie, Thank you very much for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality of the manuscript. Below is our point-by-point response to each of your comments for consideration: Comments 1: Use consistent wording based on your topic. Better to Be concise its multiple burdens of malnutrition Author's response: Thank you for the suggestion. We have kept the wording as 'undernutrition' for consistency throughout the manuscript Comment 2: First globally, then study area. Don’t write phrase like one-third and acronyms or abbreviation Authors response: We agree with the suggestion. The text has been revised accordingly global context is presented first, and informal phrases like 'one-third' and abbreviations have been avoided Comment 3:  0–23 months: Infants and young children (critical window for growth and development).  24–59 months: Preschool-aged children (toddler to early childhood phase).  0–59 months: All children under five years (captures the entire group). So, merge together in smart way Author's response: Targeting undernutrition by age groups (0–23, 24–59, and 0–59 months) allows for more precise and effective interventions. Optimal nutritional and developmental support during early childhood necessitates stage-specific interventions to mitigate potential long-term health risks. The cohort aged 0–23 months encompasses the critical “first 1,000 days”, a period during which adequate nutrition profoundly impacts neurological development, immune function, and somatic growth. Nutritional deficiencies during this phase may result in irreversible harm, necessitating interventions such as exclusive breastfeeding and appropriate complementary feeding. The period between 24 and 59 months of age is characterised by significant growth and development, leading to an elevated risk of infectious diseases due to increased physical activity and social interaction. In this age group, nutritional intake significantly impacts cognitive development, disease prevention, and readiness for school; therefore, consistent promotion of diverse diets and hygienic practices is crucial. The 0-59 month age group serves as a metric for population-level monitoring of child health and nutrition. It facilitates national and international initiatives to monitor advancements toward objectives such as the Sustainable Development Goals (SDGs) and to formulate comprehensive policy responses. Therefore, the study specifically targeted children aged 0–23 months, 24–59 months, and 0–59 months, considering the differing nutritional and developmental needs across these age groups Comment 4 Sure! Could you share the details of your current methods section or the main points you’d like to include? For example, the study design, sample size, population, data collection methods, analysis techniques, and tools used. This way, I can rewrite it comprehensively for you. Author's response: This survey used data from previously published national representative surveys, EDHS 2005, 2008 and 2014. Due to journal word limits for the abstract, detailed descriptions of data collection methods and analysis are not included in the abstract. More details about these three included surveys are provided in the manuscript's methods section. Comment 5 If you could share the exact text of the abstract or the results section you're working with, I can rewrite and enhance it for clarity, depth, and analytical rigor. Let me know if you'd like to emphasize specific aspects like statistical findings, key insights, or actionable conclusions! Authors' response: Thank you for your offer. We have kept the abstract concise while ensuring it accurately reflects the key findings. However, we have refined the results section for clarity and analytical depth, incorporating statistical insights where relevant. Please let us know if there are specific areas you believe need further enhancement Comment 6 Your conclusion is overstated. Rested over all your finding 1-3 sentences. I.e. reduce size and volume of text Author's response: Your insightful feedback is greatly appreciated. Resolved and updated as advised Comment 7 The conclusion, while emphasising the importance of sectoral collaboration, risks overgeneralizing the complexity of addressing stunting. It does not adequately acknowledge the potential challenges in implementation , such as resource constraints, political will, and the difficulties of coordinating efforts across multiple sectors. Furthermore, focusing interventions on children born to short mothers could inadvertently stigmatize this group and may overlook other critical determinants of stunting, such as paternal influence or environmental factors . The broad scope of the recommendation, which suggests large-scale interventions, does not sufficiently consider the feasibility of such initiatives, including budget limitations , sector prioritization , and community-specific barriers that could hinder successful implementation. Lastly, while interventions for low-SES families are essential, the conclusion would benefit from greater specificity regarding the types of interventions proposed, such as cash transfers , community-based education , or food security measures , to ensure clarity and practical applicability in real-world settings. Authors response: Thank you for this insightful comment. Conclusion has been updated as advised Comment 8 Revise the rest of your paper in a similar context. Author's response: Revised and updated accordingly. We sincerely appreciate your valuable feedback and remain willing to make additional revisions to further improve our paper, if required. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 26 Feb 2025 Nelmighrabi Elmighrabi , School of Health sciences, Western Sydney University - Campbelltown Campus, Campbelltown, 2560, Australia 26 Feb 2025 Author Response Dear Associate Professor Godana Arero Dassie, Thank you for your valuable comments and feedback. The F1000Research journal has a 300-word limit for the abstract, which restricts the inclusion of detailed information. ... Continue reading Dear Associate Professor Godana Arero Dassie, Thank you for your valuable comments and feedback. The F1000Research journal has a 300-word limit for the abstract, which restricts the inclusion of detailed information. However, I agree with your point regarding maternal height in the conclusion, and I am happy to revise the conclusion accordingly. Dear Associate Professor Godana Arero Dassie, Thank you for your valuable comments and feedback. The F1000Research journal has a 300-word limit for the abstract, which restricts the inclusion of detailed information. However, I agree with your point regarding maternal height in the conclusion, and I am happy to revise the conclusion accordingly. Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 26 Apr 2025 Nelmighrabi Elmighrabi , School of Health sciences, Western Sydney University - Campbelltown Campus, Campbelltown, 2560, Australia 26 Apr 2025 Author Response Dear Associate Professor Godana Arero Dassie, Thank you very much for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality ... Continue reading Dear Associate Professor Godana Arero Dassie, Thank you very much for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality of the manuscript. Below is our point-by-point response to each of your comments for consideration: Comments 1: Use consistent wording based on your topic. Better to Be concise its multiple burdens of malnutrition Author's response: Thank you for the suggestion. We have kept the wording as 'undernutrition' for consistency throughout the manuscript Comment 2: First globally, then study area. Don’t write phrase like one-third and acronyms or abbreviation Authors response: We agree with the suggestion. The text has been revised accordingly global context is presented first, and informal phrases like 'one-third' and abbreviations have been avoided Comment 3:  0–23 months: Infants and young children (critical window for growth and development).  24–59 months: Preschool-aged children (toddler to early childhood phase).  0–59 months: All children under five years (captures the entire group). So, merge together in smart way Author's response: Targeting undernutrition by age groups (0–23, 24–59, and 0–59 months) allows for more precise and effective interventions. Optimal nutritional and developmental support during early childhood necessitates stage-specific interventions to mitigate potential long-term health risks. The cohort aged 0–23 months encompasses the critical “first 1,000 days”, a period during which adequate nutrition profoundly impacts neurological development, immune function, and somatic growth. Nutritional deficiencies during this phase may result in irreversible harm, necessitating interventions such as exclusive breastfeeding and appropriate complementary feeding. The period between 24 and 59 months of age is characterised by significant growth and development, leading to an elevated risk of infectious diseases due to increased physical activity and social interaction. In this age group, nutritional intake significantly impacts cognitive development, disease prevention, and readiness for school; therefore, consistent promotion of diverse diets and hygienic practices is crucial. The 0-59 month age group serves as a metric for population-level monitoring of child health and nutrition. It facilitates national and international initiatives to monitor advancements toward objectives such as the Sustainable Development Goals (SDGs) and to formulate comprehensive policy responses. Therefore, the study specifically targeted children aged 0–23 months, 24–59 months, and 0–59 months, considering the differing nutritional and developmental needs across these age groups Comment 4 Sure! Could you share the details of your current methods section or the main points you’d like to include? For example, the study design, sample size, population, data collection methods, analysis techniques, and tools used. This way, I can rewrite it comprehensively for you. Author's response: This survey used data from previously published national representative surveys, EDHS 2005, 2008 and 2014. Due to journal word limits for the abstract, detailed descriptions of data collection methods and analysis are not included in the abstract. More details about these three included surveys are provided in the manuscript's methods section. Comment 5 If you could share the exact text of the abstract or the results section you're working with, I can rewrite and enhance it for clarity, depth, and analytical rigor. Let me know if you'd like to emphasize specific aspects like statistical findings, key insights, or actionable conclusions! Authors' response: Thank you for your offer. We have kept the abstract concise while ensuring it accurately reflects the key findings. However, we have refined the results section for clarity and analytical depth, incorporating statistical insights where relevant. Please let us know if there are specific areas you believe need further enhancement Comment 6 Your conclusion is overstated. Rested over all your finding 1-3 sentences. I.e. reduce size and volume of text Author's response: Your insightful feedback is greatly appreciated. Resolved and updated as advised Comment 7 The conclusion, while emphasising the importance of sectoral collaboration, risks overgeneralizing the complexity of addressing stunting. It does not adequately acknowledge the potential challenges in implementation , such as resource constraints, political will, and the difficulties of coordinating efforts across multiple sectors. Furthermore, focusing interventions on children born to short mothers could inadvertently stigmatize this group and may overlook other critical determinants of stunting, such as paternal influence or environmental factors . The broad scope of the recommendation, which suggests large-scale interventions, does not sufficiently consider the feasibility of such initiatives, including budget limitations , sector prioritization , and community-specific barriers that could hinder successful implementation. Lastly, while interventions for low-SES families are essential, the conclusion would benefit from greater specificity regarding the types of interventions proposed, such as cash transfers , community-based education , or food security measures , to ensure clarity and practical applicability in real-world settings. Authors response: Thank you for this insightful comment. Conclusion has been updated as advised Comment 8 Revise the rest of your paper in a similar context. Author's response: Revised and updated accordingly. We sincerely appreciate your valuable feedback and remain willing to make additional revisions to further improve our paper, if required. Dear Associate Professor Godana Arero Dassie, Thank you very much for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality of the manuscript. Below is our point-by-point response to each of your comments for consideration: Comments 1: Use consistent wording based on your topic. Better to Be concise its multiple burdens of malnutrition Author's response: Thank you for the suggestion. We have kept the wording as 'undernutrition' for consistency throughout the manuscript Comment 2: First globally, then study area. Don’t write phrase like one-third and acronyms or abbreviation Authors response: We agree with the suggestion. The text has been revised accordingly global context is presented first, and informal phrases like 'one-third' and abbreviations have been avoided Comment 3:  0–23 months: Infants and young children (critical window for growth and development).  24–59 months: Preschool-aged children (toddler to early childhood phase).  0–59 months: All children under five years (captures the entire group). So, merge together in smart way Author's response: Targeting undernutrition by age groups (0–23, 24–59, and 0–59 months) allows for more precise and effective interventions. Optimal nutritional and developmental support during early childhood necessitates stage-specific interventions to mitigate potential long-term health risks. The cohort aged 0–23 months encompasses the critical “first 1,000 days”, a period during which adequate nutrition profoundly impacts neurological development, immune function, and somatic growth. Nutritional deficiencies during this phase may result in irreversible harm, necessitating interventions such as exclusive breastfeeding and appropriate complementary feeding. The period between 24 and 59 months of age is characterised by significant growth and development, leading to an elevated risk of infectious diseases due to increased physical activity and social interaction. In this age group, nutritional intake significantly impacts cognitive development, disease prevention, and readiness for school; therefore, consistent promotion of diverse diets and hygienic practices is crucial. The 0-59 month age group serves as a metric for population-level monitoring of child health and nutrition. It facilitates national and international initiatives to monitor advancements toward objectives such as the Sustainable Development Goals (SDGs) and to formulate comprehensive policy responses. Therefore, the study specifically targeted children aged 0–23 months, 24–59 months, and 0–59 months, considering the differing nutritional and developmental needs across these age groups Comment 4 Sure! Could you share the details of your current methods section or the main points you’d like to include? For example, the study design, sample size, population, data collection methods, analysis techniques, and tools used. This way, I can rewrite it comprehensively for you. Author's response: This survey used data from previously published national representative surveys, EDHS 2005, 2008 and 2014. Due to journal word limits for the abstract, detailed descriptions of data collection methods and analysis are not included in the abstract. More details about these three included surveys are provided in the manuscript's methods section. Comment 5 If you could share the exact text of the abstract or the results section you're working with, I can rewrite and enhance it for clarity, depth, and analytical rigor. Let me know if you'd like to emphasize specific aspects like statistical findings, key insights, or actionable conclusions! Authors' response: Thank you for your offer. We have kept the abstract concise while ensuring it accurately reflects the key findings. However, we have refined the results section for clarity and analytical depth, incorporating statistical insights where relevant. Please let us know if there are specific areas you believe need further enhancement Comment 6 Your conclusion is overstated. Rested over all your finding 1-3 sentences. I.e. reduce size and volume of text Author's response: Your insightful feedback is greatly appreciated. Resolved and updated as advised Comment 7 The conclusion, while emphasising the importance of sectoral collaboration, risks overgeneralizing the complexity of addressing stunting. It does not adequately acknowledge the potential challenges in implementation , such as resource constraints, political will, and the difficulties of coordinating efforts across multiple sectors. Furthermore, focusing interventions on children born to short mothers could inadvertently stigmatize this group and may overlook other critical determinants of stunting, such as paternal influence or environmental factors . The broad scope of the recommendation, which suggests large-scale interventions, does not sufficiently consider the feasibility of such initiatives, including budget limitations , sector prioritization , and community-specific barriers that could hinder successful implementation. Lastly, while interventions for low-SES families are essential, the conclusion would benefit from greater specificity regarding the types of interventions proposed, such as cash transfers , community-based education , or food security measures , to ensure clarity and practical applicability in real-world settings. Authors response: Thank you for this insightful comment. Conclusion has been updated as advised Comment 8 Revise the rest of your paper in a similar context. Author's response: Revised and updated accordingly. We sincerely appreciate your valuable feedback and remain willing to make additional revisions to further improve our paper, if required. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 03 Jan 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 5 6 7 8 Version 3 (revision) 20 May 25 read read read read read read Version 2 (revision) 17 Mar 25 read Version 1 03 Jan 25 read Godana Arero Dassie , Adama Hospital Medical College, Adama, Ethiopia Arlette Suzy Setiawan , Universitas Padjadjaran, Bandung, Indonesia LILIK HIDAYANTI , Siliwangi University, Tasikmalaya, Indonesia Yuly Astuti , National Research and Innovation Agency, Jakarta, Indonesia Sri Sumarmi , Universitas Airlangga, Surabaya, Indonesia Fatria Harwanto , Sriwijaya University, Palembang and Indralaya, Indonesia Md. Alamgir Hossain , International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh Anesu Marume , University of Zimbabwe, Harare, Zimbabwe Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Marume A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 14 Jan 2026 | for Version 3 Anesu Marume , University of Zimbabwe, Harare, Zimbabwe 0 Views copyright © 2026 Marume A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions General Comments The manuscript addresses an important public health issue; however, substantial revisions are required to improve clarity, methodological transparency, and internal consistency. In several sections, the English language requires careful editing to improve readability and precision. Additionally, results are often presented without appropriate statistical evidence, limiting their interpretability and policy relevance. Specific Comments Abstract - Methods The statement “A multilevel regression that adjusts for…” is unclear and grammatically awkward. Please clarify whether the multilevel regression explicitly adjusts for sampling weights or merely accounts for the survey design. Similar grammatical and clarity issues are present throughout the manuscript and require systematic editing. Abstract – Results The rationale for stratifying prevalence estimates by age group is unclear. If stunting prevalence is relatively uniform across age categories, it would be more appropriate to present an overall prevalence for the study population rather than disaggregating by age without a clear justification. The abstract should prioritise statistically significant findings with clear implications for policy or intervention. Results should be accompanied by appropriate measures of association (e.g., odds ratios with 95% confidence intervals and/or p-values). Statements indicating an “association” without statistical evidence are not sufficiently justified. Language and Clarity Several sentences in the abstract are grammatically incorrect or unclear. For example, phrases such as “mothers who did not have antenatal care visits during pregnancy” require rephrasing for clarity and correctness. Abstract - Conclusion The abstract conclusion does not align with the results presented in the abstract. Conclusions should be strictly based on findings reported in the abstract; currently, there is a disconnect between the presented results and the concluding statements. Introduction Inconsistencies are evident in the framing of the burden of stunting. For example, the first paragraph refers to “one-third,” while the second paragraph refers to “one-fifth.” These figures must be reconciled and accurately referenced. Paragraph 5, line 2: Please specify the age group being referred to; otherwise, there is a disconnect between the first and second sentences. Several statistics cited are outdated (e.g. from 2014) but are presented as if current. While historical context is valuable, the authors should incorporate more recent statistics and studies to support their arguments. The final paragraph of the introduction contains a weak and potentially incorrect justification for combining datasets. Pooling data across years does not inherently strengthen an analysis unless temporal effects are explicitly modelled (e.g., through time trends, spatial–temporal analysis, or inclusion of survey year as a variable). Assuming that determinants of stunting remained constant between 2005 and 2014 may, in fact, weaken the study’s validity. Methods Study Population / Sample Selection The sample described reflects the overall EDHS sample rather than the analytic sample used in this study. The authors should clearly describe how the study sample was derived from the EDHS, including inclusion and exclusion criteria. Much of the current information is already published elsewhere and does not add value. Outcome Variable The authors must explain how unrealistic or implausible height-for-age z-scores (HAZ) were handled. This can be included in this section or in a separate data management subsection. Clarification is needed on how data from EDHS 2005 (conducted prior to the 2006 WHO Child Growth Standards) were handled. If recoding or recalculation was performed, this process should be explicitly described. The WHO standards should be correctly referred to as growth standards, not growth references. Covariates The description of the wealth index suggests it was constructed by the authors; however, this variable is already generated within DHS datasets. This should be clearly stated. The final sentence under “potential covariates” is confusing and should be revised. If variables were grouped as “other” because they did not align with the UNICEF framework, this should be stated clearly and justified. Results Descriptive characteristics of the study sample should be presented in a single table (e.g. Table 1) rather than as an extensive narrative. This would also eliminate the need for Figures 1–3, which merely replicate prevalence estimates and add limited value. A data management section is missing from the methodology, making it difficult to assess the reported sample size. The authors should clearly describe how missing data were handled; it is unlikely that no missingness existed across all variables. The section on the prevalence of stunting by factors substantially overlaps with the “Characteristics of the sample” section. These could be combined into a single results subsection with an appropriately structured table (including a total column), allowing the text to focus on key findings. In Table 1, child age appears both as a row and as a column; this is redundant and should be corrected. Additionally, the use of very small age categories may unnecessarily complicate the model and should be justified. The footnote in Table 1 is unclear; stating “CI = p-value” is incorrect and should be corrected. Claims of statistical significance must be supported by appropriate evidence (adjusted odds ratios with 95% confidence intervals and/or p-values). Discussion Results are repeatedly restated in the discussion without sufficient interpretation. The discussion should focus on explaining findings rather than duplicating results. The second paragraph of the discussion consists of a single sentence and lacks a logical connection to the surrounding paragraphs. The argument should be expanded and better integrated into the overall discussion. Is the work clearly and accurately presented and does it cite the current literature? No Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Public Health Nutrition I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Marume A. Peer Review Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r440926) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-440926 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Hossain M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 08 Jan 2026 | for Version 3 Md. Alamgir Hossain , International Centre for Diarrhoeal Disease Research, Dhaka, Dhaka Division, Bangladesh 0 Views copyright © 2026 Hossain M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is a very good study; however, the data set is older. If possible, see the trends as well with the 2005, 2008, 2014, or maybe 2018 and 2022 (if the data set are availabale. Otherwise, it seems the older result, which may not have implications for taking action. The results in abstract are very brief. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Epidemiology, Social behavior and public health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Hossain MA. Peer Review Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r440929) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-440929 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Harwanto F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 10 Nov 2025 | for Version 3 Fatria Harwanto , Sriwijaya University, Palembang and Indralaya, Indonesia 0 Views copyright © 2025 Harwanto F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions In summary, the article “Concurrent stunting among under-five children in Egypt” is a well-designed and relevant study that adds meaningful insight into the problem of child stunting in Egypt. The authors make good use of large, nationally representative data from multiple Demographic and Health Surveys (EDHS 2005–2014) and apply an appropriate analytical approach to explore the social and biological factors linked to stunting. The work is technically sound and clearly structured, showing careful attention to data analysis and presentation. That said, several points could be improved to make the paper clearer and more convincing. The term “concurrent stunting” should be explained more clearly, as it may be interpreted in different ways. The authors should also remind readers that, because the study design is cross-sectional, the findings describe associations rather than cause-and-effect relationships . Some aspects of the statistical section, such as model validation or testing for multicollinearity, could be described in more detail to strengthen the technical transparency. The discussion around the relationship between vitamin A supplementation and higher odds of stunting also needs a more careful explanation, as this could be due to reverse causality (children who are already undernourished are more likely to receive supplements). Finally, the paper would be stronger if the authors included more recent references (after 2020) and expanded their discussion of environmental and social influences, particularly water and sanitation (WASH), maternal education, and economic inequality. With these improvements, the article would make a valuable and credible contribution to the evidence base on child nutrition in Egypt and could serve as an important reference for policymakers and researchers working to reduce stunting and improve child health. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise public health nutrition, nutritional epidemiology, and biomedical aspects of maternal and child nutrition. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Harwanto F. Peer Review Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r427076) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-427076 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Sumarmi S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 10 Nov 2025 | for Version 3 Sri Sumarmi , Universitas Airlangga, Surabaya, Indonesia 0 Views copyright © 2025 Sumarmi S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Tittle may be added: "Concurrent stunting and its associated factors among children under five in Egypt: Pooled analysis from EDHS 2005-2014" Abstract: prevalence of stunting in each age group represents prevalence in what year? or it is the mean value pooled data? Pooled data is data from multiple sources that have been combined for analysis. Methods: In the methods section, author did not explain clearly what actually the study sample is its individual data or aggregate data (cluster/area). Consider the outcome variable is Z score, the unit analysis is individual data (maternal-child paired data) It is better to make a figure (chart flow) to describe clearly how you did the sample selection. Potential Covariate: The covariates in this study were selected using UNICEF framework of maternal and child malnutrition. Please ensure that authors make a proper variable grouping as basic factors, underlying factors and immediate factors. Socio economic is categorize as basic factor or as root causal, rather than underlying factors as mentioned in this study. (Please check The UNICEF conceptual framework of undernutrition is shown. Source: ( Improving Child Nutrition: The achievable imperative for global progress - UNICEF DATA , 2013. p. 4.) Maternal Nutrition is an important factor affecting child stunting, as well as antenatal care (ANC). Iron folic acid (IFA) is the crucial program for pregnant women over the world. In this study does not include this data. I suggest adding the data of IFA consumption during pregnancy include in multivariate analysis. In the other side, sensitive aspect of stunting such as Water Sanitation and Hygiene (WASH) were not complete in this analysis except water supply, without consider household sanitation and hygiene behavior among household member, particularly mothers' behavior. The category of short stature mother less than 160 cm? please elaborate why authors use the cut off 160 cm for short stature mother. Is it originally category in EDHS or you grouping with certain consideration? WHO does not specify a single fixed height threshold for short stature in adult women. WHO use <145 cm, in one of publication, but in the other report use <150 cm as cut off point to identify shorth stature mother. Conclusion can be generated after the additional data include in multivariate analysis Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise maternal and child nutrition; micronutrient I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Sumarmi S. Peer Review Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r420417) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-420417 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Astuti Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 30 Sep 2025 | for Version 3 Yuly Astuti , National Research and Innovation Agency, Jakarta, Indonesia 0 Views copyright © 2025 Astuti Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is an important study, and the authors have clearly put in a significant amount of work. The manuscript addresses stunting as a critical public health issue in Egypt and utilizes a robust dataset. While previous reviewer comments have led to improvements, there are still several areas that require further attention to enhance clarity, precision, and overall scientific rigor before indexing. The detailed comments for each section are as follows. INTRODUCTION : 1. "Undernutrition is a significant predictor of poor growth and morbidity in infants and young children. Globally, stunting (low height for age) affects 150 million children under the age of five, a substantial portion of the world’s young population." --> These two sentences are good starting points, but they would be stronger if directly linked to show the relationship between undernutrition and stunting. Currently, they feel a bit disconnected. --> Clearly state that stunting is a form of chronic undernutrition . For example: "Undernutrition is a significant predictor of poor growth and morbidity in infants and young children. Among its manifestations, stunting (defined as low height for age) is a particularly widespread form of chronic undernutrition , affecting 150 million children under the age of five globally, a substantial portion of the world’s young population." This immediately clarifies the hierarchy. 2. The introduction mentions "stunting (low height for age)" and its consequences. --> While "low height for age" is the definition, it's vital to explicitly state its chronic nature and the critical period during which it develops. This differentiates it from acute malnutrition (wasting) and explains why it has long-term, often irreversible, consequences. You briefly touch on this regarding age stratification, but it should be clearly stated here. --> After defining stunting, add a sentence emphasizing: "Stunting is fundamentally caused by prolonged periods of insufficient nutrient intake and/or recurrent infections, primarily during the crucial 1,000 First Days of Life (from conception to two years of age) . This chronic nature means its adverse effects on physical and cognitive development are largely irreversible after a child reaches two years old, though its impacts continue through the first five years of life and into adulthood." 3. Consistency in Acronyms and Terminology --> There is an inconsistency in using "Sustainable Development Goal" (singular) and "Sustainable Development Goals" (plural), as well as "SDG" and "SDGs." Consistency is key for professional writing. 4. "It stands out from previous research on stunting among children in Egypt due to its unique focus on combining data sets from 2005 to 2014. The study utilises population-based national representative data and provides age-specific results by examining the prevalence of stunting in three age groups: 0-23 months, 24-59 months, and 0-59 months across the three-survey data." --> This is a strong statement of your study's contribution. Ensure the language is precise. "Utilises" is often preferred over "utilizes" in British English (common in F1000Research). --> This section is good. Just ensure minor grammatical refinements are made during the overall language edit. 4. I found several instances of minor grammatical errors, awkward phrasing, and capitalization issues in the Introduction (and likely throughout the manuscript, as indicated in your initial comments). This affects readability and professionalism. For examples: - " The consequences, of stunting particularly in low- and middle-income countries, are far-reaching, leading to impaired growth, reduced educational attainment, delayed school enrolment, and a 20% reduction in adult income." --> The comma after "consequences" is unnecessary. - "Therefore, addressing undernutrition is important not only for public health, but also for enhancing the country long-term economic growth and social stability." --> "country long-term" should be "country's long-term." You have acknowledged the need for English editing in your author responses. A thorough review by a native English speaker or a professional editing service is highly recommended to correct these issues, ensure smooth transitions, and enhance the overall readability and conciseness of the text. Pay close attention to: article usage (a, an, the), subject-verb agreement, punctuation, and consistent capitalization. METHODS: The Methods section generally provides the necessary information about your data source, study area, sample selection, outcome variable, covariates, and statistical analysis. However, some parts could be explained more simply, and there are a number of grammatical errors and awkward sentences that make it harder to read and understand. 1. "Data Source" Sub-section: "Analysis utilised data from the EDHS conducted in 2005, 2008, and 2014. The surveys were implemented by El-Zanaty and Associates on behalf of the Ministry of Health and Population and the National Population Council, as part of the global MEASURE DHS project funded by the United States Agency for International Development (USAID)." --> The first sentence is clear. However, the next sentence about who implemented the surveys and the funding is quite long and a bit formal --> Suggestion for Improvement: Try to break down long sentences or simplify phrasing. For example: "This study used data from the Egyptian Demographic and Health Surveys (EDHS) conducted in 2005, 2008, and 2014. These surveys were carried out by El-Zanaty and Associates for the Ministry of Health and Population and the National Population Council. They were part of the worldwide MEASURE DHS project, funded mainly by the United States Agency for International Development (USAID)." 2. "Study Area" Sub-section: "Administratively, Egypt is divided into 26 governorates and Luxor City. The four Urban Governorates (Cairo, Alexandria, Port Said, and Suez) have no rural population. Each of the other 22 governorates is subdivided into urban and rural areas. Nine of these governorates are located in the Nile Delta (Lower Egypt), eight are located in the Nile Valley (Upper Egypt), and the remaining five Frontier Governorates are located on the eastern and western boundaries of Egypt." --> This description is quite detailed, which is good for context. However, some phrasing could be smoother. --> Suggestion for Improvement: "Egypt is divided into 26 governorates, plus Luxor City. Four of these, known as Urban Governorates (Cairo, Alexandria, Port Said, and Suez), do not have rural areas. The other 22 governorates are split into urban and rural parts. Nine are in the Nile Delta (Lower Egypt), eight in the Nile Valley (Upper Egypt), and the last five are 'Frontier Governorates' on the eastern and western borders." 3. "Sample Selection" Sub-section: "This study analysed data from the EDHS for 2005 (n=13,599), 2008 (n=10,590), and 2014 (n=15,668) focusing on children aged 0-59 months. The sample design was multistage sampling design enabled the estimation of key population and health indicators, including fertility and mortality rates, for Egypt, six major regions, and individual governorates." --> The second sentence is grammatically incorrect and very hard to follow. As previously noted, the detailed theoretical justification for choosing the specific age groups (0-23 months, 24-59 months, and 0-59 months) is currently only in your author response. This crucial explanation must be explicitly incorporated into this 'Sample Selection' sub-section within the main manuscript body to enhance methodological transparency and rationale. 4. "Outcome Variable" Sub-section: "The outcome variable for this study was stunting, which was determined by the height-for-age Z-score (HAZ). Children whose height-for-age is less than -2 standard deviations from the corresponding reference median (Z score≤−2) were categorised as stunted." --> No major changes needed for clarity. Just ensure consistent formatting for Z-scores (e.g., Z−score≤−2 instead of Z score≤−2). 5. "Potential Covariates" Sub-section: "The UNICEF conceptual framework of the determinants of nutritional status for mother and child health guided the selection of covariate variables, with adjustments based on a previous study conducted in 35 low- and middle-income countries." --> This sentence is quite long, difficult to follow. The lists of factors under "Basic factors," "Underlying factors," and "Immediate factors" are dense and lack clear separation for readability --> Use bullet points or a more structured list format for the factors within each category (Basic, Underlying, Immediate). This make the information much more understand. 6. "Statistical Analysis" Sub-section: "In our analysis, we examined factors associated with stunting from each EDHS 2005,2008 and 2014 surveys to determine the strength of the association of each characteristic in relation to the likelihood of stunting in Egypt." --> 2005,2008 should have a space. "In our analysis, we examined factors..." is fine, but "to determine the strength of the association of each characteristic in relation to the likelihood of stunting in Egypt" is a bit wordy --> Suggestion for Improvement: "For our analysis, we examined factors associated with stunting using data from each of the 2005, 2008, and 2014 EDHS, aiming to understand how each characteristic related to the likelihood of stunting in Egypt." "The outcome variable for the final logistic regression models is the presence or absence of stunting (Y=1= stunted, 0= not stunted)." --> As noted in the previous feedback, this phrasing can be improved . --> "The outcome variable for the final logistic regression models was the presence or absence of stunting, coded as 1 for stunted and 0 for not stunted." "All statistical analyses were carried out using STATA/MP Version.17.0 (Stata Corp, College Station, TX, USA), ( https://blog.stata.com/2021/04/20/stata-17-released/ ), and adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) obtained from the adjusted multivariate regression were used to measure the factors associated with child stunting." --> The URL for STATA is likely not needed in the main text; it's usually sufficient to just state the software and version. The sentence is also long. RESULTS: The narrative should summarize the most important findings from your tables (Table 1, Table S1, Table S2, Table S3) rather than simply restating every number. The detailed numbers belong in the tables themselves. Your narrative should guide the reader through the most salient patterns and statistically significant associations. Organize your results logically. You could group them by: - Overall prevalence and trends (as you've done); - Key findings from basic factors (e.g., region, wealth); - Key findings from underlying factors (e.g., maternal education, maternal height, ANC); - Key findings from immediate factors (e.g., breastfeeding, vitamin A); - Then, discuss specific age-group findings. Each sub-section (e.g., "Characteristics of the sample," "Prevalence of stunting," "Prevalence of stunting by factors," "Multivariable analysis") should begin with a clear introductory sentence stating what that section will present. While you mention statistical significance (e.g., p-values), ensure you emphasize the strength and direction of associations using Adjusted Odds Ratios (AORs) and their 95% Confidence Intervals (CIs). Do not just say something is "significantly associated"; explain how it's associated (e.g., "X was associated with a 1.5 times higher odds of stunting [AOR = 1.5, 95% CI: Y-Z]"). This is critical for interpreting the practical importance of your findings. Eliminate any repetitive phrases or sentences. For example, "The difference in the prevalence of stunting among children aged 0-23 months in Egypt... is illustrated in Figure 1." You can simply state: "Figure 1 illustrates the prevalence of stunting among children aged 0-23 months in Egypt." Your Figures 1, 2, and 3 are good. In the narrative, make sure you do not just state what the figures show, but interpret the key trends and changes over time, highlighting specific percentages and year-on-year differences that are most impactful. For the Results of Multivariate Logistic Regression Based on Age Stratification: Instead of jumping between age groups for each factor, consider: 1. Common Significant Factors Across All Age Groups (0-23, 24-59, 0-59 months): - Group these together first, clearly stating that these factors consistently influenced stunting across all three age cohorts. Example: Multivariate logistic regression revealed that several factors were consistently associated with stunting across all three age groups (0-23, 24-59, and 0-59 months) (Table 2). These included [list factors: e.g., survey year, region, maternal education, maternal height, ANC visits, media exposure]. For instance, children in 2014 had significantly lower odds of stunting compared to 2005 across all groups (e.g., 0-23 months: AOR=0.64, 95% CI: 0.54-0.76; 0-59 months: AOR=0.71, 95% CI: 0.59-0.84). - Explicitly mention the direction of association and provide AORs and CIs for each factor discussed. For example, for maternal primary education: Children whose mothers had only primary education were significantly more likely to be stunted than those whose mothers had secondary or higher education (e.g., 0-23 months: AOR=1.37, 95% CI: 1.20-1.72; 0-59 months: AOR=1.21, 95% CI: 1.02-1.44). Similarly, for maternal height: Mothers less than 155 cm tall had a significantly higher risk of having stunted children across all age groups compared to mothers taller than 160 cm (e.g., for 0-59 months, mothers <145 cm: AOR=3.11, 95% CI: 2.24-4.33). 2. Age-Specific Significant Factors: - Provide separate paragraphs to factors that were significant only for specific age groups. Example: - 0-23 months specific factors: Among children aged 0-23 months, significant associations were also observed with child gender, age (18-23 months), maternal marital status, place and mode of delivery, and duration of breastfeeding. Provide the AORs and CIs for each. - 24-59 months specific factors: For the 24-59 months group, additional significant factors included... (e.g., paternal age, maternal BMI > 25, maternal work status, unprotected drinking water source, frequency of reading magazine/newspaper). - 0-59 months specific factors (if any unique ones beyond the common): If there are factors significant only for the overall 0-59 months group that weren't common to all or specific to others, highlight them here. The Results section should only present findings. Avoid discussing why a finding occurred or its implications for policy; save that for the Discussion section. For example, avoid sentences like 'This is most likely due to...' or 'This finding may be attributed to the fact that...' These belong in the discussion." DISCUSSION: - Begin by briefly restating the most important findings that emerged from your results (e.g., overall prevalence, trends, and the strongest/most consistent associations from multivariate analysis across age groups). Avoid simply repeating numbers; focus on the insights . - Instead of discussing factors haphazardly, group related findings and discuss them thematically. For example, dedicate a paragraph or two to socioeconomic factors, then maternal factors, then environmental, and so on. This makes the argument easier to follow. - Your study found that boys were significantly more prone to stunting than girls. The discussion offers explanations for this, consistent with global literature. You also mention that 'in some societies or regions, the health and well-being of younger females may be prioritized by social values and practices, which may lead to superior nutrition and care for them in comparison to older girls or boys'. This is a very important point for the Egyptian context . --> elaborate on this socio-cultural aspect. Do cultural practices around feeding, care-seeking, or resource allocation differ significantly between urban and rural areas in Egypt, potentially influencing sex-based disparities in stunting? For example, are there specific traditional beliefs or gender roles in rural Upper Egypt (where stunting is high) that might lead to boys receiving less preferential feeding or healthcare than girls, or vice versa? Or perhaps, could the challenges of access to healthcare and diverse foods in rural areas (as you have mentioned) exacerbate any pre-existing biological or social vulnerabilities in boys more than girls in those settings? Are there specific cultural practices related to complementary feeding, introduction of solid foods, or healthcare-seeking for boys versus girls that might be relevant? For example, if boys are perceived as more robust, parents might delay seeking care for early signs of illness, or conversely, if boys are valued more for labor, their needs might be prioritized differently at different ages. If your data (even indirectly) or existing Egyptian qualitative research can support or refute such hypotheses, weave it into the discussion. You mention the Egyptian government's efforts (e.g., National Nutrition Strategy, Food Subsidy Programs) that likely contributed to the decline in stunting by 2014. --> The discussion of the 2008 rise and subsequent decline should lead to specific policy recommendations for preventing or mitigating future shocks (like economic crises or food price increases). CONCLUSION: The Conclusion section effectively reiterates the main problem (stunting as a public health challenge) and lists several recommended actions. To make it more impactful for a high-impact journal, it needs to be more concise, directly tied to your specific findings , and forward-looking. As emphasized before, a thorough professional English editing service is highly recommended for this manuscript. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise My expertise lies in maternal and child health, with a specific focus on the cultural and traditional influences on health outcomes, particularly concerning stunting I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Astuti Y. Peer Review Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r396491) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-396491 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 HIDAYANTI L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 30 Sep 2025 | for Version 3 LILIK HIDAYANTI , Siliwangi University, Tasikmalaya, Indonesia 0 Views copyright © 2025 HIDAYANTI L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Author(s) Congratulations on a work well done. Although the topic of stunting and its determinants is not a new area, but the study population and how this research provides a comprehensive understanding of the determinants of stunting across three age groups are important findings. There are several things to considerer The data used is data from 2005, 2008, 2014. Is it still relevant to current conditions? Why don't you try to compare the determinants between the three years to predict changes in the determinants of stunting in Egypt? For maternal characteristics, data on weight gain during pregnancy, if available, would be better compared to BMI. Since the subject's age is 0-59 months, if there is data, in addition to presenting data on breastfeeding, it would be better to present data on providing complementary foods. What is your reason for using Pearson Chi Square, why don't you use Fisher Exact or Continuity Correction? For continuous variables, why do you use an independent t-test? You should first state that all continuous variables are normally distributed. Why did you use p<0.05 to determine which variables to include in a logistic regression model? Why not choose p<0.25, even though you're building a predictive model? It's also a good idea to consider changes in the OR during the modeling process to find the most appropriate model. Table 1 is very comprehensive but confusing to read. Please explain whether the data displayed is n(%) or cOR(95%CI). If the value is cOR, please specify the reference. In the results of logistic regression modeling, it is best to explain at the start of the modeling how many variables can be included in the model, and also how many times the modeling has been carried out to obtain the most appropriate model. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise public health nutrition I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) HIDAYANTI L. Peer Review Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.180883.r416860) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-15/v3#referee-response-416860 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Setiawan A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 02 Apr 2025 | for Version 2 Arlette Suzy Setiawan , Universitas Padjadjaran, Bandung, Indonesia 0 Views copyright © 2025 Setiawan A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Authors, This timely and important study investigates the prevalence and causes of stunting in Egyptian children under five years of age using nationally representative data from the 2005, 2008, and 2014 Egyptian Demographic and Health Surveys (EDHS). Aggregate data and age-specific analyses provide new insights into the current work. The work is methodologically sound and addresses an important public health question with clear policy importance. However, there are still some areas for improvement, especially in terms of language clarity, organization of data presentation, and interpretation of results. You will find detailed comments below that would help improve the article. Strengths: Substantive Methodology: The validity of the results is enhanced by multistage logistic regression and appropriate adjustments to the survey design. Large, representative sample: Combining data from three DHS surveys provides a comprehensive picture and improves the generalizability of the study. Unique contribution of age-stratified analysis: The stratification of results into three age groups—0–23 months, 24–59 months, and 0–59 months—provides a deeper understanding of the risk variables for stunting at different developmental stages. Policy implications: The paper, relevant to Egyptian legislators, makes a strong case for multisectoral interventions to combat stunting. Work points: A comprehensive revision of the English paper would help correct grammar, improve sentence structure, and enhance readability. Some statements are awkward or repetitive, such as: "Despite the Egyptian government's efforts to date, malnutrition remains a significant problem in Egypt." Presentation of results: Table 1 is difficult to read but still detailed. Consider visual representations (e.g., heatmaps or forest plots) or summaries of key results. The narrative results section repeats much of the material presented in the table. A more concise summary is recommended. Interpretation of results: The association between vitamin A supplementation and a higher risk of stunting in children aged 0-23 months should be carefully discussed as it may indicate a reverse causal relationship. The findings that children from middle-income families are at lower risk of stunting than those from the wealthiest families also require further discussion. or theory. The significant increase in stunting rates in 2008 requires more in-depth contextual analysis (e.g., political factors, economic situation). The discussion could be extended to consider how stunting patterns during the study period were influenced by Egypt’s political environment. Policy recommendations could be more specific and practical, such as: B. Expanding ANC work in communities, targeted maternal education initiatives, or improving access to water, sanitation, and hygiene services (WASH) in Upper Egypt. A section of the study specifically addresses limitations and will help highlight issues such as recall bias, missing covariates (e.g., dietary diversity), and lack of post-2014 data. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise stunting I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 21 Apr 2025 Nelmighrabi Elmighrabi, School of Health sciences, Western Sydney University - Campbelltown Campus, Campbelltown, 2560, Australia Dear Professor Arlette Suzy Setiawan, Thank you very much, Professor, for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality of the manuscript. Below is our point-by-point response to each of your comments for consideration. Comment 1 A comprehensive revision of the English paper would help correct grammar, improve sentence structure, and enhance readability. Author's response: Thank you for your suggestion. We have revised the manuscript thoroughly to improve grammar, sentence structure, and overall readability. I hope the updated version meets the required standard grammar. Comment 2 Some statements are awkward or repetitive, such as: "Despite the Egyptian government's efforts to date, malnutrition remains a significant problem in Egypt." Authors' response: Thank you for your valuable feedback. We have addressed the awkward or repetitive sections to improve clarity and readability . Comment 3 Presentation of results: Table 1 is difficult to read but still detailed. Consider visual representations (e.g., heatmaps or forest plots) or summaries of key results. Authors' response: Thank you for your thoughtful suggestion. We acknowledge that Table 1 is detailed; however, we believe it is important to retain the table in its current format to provide a comprehensive view of the distribution of determinants across all survey years. The detailed presentation is necessary to allow readers and researchers to interpret the full scope of the data. To address readability concerns, we have added a brief summary of the key findings from Table 1 within the results section to guide interpretation and highlight the most relevant trends. Comment 4 The narrative results section repeats much of the material presented in the table. A more concise summary is recommended. We understand your point, but multiple risk factors contribute to stunting among children under five in Egypt, which could be one of the reasons why stunting is still prevalent even though Egypt is one of the oldest Arab countries and the cradle of multiple ancient civilisations. In the narrative results, we only reported the factors that showed a significant association with this issue. Comment 5 Interpretation of results: The association between vitamin A supplementation and a higher risk of stunting in children aged 0-23 months should be carefully discussed, as it may indicate a reverse causal relationship. Author's response: We apologise for this mistake and sincerely appreciate your insightful feedback. Inadequate use of vitamin A supplements was associated with stunting, as shown in the results in the last table. The results throughout the manuscript related to this issue have been reviewed and updated accordingly Comment 6 The findings that children from middle-income families are at lower risk of stunting than those from the wealthiest families also require further discussion. or theory. Authors response: This issue has been resolved by discussing the potential that could be behind this difference Comment 7 The significant increase in stunting rates in 2008 requires more in-depth contextual analysis (e.g., political factors, economic situation). Author's response: addressed by providing a more in-depth contextual analysis of why the significant increase in stunting rates among children under five in 2008. Comment 8 The discussion could be extended to consider how stunting patterns during the study period were influenced by Egypt’s political environment. Policy recommendations could be more specific and practical, such as: B. Expanding ANC work in communities, targeted maternal education initiatives, or improving access to water, sanitation, and hygiene services (WASH) in Upper Egypt. Author's response: We appreciate this valuable suggestion. We have updated the manuscript to include more specific and practical policy recommendations, such as fostering collaboration between the healthcare, education, WASH, and social protection sectors to address the multifaceted determinants of stunting among children under five. These revisions have been incorporated throughout the manuscript where appropriate. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Setiawan AS. Peer Review Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.178689.r374387) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-15/v2#referee-response-374387 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Dassie G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 27 Jan 2025 | for Version 1 Godana Arero Dassie , Adama Hospital Medical College, Adama, Ethiopia 0 Views copyright © 2025 Dassie G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (2) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions While emphasizing the importance of sectoral collaboration, risks overgeneralizing the complexity of addressing stunting. It does not adequately acknowledge the potential challenges in implementation, such as resource constraints, political will, and the difficulties of coordinating efforts across multiple sectors. Please refer to the detailed assessment of the article here - https://f1000research.s3.amazonaws.com/linked/704364.Under_reviewing.docx Furthermore, focusing interventions on children born to short mothers could inadvertently stigmatize this group and may overlook other critical determinants of stunting, such as paternal influence or environmental factors. The broad scope of the recommendation, which suggests large-scale interventions, does not sufficiently consider the feasibility of such initiatives, including budget limitations, sector prioritization, and community-specific barriers that could hinder successful implementation. Lastly, while interventions for low-SES families are essential, the conclusion would benefit from greater specificity regarding the types of interventions proposed, such as cash transfers, community-based education, or food security measures, to ensure clarity and practical applicability in real-world settings. To address stunting in Egypt, a coordinated approach across health, WASH, education, and social protection is essential. Interventions should target high-risk groups, particularly those with low socioeconomic status, focusing on healthcare access, parental education, and infant feeding practices. While short maternal height increases risk, interventions must also tackle broader factors like food security and sanitation. A nutrition monitoring framework integrated into health systems will enable data collection, evidence-based actions, and progress tracking. Effective implementation requires cost-effective, scalable solutions, community involvement, and resource prioritization to ensure sustainability and equity. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? No Competing Interests No competing interests were disclosed. Reviewer Expertise Nutrition I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (2) Author Response 26 Feb 2025 Nelmighrabi Elmighrabi, School of Health sciences, Western Sydney University - Campbelltown Campus, Campbelltown, 2560, Australia Dear Associate Professor Godana Arero Dassie, Thank you for your valuable comments and feedback. The F1000Research journal has a 300-word limit for the abstract, which restricts the inclusion of detailed information. However, I agree with your point regarding maternal height in the conclusion, and I am happy to revise the conclusion accordingly. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Author Response 26 Apr 2025 Nelmighrabi Elmighrabi, School of Health sciences, Western Sydney University - Campbelltown Campus, Campbelltown, 2560, Australia Dear Associate Professor Godana Arero Dassie, Thank you very much for taking the time to review our work. Your valuable feedback and insights have been extremely helpful in improving the quality of the manuscript. Below is our point-by-point response to each of your comments for consideration: Comments 1: Use consistent wording based on your topic. Better to Be concise its multiple burdens of malnutrition Author's response: Thank you for the suggestion. We have kept the wording as 'undernutrition' for consistency throughout the manuscript Comment 2: First globally, then study area. Don’t write phrase like one-third and acronyms or abbreviation Authors response: We agree with the suggestion. The text has been revised accordingly global context is presented first, and informal phrases like 'one-third' and abbreviations have been avoided Comment 3:  0–23 months: Infants and young children (critical window for growth and development).  24–59 months: Preschool-aged children (toddler to early childhood phase).  0–59 months: All children under five years (captures the entire group). So, merge together in smart way Author's response: Targeting undernutrition by age groups (0–23, 24–59, and 0–59 months) allows for more precise and effective interventions. Optimal nutritional and developmental support during early childhood necessitates stage-specific interventions to mitigate potential long-term health risks. The cohort aged 0–23 months encompasses the critical “first 1,000 days”, a period during which adequate nutrition profoundly impacts neurological development, immune function, and somatic growth. Nutritional deficiencies during this phase may result in irreversible harm, necessitating interventions such as exclusive breastfeeding and appropriate complementary feeding. The period between 24 and 59 months of age is characterised by significant growth and development, leading to an elevated risk of infectious diseases due to increased physical activity and social interaction. In this age group, nutritional intake significantly impacts cognitive development, disease prevention, and readiness for school; therefore, consistent promotion of diverse diets and hygienic practices is crucial. The 0-59 month age group serves as a metric for population-level monitoring of child health and nutrition. It facilitates national and international initiatives to monitor advancements toward objectives such as the Sustainable Development Goals (SDGs) and to formulate comprehensive policy responses. Therefore, the study specifically targeted children aged 0–23 months, 24–59 months, and 0–59 months, considering the differing nutritional and developmental needs across these age groups Comment 4 Sure! Could you share the details of your current methods section or the main points you’d like to include? For example, the study design, sample size, population, data collection methods, analysis techniques, and tools used. This way, I can rewrite it comprehensively for you. Author's response: This survey used data from previously published national representative surveys, EDHS 2005, 2008 and 2014. Due to journal word limits for the abstract, detailed descriptions of data collection methods and analysis are not included in the abstract. More details about these three included surveys are provided in the manuscript's methods section. Comment 5 If you could share the exact text of the abstract or the results section you're working with, I can rewrite and enhance it for clarity, depth, and analytical rigor. Let me know if you'd like to emphasize specific aspects like statistical findings, key insights, or actionable conclusions! Authors' response: Thank you for your offer. We have kept the abstract concise while ensuring it accurately reflects the key findings. However, we have refined the results section for clarity and analytical depth, incorporating statistical insights where relevant. Please let us know if there are specific areas you believe need further enhancement Comment 6 Your conclusion is overstated. Rested over all your finding 1-3 sentences. I.e. reduce size and volume of text Author's response: Your insightful feedback is greatly appreciated. Resolved and updated as advised Comment 7 The conclusion, while emphasising the importance of sectoral collaboration, risks overgeneralizing the complexity of addressing stunting. It does not adequately acknowledge the potential challenges in implementation , such as resource constraints, political will, and the difficulties of coordinating efforts across multiple sectors. Furthermore, focusing interventions on children born to short mothers could inadvertently stigmatize this group and may overlook other critical determinants of stunting, such as paternal influence or environmental factors . The broad scope of the recommendation, which suggests large-scale interventions, does not sufficiently consider the feasibility of such initiatives, including budget limitations , sector prioritization , and community-specific barriers that could hinder successful implementation. Lastly, while interventions for low-SES families are essential, the conclusion would benefit from greater specificity regarding the types of interventions proposed, such as cash transfers , community-based education , or food security measures , to ensure clarity and practical applicability in real-world settings. Authors response: Thank you for this insightful comment. Conclusion has been updated as advised Comment 8 Revise the rest of your paper in a similar context. Author's response: Revised and updated accordingly. We sincerely appreciate your valuable feedback and remain willing to make additional revisions to further improve our paper, if required. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Dassie GA. Peer Review Report For: Concurrent stunting among under-five children in Egypt [version 3; peer review: 8 approved with reservations] . F1000Research 2025, 14 :15 ( https://doi.org/10.5256/f1000research.174857.r358467) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-15/v1#referee-response-358467 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Stay Updated Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with F1000Research Already registered? Sign in Not now, thanks close PLEASE NOTE If you are an AUTHOR of this article, please check that you signed in with the account associated with this article otherwise we cannot automatically identify your role as an author and your comment will be labelled as a “User Comment”. If you are a REVIEWER of this article, please check that you have signed in with the account associated with this article and then go to your account to submit your report, please do not post your review here. If you do not have access to your original account, please contact us . All commenters must hold a formal affiliation as per our Policies . The information that you give us will be displayed next to your comment. User comments must be in English, comprehensible and relevant to the article under discussion. We reserve the right to remove any comments that we consider to be inappropriate, offensive or otherwise in breach of the User Comment Terms and Conditions . Commenters must not use a comment for personal attacks. When criticisms of the article are based on unpublished data, the data should be made available. I accept the User Comment Terms and Conditions Please confirm that you accept the User Comment Terms and Conditions. Affiliation ✕ refresh Please enter your institution. Note: To add your institution or organisation, start typing the name and then select the correct name from the list. Where applicable, the name will appear in both the original language and in English. Do not paste in the name. If the name does not appear in the drop-down list, we will display the information you have entered. ✕ refresh Country/Region * USA UK Canada China France Germany Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo (Serbia and Montenegro) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Minor Outlying Islands of the United States Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Is South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu UK USA Uganda Ukraine United Arab Emirates United States Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna West Bank and Gaza Strip Western Sahara Yemen Zambia Zimbabwe Please select your country/region. You must enter a comment. Competing Interests Please disclose any competing interests that might be construed to influence your judgment of the article's or peer review report's validity or importance. Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Please state your competing interests The comment has been saved. An error has occurred. Please try again. Cancel Post var lTitle = "Concurrent stunting among under-five children...".replace("'", ''); var linkedInUrl = "http://www.linkedin.com/shareArticle?url=https://f1000research.com/articles/14-15/v3" + "&title=" + encodeURIComponent(lTitle) + "&summary=" + encodeURIComponent('Read the article by '); var deliciousUrl = "https://del.icio.us/post?url=https://f1000research.com/articles/14-15/v3&title=" + encodeURIComponent(lTitle); var redditUrl = "http://reddit.com/submit?url=https://f1000research.com/articles/14-15/v3" + "&title=" + encodeURIComponent(lTitle); linkedInUrl += encodeURIComponent('Elmighrabi NF et al.'); var offsetTop = /chrome/i.test( navigator.userAgent ) ? 4 : -10; var addthis_config = { ui_offset_top: offsetTop, services_compact : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_expanded : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_custom : [ { name: "LinkedIn", url: linkedInUrl, icon:"/img/icon/at_linkedin.svg" }, { name: "Mendeley", url: "http://www.mendeley.com/import/?url=https://f1000research.com/articles/14-15/v3/mendeley", icon:"/img/icon/at_mendeley.svg" }, { name: "Reddit", url: redditUrl, icon:"/img/icon/at_reddit.svg" }, ] }; var addthis_share = { url: "https://f1000research.com/articles/14-15", templates : { twitter : "Concurrent stunting among under-five children in\u202FEgypt. Elmighrabi NF et al., published by " + "@F1000Research" + ", https://f1000research.com/articles/14-15/v3" } }; if (typeof(addthis) != "undefined"){ addthis.addEventListener('addthis.ready', checkCount); addthis.addEventListener('addthis.menu.share', checkCount); } $(".f1r-shares-twitter").attr("href", "https://twitter.com/intent/tweet?text=" + addthis_share.templates.twitter); $(".f1r-shares-facebook").attr("href", "https://www.facebook.com/sharer/sharer.php?u=" + addthis_share.url); $(".f1r-shares-linkedin").attr("href", addthis_config.services_custom[0].url); $(".f1r-shares-reddit").attr("href", addthis_config.services_custom[2].url); $(".f1r-shares-mendelay").attr("href", addthis_config.services_custom[1].url); function checkCount(){ setTimeout(function(){ $(".addthis_button_expanded").each(function(){ var count = $(this).text(); if (count !== "" && count != "0") $(this).removeClass("is-hidden"); else $(this).addClass("is-hidden"); }); }, 1000); } close How to cite this report {{reportCitation}} Cancel Copy Citation Details $(function(){R.ui.buttonDropdowns('.dropdown-for-downloads');}); $(function(){R.ui.toolbarDropdowns('.toolbar-dropdown-for-downloads');}); $.get("/articles/acj/159168/180883") new F1000.Clipboard(); new F1000.ThesaurusTermsDisplay("articles", "article", "180883"); $(document).ready(function() { $( "#frame1" ).on('load', function() { var mydiv = $(this).contents().find("div"); var h = mydiv.height(); console.log(h) }); var tooltipLivingFigure = jQuery(".interactive-living-figure-label .icon-more-info"), titleLivingFigure = tooltipLivingFigure.attr("title"); tooltipLivingFigure.simpletip({ fixed: true, position: ["-115", "30"], baseClass: 'small-tooltip', content:titleLivingFigure + " " }); tooltipLivingFigure.removeAttr("title"); $("body").on("click", ".cite-living-figure", function(e) { e.preventDefault(); var ref = $(this).attr("data-ref"); $(this).closest(".living-figure-list-container").find("#" + ref).fadeIn(200); }); $("body").on("click", ".close-cite-living-figure", function(e) { e.preventDefault(); $(this).closest(".popup-window-wrapper").fadeOut(200); }); $(document).on("mouseup", function(e) { var metricsContainer = $(".article-metrics-popover-wrapper"); if (!metricsContainer.is(e.target) && metricsContainer.has(e.target).length === 0) { $(".article-metrics-close-button").click(); } }); var articleId = $('#articleId').val(); if($("#main-article-count-box").attachArticleMetrics) { $("#main-article-count-box").attachArticleMetrics(articleId, { articleMetricsView: true }); } }); var figshareWidget = $(".new_figshare_widget"); if (figshareWidget.length > 0) { window.figshare.load("f1000", function(Widget) { // Select a tag/tags defined in your page. In this tag we will place the widget. _.map(figshareWidget, function(el){ var widget = new Widget({ articleId: $(el).attr("figshare_articleId") //height:300 // this is the height of the viewer part. [Default: 550] }); widget.initialize(); // initialize the widget widget.mount(el); // mount it in a tag that's on your page // this will save the widget on the global scope for later use from // your JS scripts. This line is optional. //window.widget = widget; }); }); } close Error Close Add Reset F1000.MICROSERVICES.AFFILIATION = ''; $(document).ready(function () { $('.js-affiliations-form').each((index, form) => { new AffiliationForm({ formId: form.id, institutionErrorSelector: '.comment-enter-institution', departmentErrorSelector: '.comment-enter-department', placeSelector: '.js-add-comment-place', stateSelector: '.js-add-comment-state', zipCodeSelector: '.js-add-comment-zipcode', countrySelector: '.js-add-comment-country', countryErrorSelector: '.comment-enter-country', }); }); }); $(document).ready(function () { var reportIds = { "394774": 0, "394775": 0, "394772": 0, "394773": 0, "420373": 0, "394770": 0, "394771": 0, "394768": 0, "394769": 0, "420381": 0, "420378": 0, "420379": 0, "394776": 0, "420376": 0, "394777": 0, "423718": 0, "423719": 0, "423726": 0, "423727": 0, "423724": 0, "423725": 0, "423722": 0, "423723": 0, "423720": 0, "423721": 0, "358461": 0, "427071": 0, "358460": 0, "358463": 0, "358462": 0, "358459": 0, "427078": 0, "386116": 0, "427079": 0, "358468": 0, "420420": 0, "427076": 10, "420421": 0, "427077": 0, "420418": 0, "427074": 0, "358465": 0, "420419": 0, "427075": 0, "358464": 0, "386115": 0, "427072": 0, "358467": 20, "427073": 0, "420417": 7, "358466": 0, "392781": 0, "392780": 0, "392783": 0, "392782": 0, "392779": 0, "427080": 0, "392778": 0, "392785": 0, "392784": 0, "392787": 0, "392786": 0, "416862": 0, "440926": 2, "416863": 0, "440927": 0, "440924": 0, "416860": 5, "416861": 0, "398685": 0, "440925": 0, "416858": 0, "416859": 0, "440923": 0, "371291": 0, "416857": 0, "398694": 0, "398695": 0, "398692": 0, "440932": 0, "398693": 0, "416866": 0, "398690": 0, "440930": 0, "398691": 0, "440931": 0, "416864": 0, "440928": 0, "416865": 0, "440929": 3, "386413": 0, "386412": 0, "386415": 0, "386414": 0, "398698": 0, "386409": 0, "398696": 0, "386411": 0, "398697": 0, "386410": 0, "374389": 0, "374388": 0, "374391": 0, "374390": 0, "386416": 0, "374387": 12, "374396": 0, "374393": 0, "374392": 0, "374395": 0, "374394": 0, "396486": 0, "388805": 0, "396487": 0, "388804": 0, "388807": 0, "396485": 0, "388806": 0, "388813": 0, "355789": 0, "388812": 0, "355788": 0, "396492": 0, "355791": 0, "396493": 0, "355790": 0, "396490": 0, "388809": 0, "396491": 8, "388808": 0, "396488": 0, "388811": 0, "355787": 0, "396489": 0, "388810": 0, "355796": 0, "355793": 0, "355792": 0, "396496": 0, "355795": 0, "355794": 0, "390621": 0, "390620": 0, "390623": 0, "390622": 0, "390617": 0, "390619": 0, "390618": 0, "429798": 0, "429799": 0, "390625": 0, "390624": 0, "390626": 0, "402926": 0, "429806": 0, "402927": 0, "429807": 0, "402924": 0, "429804": 0, "402925": 0, "429805": 0, "402922": 0, "429802": 0, "402923": 0, "429803": 0, "429800": 0, "402921": 0, "429801": 0, "400630": 0, "400631": 0, "400628": 0, "400629": 0, "402930": 0, "400627": 0, "402928": 0, "402929": 0, "400636": 0, "400634": 0, "400635": 0, "400632": 0, "400633": 0, }; $(".referee-response-container,.js-referee-report").each(function(index, el) { var reportId = $(el).attr("data-reportid"), reportCount = reportIds[reportId] || 0; $(el).find(".comments-count-container,.js-referee-report-views").html(reportCount); }); var uuidInput = $("#article_uuid"), oldUUId = uuidInput.val(), newUUId = "3b7f1d7d-ca33-4282-a34d-9f64cf680637"; uuidInput.val(newUUId); $("a[href*='article_uuid=']").each(function(index, el) { var newHref = $(el).attr("href").replace(oldUUId, newUUId); $(el).attr("href", newHref); }); }); An innovative open access publishing platform offering rapid publication and open peer review, whilst supporting data deposition and sharing. Browse Gateways Collections How it Works Contact For Developers Cookie Notice Privacy Notice RSS Submit Your Research Follow us © 2012-2026 F1000 Research Ltd. ISSN 2046-1402 | Legal | Partner of Research4Life • CrossRef • ORCID • FAIRSharing R.templateTests.simpleTemplate = R.template(' $text $text $text $text $text '); R.templateTests.runTests(); var F1000platform = new F1000.Platform({ name: "f1000research", displayName: "F1000Research", hostName: "f1000research.com", id: "1", editorialEmail: "[email protected]", infoEmail: "[email protected]", usePmcStats: true }); $(function(){R.ui.dropdowns('.dropdown-for-authors, .dropdown-for-about, .dropdown-for-myresearch');}); // $(function(){R.ui.dropdowns('.dropdown-for-referees');}); $(document).ready(function () { if ($(".cookie-warning").is(":visible")) { $(".sticky").css("margin-bottom", "35px"); $(".devices").addClass("devices-and-cookie-warning"); } $(".cookie-warning .close-button").click(function (e) { $(".devices").removeClass("devices-and-cookie-warning"); $(".sticky").css("margin-bottom", "0"); }); $("#tweeter-feed .tweet-message").each(function (i, message) { var self = $(message); self.html(linkify(self.html())); }); $(".partner").on("mouseenter mouseleave", function() { $(this).find(".gray-scale, .colour").toggleClass("is-hidden"); }); }); Sign In Remember me Forgotten your password? Sign In Cancel Email or password not correct. Please try again Please wait... $(function(){ // Note: All the setup needs to run against a name attribute and *not* the id due the clonish // nature of facebox... $("a[id=googleSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("GOOGLE"); $("form[id=oAuthForm]").submit(); }); $("a[id=facebookSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("FACEBOOK"); $("form[id=oAuthForm]").submit(); }); $("a[id=orcidSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("ORCID"); $("form[id=oAuthForm]").submit(); }); }); If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here . If you still need help with your Google account password, please click here . You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here . If you still need help with your Facebook account password, please click here . Code not correct, please try again Reset password Cancel Email us for further assistance. Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait... Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); });