Effect of Sugar-Sweetened Beverage Imports on the Prevalence of Overweight among Underfive Children in Nine Eastern Africa Countries

Effect of Sugar-Sweetened Beverage Imports on the Prevalence of Overweight among Underfive Children in Nine Eastern Africa Countries | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (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;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Sugar-Sweetened Beverage Imports on the Prevalence of Overweight among Underfive Children in Nine Eastern Africa Countries François Niragire, Lambert Kwizera, Olive Dushimimana, Florent Uwacu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4697545/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Overweighting among children under five years of age is increasingly becoming a global health concern. This has a connection with international trade and its influence on the increasing availability and consumption of sugar in different forms. This study seeks to identify the effects of the import of sugar-sweetened beverages on the prevalence of overweight among children under five years of age in nine Eastern Africa countries (EAC). Methods This study analyzed data from the UN Comtrade Database and World Development Indicators (WDI) of the World Bank (WB) spanning from 2000–2022. The East African countries selected are Burundi, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, Madagascar and Zimbabwe. With these panel data, the fixed-effect estimation approach was employed as a technique to study the effect. Results The analysis revealed that the imports of sugar-sweetened beverages such as milk drinks, tea and coffee, and water, including mineral and aerated drinks, had a negative effect on the incidence of overweight among children under five years old in the EAC, but the difference was not statistically significant. However, GDP per capita was found to be positively related to the incidence of overweight. Conclusions This study did not find any evidence that SSB consumption in EACs contributes to the prevalence of overweight among children under five years old. Only GDP growth per capita was found to have a positive effect on the prevalence of child overweight. The findings suggest that international trade policies and agreements should consider the effect of economic growth on adverse health outcomes among children under five years of age in EACs and other similar developing countries. sugar-sweetened beverages overweight underfive children imports eastern Africa Background Globally, there is no country that is on the track to prevent the increase in overweight among children under 5 years of age (Branca et al., 2023 ). Studies have established a link between sugar intake and overweight or obesity (Magriplis et al., 2021 ; Yu et al., 2022 ; Kuhnle et al., 2015 ). The availability of sugar-sweetened commodities, especially through trade, has also been reported by several studies (Schram et al., 2015 ; Mendez Lopez et al., 2017 ; Lo et al., 2021 ; Mabeta & Smutka, 2023 ). A report from the 2023 World Obesity Federation revealed that almost 400 million children will be overweight or obese by 2035 (Lobstein et al., 2023 ). The same report indicates that the global increase in obesity incidence among children and adolescents will be the most pronounced, from 8–18% in girls and from 10–20% in boys from 2020 to 2035. Consequently, there is an increasing economic impact of obesity globally. It is estimated that its cost will increase from US $ 1.96 trillion in 2020 to over US $ 4 trillion in 2035, at a constant US $ value. The impacts include healthcare costs, loss of productivity, and premature death. Due to overweight or obesity, the global gross domestic product (GDP) is expected to decrease by 2.4% in 2020 and then increase to 2.9% from that value (2.4%) by 2035 (Lobstein et al., 2023 ). Overweight is no longer a health problem in high-income countries but has also dramatically risen in low- and middle-income countries, including countries in eastern Africa. Previous studies have reported that there has been a considerable increase in childhood obesity in Sub-Saharan Africa over the past two decades (Danquah et al., 2019 ). For instance, in their review, Danquah et al. ( 2020 ) reported that in SSA, childhood obesity or overweight has increasingly become a public health concern. This increase was also observed in West African countries (Diallo et al., 2023 ). In sub-Saharan Africa (SSA), the prevalence of obesity among children and adolescents is expected to increase from 5–14% in girls and from 4–7% in boys between 2020 and 2035. By 2035, the yearly economic impact is projected to be more than US $ 50 billion or 1.6% of the region’s GDP (in constant 2019 dollars) (Lobstein et al., 2023 ). Several studies have investigated the risk factors leading to overweight among underfive children (Saha et al., 2022 ; Tiruneh et al., 2021 ). The major contributors to overweight or obesity have been found to be the consumption of high-fatty products, high-sugars, and micro nutrient-poor diets (BA et al., 2004 ; Ruhara et al., 2021 ). Most of these products are easily imported in many countries, especially LMC. Additionally, the expanding scope of international trade agreements and policies has facilitated the sudden increase in imports of sugar-sweetened beverages (Ruhara et al., 2021 ). Although some previous studies have indicated that trade has a positive impact on health outcomes, such as reducing infant mortality and improving life expectancy (Zhang et al., 2022 ), some trade policies, such as trade openness and trade and investment agreements, have also been proven to have adverse effects on health outcomes (Barlow et al., 2022 ). Trade liberalization, as a trade policy, tends to be conducive to the consumption of sugary drinks or sweetened beverages (Mendez Lopez et al., 2017 ), which can lead to chronic diseases (Lo et al., 2021 ; Teng et al., 2020 ). In particular, overweight or obese children are prone to experiencing an increased risk of having high blood pressure, high cholesterol concentrations, type 2 diabetes, asthma, joint problems, gallstones, anxiety, depression, insulin resistance, hypertension, hyperlipidemia, liver and kidney disease, and reproductive problems (Albataineh et al., 2019 ; Sahoo et al., 2015 ). These consequences are connected to the manufacturing, importing or purchasing and consumption of sugar-sweetened beverages and foods that contain high amounts of energy, fat, sugar, salt and low amounts of vitamins and minerals (WB & PAHO, 2020). The literature indicates factors associated with overweight in children in SSA (Choukem et al., 2020 ). Similarly, studies have attempted to use child overweight data relating to import data (Ferretti and Mariani, 2019 ; Schmidt & Fang, 2021 ). Beverage waters sweetened or flavored ranked 281st in terms of global trade in 2021, with $ 12.6 billion in total trade. Exports of sweetened or flavored beverage waters increased by 24.7% between 2020 and 2021, from $ 10.1 billion to $ 12.6 billion. In general, trade in sweetened or flavored beverage waters constitutes 0.06% of global trade (OEC, 2023 ). Analysis of the most recent Demographic and Health Survey (DHS) data showed that the prevalence of overweight among children under five years of age ranged from 3.2% in Kenya to 5.6% in Rwanda (KNBS & ICF, 2023; NISR et al., 2021). In addition, it varied from 1.4% in Burundi to 2% and 5.2% in Ethiopia and Zambia, respectively (EPHI & ICF, 2021; MPBGP et al., 2017). While various factors contribute to overweight and obesity in Africa, economic risk factors play a major role in increasing incidence of childhood obesity, especially in the East African context. For example, a study performed in 175 countries between 1975 and 2016 showed that international trade openness was positively associated with country obesity, where an increase of 10% in trade openness was associated with an increase in the obesity rate of 0.80% (An et al., 2019 ). A study performed in Kenya showed that 18% of children under five years of age were overweight, which was found to be associated with maternal overweight and obesity, higher education levels, a very large child at birth and stunting (Gewa, 2010 ). Another study performed in sub-Saharan Africa in 2022 showed that overweight and obesity in preschool children were strongly associated with the home food environment and high maternal BMI. The economic transition in many African countries, including East African countries, has led to a shift in dietary patterns and physical activity levels, which contributes to an increased prevalence of overweight in children and urbanization (Kwansa et al., 2022 ). Urbanization and globalization, particularly the free trade of services such as the modern marketing food trade in food products, have brought about changes in food systems and marketing exchange practices. This has resulted in the proliferation of inexpensive, highly processed foods that are energy dense but nutrient poor; these foods are more accessible and affordable than healthier foods are, and as a result, this exacerbates the risk of childhood overweight in economically disadvantaged communities (Popkin et al., 2020 ). Childhood overweight or obesity has been considered an epidemic (Paul, 2023 ; Tiruneh et al., 2021 ) and a pandemic in the Global South (Paul, 2023 ). Child overweight, according to the World Health Organization (WHO), is a condition in which the child’s weight is not proportional to his or her height (Jones et al., 2017 ; Ayele et al., 2022 ; Flynn et al., 2022 ). Overweight children have a weight-for-height greater than two (2) standard deviations (SDs) above the median of the WHO Child Growth Standards (WHO, 2024 ; de Onis, 2015 ; LBD Double Burden of Malnutrition Collaborators, 2020 ). There is a connection between international trade, globalization of trade and public health. An increase in trade has noticeable effects on health outcomes (Bettcher et al., 2000 ; Loewenson et al., 2007 ; Cyrus, 2018 ). Recent trends have shown a concerning increase in the prevalence of overweight and obesity among children under five years of age in East African countries (S.A. Tiruneh, 2021). This escalation appears to be significantly influenced by the regular consumption of soft drinks, including both carbonated and noncarbonated sugar-sweetened beverages (SSBs). Several studies conducted in developed countries have investigated this health concern (Malik VS, Pan A, Willett WC et al., 2013; F.B. Hu, 2013 ; Ferretti and Mariani, 2019 ). The estimation of sugar-sweetened beverage (SSB) imports has evolved over time, reflecting shifts in consumer behavior, policy interventions, and global trade dynamics. SSBs are any drinks that contain added sugar or sweeteners. These beverages contain free sugars, which include carbonated or noncarbonated soft drinks; 100% fruit/vegetable juices and drinks; liquid and powder concentrates; flavored water; energy and sports drinks; ready-to-drink tea; ready-to-drink coffee; and flavored milk drinks (Sousa et al., 2020 ; Malik & Hu, 2022 ). Previous studies examining the link between SSBs and child nutrition outcomes range from systematic reviews to cross-sectional and ecological analyses, covering a broad spectrum of countries and regions. Key themes include the effectiveness of SSB taxation in reducing consumption and obesity rates (Itria et al., 2021 ), the role of SSB affordability in increasing obesity incidence (Ferretti and Mariani, 2019 ), and the global consumption patterns of SSBs among children and adolescents and their health implications (Ooi et al., 2022). The literature has also explored the broader impacts of global trade on health (Bettcher et al., 2000 ) and the determinants of obesity in East African children (Tiruneh et al., 2021 ). Each study contributes to a nuanced understanding of how SSB consumption, influenced by factors such as taxation, affordability, and global trade, is linked to the rising prevalence of obesity and related health issues. Thus, understanding global evidence and providing region-specific data on the relationship between SSB imports and the prevalence of overweight are crucial for effectively informing the design and implementation of locally specific and relevant prevention and intervention programs. However, there remains a significant gap in the related literature within developing regions, especially in eastern African countries. Research on the linkage between international trade, trade policies and agreements and health outcomes such as overweight among children under the age of five years in Eastern African countries is scarce. In particular, there is a lack of specific knowledge on the effects of SSB imports on the increasing incidence of childhood overweight in these countries. This study aimed to investigate the effect of the import of sugar-sweetened beverages (SSBs) on the prevalence of overweight in underfive children in nine Eastern African countries, namely, Burundi, Madagascar, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. This study focused on the effects of importing juices, milk drinks, tea and coffee, and water with mineral and aerated drinks, which are commonly called SSBs or sugary drinks (Bahl & Bird, 2020 ). Methods Data This study used data from the World Development Indicators (WDI) of the World Bank (WB) and UN Comtrade for the period spanning from 2000–2022. The authors analyzed data for nine selected East African countries, namely, Burundi, Madagascar, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. These countries were included in this study because they fulfilled the following criteria or conditions. These countries were selected because the prevalence of overweight is on the rise in low- and middle-income countries (LMICs). In the eastern part of Africa, underfive children tend to be overweight (Tiruneh et al., 2021 ). This region has persistent problems associated with malnutrition, as revealed in the 2022 Global Nutrition Report. The same report revealed that the average incidence of overweight was 4%, the lowest value compared with that in other subregions of Africa. In the same region, the UNICEF, WHO and World Bank (2023) reported that the prevalence of overweight among children under five years of age has not changed since 2015. According to the 2025–2030 World Health Assembly (WHA), the WHO and UNICEF suggest that child overweight status be reduced and will remain constant at less than 3% by 2030 (Chadare et al., 2022). However, this region is off track to meet the target. Moreover, these countries were also selected due to the availability of data. Dependent Variable The dependent variable of the study was the prevalence of overweight in children under five years of age. According to the WHO's 2006 Child Growth Standards, the prevalence of overweight children is defined as the percentage of children under the age of five whose weight-for-height ratio is more than two standard deviations above the median for the international reference population of the corresponding age. This variable indicates the nutritional status of the child. We obtained data on the prevalence of overweight from the website of the World Bank Development Indicators (WDI). The data are expressed as percentages. It is a modeled estimate. Independent variables The independent variable of interest in this study is the amount of sugar-sweetened beverage (SSB) imports. These include the imports of juice, milk drinks, tea and coffee, and water, including mineral and aerated drinks. These SSBs have been associated with weight gain (Malik & Hu, 2022 ). The present study aimed to assess the effects of these variables on the prevalence of overweight among children under five years of age. Table 1 provides a description of the SSBs according to the WHO nutritional profile and their Harmonized systems (HS) classification in The United Nations Commodity Trade Statistics Database (UN Comtrade) (WHO Regional Office for Africa, 2018 ). Table 1 Sugar-sweetened beverages according to the WHO nutritional profile from the UN Comtrade website Sugar-sweetened beverages Harmonized System (HS) code Description Juices 2009 Fruit or nut juices (including grape must and coconut water) and vegetable juices, unfermented, not containing added spirit, whether or not containing added sugar or other sweetening matter Milk drinks 0402 Milk and cream; concentrated or containing added sugar or other sweetening matter Tea and coffee 210112 Preparations with a basis of extracts, essences or concentrates or with a basis of coffee Water, including mineral and aerated drinks 2202 Waters, including mineral and aerated waters, containing added sugar or sweetening matter, flavored; other nonalcoholic beverages, not including fruit, nut or vegetable juices of heading no. 2009 We considered the value of imports (trade flows) expressed in United States dollars (USD) for the period from 2000–2022. The data were sourced for the nine selected countries as “ Reporters ”, while the “ Partners ” were the World . To obtain the data used in this study from the UN Comtrade website, we considered TOTAL Modes of Transport for “Mode of Transports”, and TOTAL customs procedure codes were considered for the “Customs code”. In addition, the “Set your query options” feature has the “Breakdown Mode”, which was considered to be Plus , while the “Aggregate by” feature remained with the value None . In addition to SSBs, this study considered a number of control variables. The latter include trade openness and GDP per capita growth. Data on trade openness were obtained from the World Development Indicators (WDI) of the World Bank and from the website of our World in Data 1 . These data are expressed in terms of the annual percentage of GDP, that is, Trade in terms of % GDP. This trade openness index is computed by summing the imports and exports of goods and services, and this sum is divided by GDP. We drew GDP per capita growth data from the WDI website. It is the annual percentage growth rate of GDP per capita based on constant local currency. This value is computed by taking annual GDP and dividing by the mid-year population. The annual percentage growth rate of GDP per capita is based on a constant local currency. The GDP per capita is the gross domestic product divided by the midyear population. Table 2 provides the description and summarizes the origin of the data. Table 2 Description of variables and sources of data Variable Description Unit Source of data Dependent variable Prevalence of overweight Prevalence of overweight children is the percentage of children under age 5 percentage WDI Independent variables Imports of juice Total value of imports of juice (USD) USD UN Comtrade Imports of Milk drinks Total value of imports of milk drinks (USD) USD UN Comtrade Imports of Tea and Coffee Total value of imports of Tea and Coffee (USD) USD UN Comtrade Imports of water, including mineral and aerated drinks Total value of imports of water, including mineral and aerated drinks USD UN Comtrade Trade openness The ratio from the sum of imports and exports divided by GDP Import + export ratio to GDP expressed in annual percentage WDI GDP per capita growth Annual percentage growth rate of GDP per capita based on constant local currency. annual percentage WDI Data analysis methods As an empirical estimation method, we used the fixed effects approach to investigate the effects of SSB consumption on the prevalence of overweight among children under five years of age in nine EAC countries. The fixed effect model indicates the relationship between dependent and independent variables within a country (considered an entity). With this approach, it is assumed that these entities may have individual observations or characteristics that may or may not have an effect on the outcome and/or predictor variables. These individual characteristics are not random and may influence the dependent or predictor variables. This issue has to be controlled for. Therefore, the impact of independent variables may not be influenced by those fixed observations. Moreover, this fixed effect approach assumes that there is no correlation between the entity’s error term and independent variables (predictors). The Hausman test, when performed, indicated the choice of the fixed effect model. The data included 9 countries (n = 9), and the time period was 22 years (2000–2022) (T = 22). This study estimated the following econometric model, also known as the health production function, with the prevalence of overweight as the response variable: $$\:overweigh{t}_{it}={\beta\:}_{0}+{\beta\:}_{1}Juic{e}_{it}+{\beta\:}_{2}Mil{k}_{it}+{\beta\:}_{3}TCoffe{e}_{it}+{\beta\:}_{4}Wate{r}_{it}+{\beta\:}_{5}{X}_{it}+{ϵ}_{it}$$ where overweight represents the incidence of overweight children under five years of age, for i = 1, 2, …, N indicates the number of countries, and t = 1,2..,T indicates the time periods. Betas are coefficients. Juice represents the total value of imports of juices. Milk represents the total value of imports of milk drinks. TCoffee represents the total value of imports of tea and coffee. Water represents the total value of water, including mineral and aerated drinks. X represents control variables such as Trade openness and GDP per capita growth. ε it represents the error term for country i at time t and is calculated as follows: $$\:{ϵ}_{i}{,}_{t}={\mu\:}_{i}+{\gamma\:}_{t}$$ µ i = country-specific fixed effects constant in time, \(\:{\gamma\:}_{t}\) = time-specific fixed effects Additionally, to analyze the data, we used Stata version 15 MP. Moreover, because some countries have missing data, interpolation techniques were used to construct a complete dataset. This technique is more reliable than extrapolation because it provides a valid estimate. We performed log-transformation for easy interpretation in terms of elasticity: when the independent variable increases by 1% over time, the dependent variable (y) changes by 𝛽% or elasticity. Moreover, the study performed OLS regression analysis with the Stata command reg and panel regression analysis with the xtreg command. This command is generally employed for panel data. The study used the reghdfe command, which estimates regressions with multiple levels of fixed effects. Results Table 3 presents the summary statistics for the study variables. The analysis was based on balanced panel data; however, for certain variables, data for certain periods of the year (2000–2023) were missing for all 9 countries. The descriptive analysis revealed that the average incidence of overweight among children under 5 years of age was approximately 5.1% in nine East African countries during the period of 23 years (2000–2022). Table 3 Average magnitude of the study variables. Variable n Mean Std. Dev. Min Max Prevalence of overweight 207 0.051 0.022 0.015 0.122 Juices 207 4269802.3 2444619.6 484204.13 7759806.9 Milk drinks 207 7165305.4 3078010.6 2271723.9 13083675 Tea Coffee 207 191383.1 159065.32 14479.625 591932.5 Water mineral drinks 207 4918825.4 2965123.6 834614.33 10090190 Trade openness 198 0.537 0.059 0.413 0.62 GDP per capita growth 207 0.017 0.045 -0.183 0.199 During the study period, the average total value of imports of juices in these countries was 4,269,802.3 USD. This amount was 7,165,305.4 USD for milk drinks, 191,383.1 USD for tea and 4,918,825.4 USD for water, including mineral and aerated drinks.. The average trade openness (import + export ratio to GDP) in the nine selected (9) EACs was 0.537 (53.7%), while the average annual percentage growth rate of GDP per capita based on constant local currency was 0.017 (1.7%). Table 4 Correlations between child overweight and the selected study variables Variables (1) (2) (3) (4) (5) (6) (7) ln of prevalence of overweight (1) 1.000 Juices (2) -0.374 1.000 Milk drinks (3) -0.350 0.882 1.000 Tea and coffee (4) -0.360 0.802 0.767 1.000 Water mineral drinks (5) -0.371 0.971 0.812 0.806 1.000 Trade openness (6) -0.287 0.776 0.888 0.546 0.674 1.000 GDP per capita growth (7) 0.219 0.047 0.073 -0.069 0.013 0.112 1.000 The results in Table 4 indicate that the incidence of overweight among children under five years of age in the nine EACs during the period 2000–2022 and the imports of juice are negatively correlated. The same relationship was also observed for the imports of milk drinks, tea and coffee, and water, including mineral and aerated drinks. In contrast, there was a positive correlation between GDP per capita growth and the incidence of overweight. The results reveal that, except for GDP per capita growth, the other study variables were strongly correlated with each other, all of which were considered together. Relationships between under five years of overweight and the selected variables Table 3 shows the results of the fixed effect regression analyses. The results suggest that the import of sugar-sweetened beverages (SSBs) did not contribute to an increase in the prevalence of overweight in children under the age of 5 years in the nine EAC. Column (1) of Table 3 shows the results from the pooled ordinary least squares (OLS) regression, column (2) shows the fixed-effect regression results, and column (3) shows the results of a multiway fixed regression (regditional). Overall, the coefficients are similar, though robust standard errors are different. Table 3 Regression analyses of the influence of the selected factors on child overweight in EACs Full Model Reduced model (1) (2) (3) (1) (2) (3) VARIABLES Using -reg- Using -xtreg- Using -reghdfe- Using -reg- Using -xtreg- Using -reghdfe- Juices -0.0693 -0.0693 -0.0693 -0.0424 -0.0424 -0.0424 (0.0573) (0.0556) (0.0556) (0.0259) (0.0253) (0.0253) Milk drinks -0.0723 -0.0723 -0.0723 -0.0132 -0.0132 -0.0132 (0.104) (0.101) (0.101) (0.0206) (0.0202) (0.0202) Tea and Coffee -0.0500 -0.0500 -0.0500 -0.0961* -0.0961* -0.0961* (0.0430) (0.0418) (0.0418) (0.0490) (0.0481) (0.0481) Water Mineral drinks -0.0807 -0.0807 -0.0807 -0.0506 -0.0506 -0.0506 (0.0488) (0.0474) (0.0474) (0.0302) (0.0296) (0.0296) Trade openness 0.373 0.373 0.373 (0.322) (0.313) (0.313) GDP per capita growth 0.0187** 0.0187** 0.0187** (0.00689) (0.00669) (0.00669) Constant 1.232 1.232 -0.360 -0.360 (1.684) (1.684) (0.715) (0.715) Observations 148 148 148 207 207 207 R-squared 0.907 0.644 0.907 0.863 0.538 0.863 Country Fixed Effects YES YES YES YES YES YES Robust standard errors in parentheses *** p < 0.01, ** p < 0.05, * p < 0.1 The results based on the full model indicate that the imports of juice, imports of milk drinks, imports of tea and coffee, and imports of water are negatively correlated with the prevalence of overweight in children under five years of age, and these effects are not statistically significant. Unlike the other variables considered, this study revealed that GDP per capita has a positive effect on overweight children under five years of age. The results indicate that when the GDP per capita increases by 1% over time, the incidence of overweight increases by 1.87%. The reduced model did not include the variables of trade openness or GDP per capita. The results based on the reduced model showed that the imports of tea and coffee had a statistically negative effect on the prevalence of overweight in individuals under five years old. An increase in the USD in imports of tea and coffee is associated with a decrease in the prevalence of overweight under five years of age by 9.61% over time. When we include the country fixed effect and perform all three models, we observe a decrease in robust standard errors of coefficient estimates. Discussion This study aimed to investigate the effect of the import of sugar-sweetened beverages on the prevalence of overweight among children under five (U5) in nine (9) East African countries. These countries include Burundi, Malawi, Mozambique, Madagascar, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. We found that the variables of interest, including the imports of juice, milk drinks, tea and coffee, and water (including mineral and aerated drinks), were not significantly different, despite their negative effect on the prevalence of overweight in children under five years old in those countries. This study revealed that the GDP growth per capita in these countries has a positive effect on the prevalence of overweight among children under five years of age. Several studies have established that there is a positive relationship between GDP per capita and overweight or obesity (Hu et al., 2020 ). These findings corroborate prior evidence of the relationship between economic development and the nutritional status of children, such as obese or overweight children (Egger et al., 2012 ; Bu et al., 2021 ). It has been suggested that the prevalence of overweight depends on the increase in economic growth in developing countries (Seyde et al., 2016 ). The increase in overweight people around the world is attributed to important economic factors, such as economic development, urbanization and women’s empowerment (Fox et al., 2019 ), as well as trade (Giuntella et al., 2020 ). However, because SSBs are related to overweighting under five children in the context of EAC and because of the negative effects of SSBs, our study aimed to be similar to other studies that have attempted to establish a relationship between trade and health outcomes. Our study also relates to the work of Agüero and Ukil ( 2022 ), which assessed the effect of Chinese imports on birth weight gain as an infant health outcome in sub-Saharan African countries. These authors found that a significant increase in birth weight was associated with greater exposure to Chinese imports based on a sample of more than 350,000 births from 22 sub-Saharan African nations. Other studies have indicated that there is a positive relationship between SSB consumption and overweight (Yu, et al., 2022 ; Freire et al., 2018 and Ferretti & Mariani, 2019 ). These studies revealed that these SSBs are typically imported and consumed as part of a meal (Freire et al., 2018 ). However, Freire et al. ( 2018 ) indicated that the affordability of SSBs, which include noncarbonated drinks (such as ready to drink tea, coffee, and juice, as well as sports/energy and Asian drinks) and soft drinks, has a positive influence on the prevalence of overweight among individuals of both sexes (BMI ≥ 25) who are older than 18 years in 150 countries worldwide. In addition, several studies and reports indicate that increased consumption of SSBs is linked to a greater incidence of overweight (Keller & Bucher Della Torre, 2015; Rousham et al., 2022 ; Yu et al., 2016). The same evidence was found in East African countries. Using data from demographic and health surveys (DHS), Tiruneh et al. ( 2021 ) reported that overweight was affected by overweight in children under five years old living in affluent households in East African countries such as Malawi, Mozambique, Rwanda, Tanzania, and Uganda. However, in our study, we examined the association between SSB imports and consumption among children under 5 years of age in 9 African countries and found that SSB imports have a negative but not statistically significant effect. However, it was found that GDP per capita has a positive effect on the incidence of overweight in children under five years of age. This study revealed that the imports of juices, milk drinks, tea, coffee, and water, including mineral and aerated drinks, have a negative relationship with the prevalence of overweight in individuals under five years of age. However, the causal mechanisms through which SSB imports negatively affect the prevalence of overweight were not identified. Conclusion This study examined the effect of the import of sugar-sweetened beverages (SSBs) on the prevalence of overweight among underfive children in nine selected EACs, namely, Burundi, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, Madagascar and Zimbabwe. This study bridges the gap in the literature on the potential influence of SSB imports on the prevalence of child overweight within developing regions, especially in eastern African countries. The findings revealed that the underfive overweight population in the study countries cannot be directly explained by the volume of SSB imports, such as juice, milk drinks, tea and coffee as well as mineral water and aerated drinks. The study did not find any evidence that SSB imports in EACs contribute to the prevalence of overweight among children under five years of age. However, GDP growth per capita was accompanied by an increase in the prevalence of child overweight. These findings suggest that the import of SSBs has a significant adverse effect on child health outcomes when access increases considerably. Therefore, trade policies should be enacted considering the effect of economic growth on adverse health outcomes among children under five years of age in EACs. Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials All the data were obtained from the World Development Indicators (WDI) of the World Bank (WB) and UN Comtrade and are freely accessible through the following link: https://osf.io/a896w/ Competing interests The authors declare that they have no competing interests. Funding This research did not receive funding for data collection or manuscript publication. The authors received financial support from the University of Rwanda (UR) World Trade Organization Chairs Programme (WCP) at the University of Rwanda to organize the manuscript writing meetings. No other funding was obtained for this study. Authors' contributions - provide individual author contribution FN, LK, OD, and FU contributed to the study's conceptualization, data analysis, and manuscript writing. LK acquired the study data and performed the data management and analysis. All the authors read and approved the final version of the manuscript. Acknowledgments The authors would like to thank Emmanuel Ndagijimana, College of Medicine and Health Sciences, University of Rwanda, for proofreading the manuscript. Authors' information Prof. François NIRAGIRE Department of Applied Statistics, College of Business and Economics, University of Rwanda, Kigali, Rwanda Email: [email protected] ORCID: https://orcid.org/0000-0003-0473-387X Mr. Lambert KWIZERA Department of Economics, College of Business and Economics, University of Rwanda, Kigali, P.O. Box 4285, Kigali, Rwanda Email: [email protected] ORCID: https://orcid.org/0000-0002-4044-4568 Mrs. Olive DUSHIMIMANA Department of Epidemiology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Email: [email protected] Mr. Florent UWACU Business Research Centre, Rwanda Private Sector Federation (PSF), Kigali, Rwanda Email: [email protected] References Agüero JM, Ukil P. (2022). 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SSRN Electron J. 2020. https://doi.org/10.2139/ssrn.3649182 . Barlow P, Sanap R, Garde A, Winters LA, Mabhala MA, Thow A-M. Reassessing the health impacts of trade and investment agreements: a systematic review of quantitative studies, 201620. Lancet Planet Health. 2022;6(5):e431–8. https://doi.org/10.1016/S2542-5196(22)00047-X . Bettcher DW, Yach D, Guindon GE. (2000). Global trade and health: key linkages and future challenges. Bulletin of the World Health Organization . Branca F, Ursu P, Aguayo V. A plan for accelerated action on obesity. Lancet Global Health. 2023;11(8):e1170–1. https://doi.org/10.1016/S2214-109X(23)00257-7 . Bu T, Popovic S, Huang H, Fu T, Gardasevic J. (2021). Relationship between National Economic Development and Body Mass Index in Chinese children and adolescents aged 5–19 from 1986 to 2019. Frontiers in Pediatrics , 9 . https://doi.org/10.3389/fped.2021.671504 . 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A Systematic Review of the Recent Consumption Levels of Sugar-Sweetened Beverages in Children and Adolescents From the World Health Organization Regions With High Dietary–Related Burden of Disease. Asia Pac J Public Health. 2021;101053952110146. 10.1177/10105395211014642 . Paul M. (2023). Africa’s obesity epidemic: Children, adults to rapidly pile up the pounds in coming years, says new report. In Down To Earth . https://www.downtoearth.org.in/news/africa/africa-s-obesity-epidemic-children-adults-to-rapidly-pile-up-the-pounds-in-coming-years-says-new-report-88071 . Popkin B, Eberwein JD, Okamura KS. (2020). Factors affecting overweight/obesity prevalence (pp. 95–108). The World Bank. https://doi.org/10.1596/978-1-4648-1491-4_ch4 . Rousham EK, Goudet S, Markey O, Griffiths P, Boxer B, Carroll C, Petherick ES, Pradeilles R. Unhealthy food and beverage consumption in children and risk of overweight and obesity: A systematic review and meta-analysis. Adv Nutr. 2022;13(5):1669–96. https://doi.org/10.1093/advances/nmac032 . Ruhara CM, Karim A, Erzse S, Thow A, Ntirampeba A-M, S., Hofman KJ. Strengthening prevention of nutrition-related noncommunicable diseases through sugar-sweetened beverages tax in Rwanda: a policy landscape analysis. Global Health Action. 2021;14(1):1883911. https://doi.org/10.1080/16549716.2021.1883911 . Saha J, Chouhan P, Ahmed F, Ghosh T, Mondal S, Shahid M, Fatima S, Tang K. Overweight/obesity prevalence among underfive children and risk factors in India: A cross-sectional study using the national family health survey (20152016). Nutrients. 2022;14(17):3621. https://doi.org/10.3390/nu14173621 . Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: Causes and consequences. J Family Med Prim Care. 2015;4(2):187–92. https://doi.org/10.4103/2249-4863.154628 . Schmidt E, Fang P. Papua New Guinea agri-food trade and household consumption trends point toward dietary change and increased overweight and obesity prevalence. Globalization Health. 2021;17(1). https://doi.org/10.1186/s12992-021-00787-0 . Schram A, Labonte R, Baker P, Friel S, Reeves A, Stuckler D. The role of Trade and investment liberalization in the sugar-sweetened carbonated beverages market: A natural experiment contrasting Vietnam and the Philippines. Globalization Health. 2015;11(1). https://doi.org/10.1186/s12992-015-0127-7 . Seyde GS, Kucukoglu O, Altinbas A, Demir OO, Yilmaz S, Akkiz H, Otan E, Sowa J-P, Canbay A. Economic growth leads to increase of obesity and associated hepatocellular carcinoma in developing countries. Ann Hepatol. 2016;15(5):662–72. https://doi.org/10.5604/16652681.1212316 . Sousa A, Sych J, Rohrmann S, Faeh D. (2020). The importance of sweet beverage definitions when targeting health policies—the case of Switzerland. Nutrients , 12 (7), 1976. https://doi.org/10.3390/nu12071976 . Teng A, Puloka V, Genç M, Filimoehala O, Latu C, Lolomana’ia M, Osornprasop S, Signal L, Wilson N. Sweetened beverage taxes and changes in beverage price, imports and manufacturing: Interrupted time series analysis in a middle-income country. Int J Behav Nutr Phys Activity. 2020;17(1):90. https://doi.org/10.1186/s12966-020-00980-1 . Tiruneh SA, Gebremariam AD, Engidaw MT, Tesfa D, Dagnaw FT, Zewde EA, Azanaw MM. Overweight and/or obesity and its determinants among underfive children in east African countries: A multilevel analysis using Bayesian approach. Heliyon. 2021;7(12):e08643. https://doi.org/10.1016/j.heliyon.2021.e08643 . UNICEF, WHO & World Bank. 2023. UNICEF-WHO-World Bank: Joint child malnutrition estimates - Levels and trends (2023 edition). https://data.unicef.org/resources/jme-report-2023 . WB, & PAHO. (2020). Sugar-sweetened beverages and prepackaged foods: The impact of taxation on price, consumption, and revenues and its contribution to achieving the sustainable development goals in central America, Panama, and the Dominican republic. In The World Bank . World Bank (WB); Pan American Health Organization (PAHO). https://pubdocs.worldbank.org/en/611961599658512658/TF0A4082-Full-reportSugarSweetDrinksEnglish-Final-2020-1.pdf . WHO. (2024).Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight . WHO Regional Office for Africa. Nutrient profile model for the WHO African region: a tool for implementing WHO recommendations on the marketing of foods and nonalcoholic beverages to children Brazzaville. WHO Regional Office for Africa; 2018. WTO. (2023). World trade statistical review 2023. In World Trade Organization . World Trade Organization (WTO). https://www.wto.org/english/res_e/booksp_e/wtsr_2023_e.pdf . 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Footnotes https://ourworldindata.org/grapher/trade-as-share-of-gdp Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4697545","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":330712283,"identity":"1e89c0b9-8115-4bc6-8335-dcfc9c8ad8be","order_by":0,"name":"François Niragire","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"François","middleName":"","lastName":"Niragire","suffix":""},{"id":330712284,"identity":"c390276d-0a71-4c17-bf7d-a0814e1d2f7e","order_by":1,"name":"Lambert Kwizera","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYBACPgYGNhBtwMAM5tsAMWPjAXxa2CBaDGBa0kBaGojUAgGHwSR+Leyn0x583PPH2OA4+8PHFTXn7da2HwbaUmMTjVMLT+52wxnPDMwMDjMkG545djt525lEoJZjabkNOB2Wu02a54CBjdlhhmOSDWy3k80OALUwNhzGrYX/7TbpP2AtjO0/G/6dSzY7/5CAFgmgLQwHDMzMDjOzMTa2HbAzu0HIFom32w17Dhgb2x9mY5Zs7EtOMLsBtCUBj1/4+XO3PfhxQM5wZv/xhx8bvtnZm51Pf/jgQ40NTi0YIBGsMoFY5SBgT4riUTAKRsEoGBkAAOFjYdZL4eq/AAAAAElFTkSuQmCC","orcid":"","institution":"University of Rwanda","correspondingAuthor":true,"prefix":"","firstName":"Lambert","middleName":"","lastName":"Kwizera","suffix":""},{"id":330712287,"identity":"bbf6883a-b6e6-4bf3-a551-9f9e3daa8a2b","order_by":2,"name":"Olive Dushimimana","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Olive","middleName":"","lastName":"Dushimimana","suffix":""},{"id":330712288,"identity":"449aca89-bb80-4f17-917c-8f4d28899f20","order_by":3,"name":"Florent Uwacu","email":"","orcid":"","institution":"Rwanda Private Sector Federation (PSF)","correspondingAuthor":false,"prefix":"","firstName":"Florent","middleName":"","lastName":"Uwacu","suffix":""}],"badges":[],"createdAt":"2024-07-06 16:00:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4697545/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4697545/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83570961,"identity":"984c08aa-92ed-491a-972b-975a32f5f311","added_by":"auto","created_at":"2025-05-28 16:46:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":985880,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4697545/v1/b21949df-c78d-49e9-a399-7261f66a9f0d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Sugar-Sweetened Beverage Imports on the Prevalence of Overweight among Underfive Children in Nine Eastern Africa Countries","fulltext":[{"header":"Background","content":"\u003cp\u003eGlobally, there is no country that is on the track to prevent the increase in overweight among children under 5 years of age (Branca et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Studies have established a link between sugar intake and overweight or obesity (Magriplis et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Yu et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Kuhnle et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The availability of sugar-sweetened commodities, especially through trade, has also been reported by several studies (Schram et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Mendez Lopez et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Lo et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mabeta \u0026amp; Smutka, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). A report from the 2023 World Obesity Federation revealed that almost 400\u0026nbsp;million children will be overweight or obese by 2035 (Lobstein et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The same report indicates that the global increase in obesity incidence among children and adolescents will be the most pronounced, from 8\u0026ndash;18% in girls and from 10\u0026ndash;20% in boys from 2020 to 2035.\u003c/p\u003e \u003cp\u003eConsequently, there is an increasing economic impact of obesity globally. It is estimated that its cost will increase from US\u003cspan\u003e$\u003c/span\u003e1.96 trillion in 2020 to over US\u003cspan\u003e$\u003c/span\u003e4 trillion in 2035, at a constant US\u003cspan\u003e$\u003c/span\u003e value. The impacts include healthcare costs, loss of productivity, and premature death. Due to overweight or obesity, the global gross domestic product (GDP) is expected to decrease by 2.4% in 2020 and then increase to 2.9% from that value (2.4%) by 2035 (Lobstein et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOverweight is no longer a health problem in high-income countries but has also dramatically risen in low- and middle-income countries, including countries in eastern Africa. Previous studies have reported that there has been a considerable increase in childhood obesity in Sub-Saharan Africa over the past two decades (Danquah et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). For instance, in their review, Danquah et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) reported that in SSA, childhood obesity or overweight has increasingly become a public health concern. This increase was also observed in West African countries (Diallo et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn sub-Saharan Africa (SSA), the prevalence of obesity among children and adolescents is expected to increase from 5\u0026ndash;14% in girls and from 4\u0026ndash;7% in boys between 2020 and 2035. By 2035, the yearly economic impact is projected to be more than US\u003cspan\u003e$\u003c/span\u003e50\u0026nbsp;billion or 1.6% of the region\u0026rsquo;s GDP (in constant 2019 dollars) (Lobstein et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral studies have investigated the risk factors leading to overweight among underfive children (Saha et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Tiruneh et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The major contributors to overweight or obesity have been found to be the consumption of high-fatty products, high-sugars, and micro nutrient-poor diets (BA et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Ruhara et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Most of these products are easily imported in many countries, especially LMC. Additionally, the expanding scope of international trade agreements and policies has facilitated the sudden increase in imports of sugar-sweetened beverages (Ruhara et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough some previous studies have indicated that trade has a positive impact on health outcomes, such as reducing infant mortality and improving life expectancy (Zhang et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), some trade policies, such as trade openness and trade and investment agreements, have also been proven to have adverse effects on health outcomes (Barlow et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Trade liberalization, as a trade policy, tends to be conducive to the consumption of sugary drinks or sweetened beverages (Mendez Lopez et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), which can lead to chronic diseases (Lo et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Teng et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In particular, overweight or obese children are prone to experiencing an increased risk of having high blood pressure, high cholesterol concentrations, type 2 diabetes, asthma, joint problems, gallstones, anxiety, depression, insulin resistance, hypertension, hyperlipidemia, liver and kidney disease, and reproductive problems (Albataineh et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Sahoo et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). These consequences are connected to the manufacturing, importing or purchasing and consumption of sugar-sweetened beverages and foods that contain high amounts of energy, fat, sugar, salt and low amounts of vitamins and minerals (WB \u0026amp; PAHO, 2020). The literature indicates factors associated with overweight in children in SSA (Choukem et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Similarly, studies have attempted to use child overweight data relating to import data (Ferretti and Mariani, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Schmidt \u0026amp; Fang, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBeverage waters sweetened or flavored ranked 281st in terms of global trade in 2021, with \u003cspan\u003e$\u003c/span\u003e12.6\u0026nbsp;billion in total trade. Exports of sweetened or flavored beverage waters increased by 24.7% between 2020 and 2021, from \u003cspan\u003e$\u003c/span\u003e10.1\u0026nbsp;billion to \u003cspan\u003e$\u003c/span\u003e12.6\u0026nbsp;billion. In general, trade in sweetened or flavored beverage waters constitutes 0.06% of global trade (OEC, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnalysis of the most recent Demographic and Health Survey (DHS) data showed that the prevalence of overweight among children under five years of age ranged from 3.2% in Kenya to 5.6% in Rwanda (KNBS \u0026amp; ICF, 2023; NISR et al., 2021). In addition, it varied from 1.4% in Burundi to 2% and 5.2% in Ethiopia and Zambia, respectively (EPHI \u0026amp; ICF, 2021; MPBGP et al., 2017).\u003c/p\u003e \u003cp\u003eWhile various factors contribute to overweight and obesity in Africa, economic risk factors play a major role in increasing incidence of childhood obesity, especially in the East African context. For example, a study performed in 175 countries between 1975 and 2016 showed that international trade openness was positively associated with country obesity, where an increase of 10% in trade openness was associated with an increase in the obesity rate of 0.80% (An et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA study performed in Kenya showed that 18% of children under five years of age were overweight, which was found to be associated with maternal overweight and obesity, higher education levels, a very large child at birth and stunting (Gewa, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Another study performed in sub-Saharan Africa in 2022 showed that overweight and obesity in preschool children were strongly associated with the home food environment and high maternal BMI. The economic transition in many African countries, including East African countries, has led to a shift in dietary patterns and physical activity levels, which contributes to an increased prevalence of overweight in children and urbanization (Kwansa et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUrbanization and globalization, particularly the free trade of services such as the modern marketing food trade in food products, have brought about changes in food systems and marketing exchange practices. This has resulted in the proliferation of inexpensive, highly processed foods that are energy dense but nutrient poor; these foods are more accessible and affordable than healthier foods are, and as a result, this exacerbates the risk of childhood overweight in economically disadvantaged communities (Popkin et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChildhood overweight or obesity has been considered an epidemic (Paul, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Tiruneh et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and a pandemic in the Global South (Paul, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Child overweight, according to the World Health Organization (WHO), is a condition in which the child\u0026rsquo;s weight is not proportional to his or her height (Jones et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Ayele et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Flynn et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Overweight children have a weight-for-height greater than two (2) standard deviations (SDs) above the median of the WHO Child Growth Standards (WHO, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; de Onis, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; LBD Double Burden of Malnutrition Collaborators, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere is a connection between international trade, globalization of trade and public health. An increase in trade has noticeable effects on health outcomes (Bettcher et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Loewenson et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Cyrus, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Recent trends have shown a concerning increase in the prevalence of overweight and obesity among children under five years of age in East African countries (S.A. Tiruneh, 2021). This escalation appears to be significantly influenced by the regular consumption of soft drinks, including both carbonated and noncarbonated sugar-sweetened beverages (SSBs). Several studies conducted in developed countries have investigated this health concern (Malik VS, Pan A, Willett WC et al., 2013; F.B. Hu, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Ferretti and Mariani, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe estimation of sugar-sweetened beverage (SSB) imports has evolved over time, reflecting shifts in consumer behavior, policy interventions, and global trade dynamics. SSBs are any drinks that contain added sugar or sweeteners. These beverages contain free sugars, which include \u003cem\u003ecarbonated or noncarbonated soft drinks; 100% fruit/vegetable juices and drinks; liquid and powder concentrates; flavored water; energy and sports drinks; ready-to-drink tea; ready-to-drink coffee; and flavored milk drinks\u003c/em\u003e (Sousa et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Malik \u0026amp; Hu, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevious studies examining the link between SSBs and child nutrition outcomes range from systematic reviews to cross-sectional and ecological analyses, covering a broad spectrum of countries and regions. Key themes include the effectiveness of SSB taxation in reducing consumption and obesity rates (Itria et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), the role of SSB affordability in increasing obesity incidence (Ferretti and Mariani, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), and the global consumption patterns of SSBs among children and adolescents and their health implications (Ooi et al., 2022). The literature has also explored the broader impacts of global trade on health (Bettcher et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2000\u003c/span\u003e) and the determinants of obesity in East African children (Tiruneh et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Each study contributes to a nuanced understanding of how SSB consumption, influenced by factors such as taxation, affordability, and global trade, is linked to the rising prevalence of obesity and related health issues.\u003c/p\u003e \u003cp\u003eThus, understanding global evidence and providing region-specific data on the relationship between SSB imports and the prevalence of overweight are crucial for effectively informing the design and implementation of locally specific and relevant prevention and intervention programs. However, there remains a significant gap in the related literature within developing regions, especially in eastern African countries. Research on the linkage between international trade, trade policies and agreements and health outcomes such as overweight among children under the age of five years in Eastern African countries is scarce. In particular, there is a lack of specific knowledge on the effects of SSB imports on the increasing incidence of childhood overweight in these countries.\u003c/p\u003e \u003cp\u003eThis study aimed to investigate the effect of the import of sugar-sweetened beverages (SSBs) on the prevalence of overweight in underfive children in nine Eastern African countries, namely, Burundi, Madagascar, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. This study focused on the effects of importing juices, milk drinks, tea and coffee, and water with mineral and aerated drinks, which are commonly called SSBs or sugary drinks (Bahl \u0026amp; Bird, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData\u003c/h2\u003e \u003cp\u003eThis study used data from the World Development Indicators (WDI) of the World Bank (WB) and UN Comtrade for the period spanning from 2000\u0026ndash;2022. The authors analyzed data for nine selected East African countries, namely, Burundi, Madagascar, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe.\u003c/p\u003e \u003cp\u003eThese countries were included in this study because they fulfilled the following criteria or conditions. These countries were selected because the prevalence of overweight is on the rise in low- and middle-income countries (LMICs). In the eastern part of Africa, underfive children tend to be overweight (Tiruneh et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This region has persistent problems associated with malnutrition, as revealed in the 2022 Global Nutrition Report. The same report revealed that the average incidence of overweight was 4%, the lowest value compared with that in other subregions of Africa. In the same region, the UNICEF, WHO and World Bank (2023) reported that the prevalence of overweight among children under five years of age has not changed since 2015. According to the 2025\u0026ndash;2030 World Health Assembly (WHA), the WHO and UNICEF suggest that child overweight status be reduced and will remain constant at less than 3% by 2030 (Chadare et al., 2022). However, this region is off track to meet the target. Moreover, these countries were also selected due to the availability of data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDependent Variable\u003c/h2\u003e \u003cp\u003eThe dependent variable of the study was the prevalence of overweight in children under five years of age. According to the WHO's 2006 Child Growth Standards, the prevalence of overweight children is defined as the percentage of children under the age of five whose weight-for-height ratio is more than two standard deviations above the median for the international reference population of the corresponding age. This variable indicates the nutritional status of the child.\u003c/p\u003e \u003cp\u003eWe obtained data on the prevalence of overweight from the website of the World Bank Development Indicators (WDI). The data are expressed as percentages. It is a modeled estimate.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eIndependent variables\u003c/h2\u003e \u003cp\u003eThe independent variable of interest in this study is the amount of sugar-sweetened beverage (SSB) imports. These include the imports of juice, milk drinks, tea and coffee, and water, including mineral and aerated drinks. These SSBs have been associated with weight gain (Malik \u0026amp; Hu, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The present study aimed to assess the effects of these variables on the prevalence of overweight among children under five years of age. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides a description of the SSBs according to the WHO nutritional profile and their Harmonized systems (HS) classification in The United Nations Commodity Trade Statistics Database (UN Comtrade) (WHO Regional Office for Africa, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSugar-sweetened beverages according to the WHO nutritional profile from the UN Comtrade website\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSugar-sweetened beverages\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHarmonized System (HS) code\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJuices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFruit or nut juices (including grape must and coconut water) and vegetable juices, unfermented, not containing added spirit, whether or not containing added sugar or other sweetening matter\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMilk drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0402\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMilk and cream; concentrated or containing added sugar or other sweetening matter\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTea and coffee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e210112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreparations with a basis of extracts, essences or concentrates or with a basis of coffee\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWater, including mineral and aerated drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWaters, including mineral and aerated waters, containing added sugar or sweetening matter, flavored; other nonalcoholic beverages, not including fruit, nut or vegetable juices of heading no. 2009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe considered the value of imports (trade flows) expressed in United States dollars (USD) for the period from 2000\u0026ndash;2022. The data were sourced for the nine selected countries as \u0026ldquo;\u003cem\u003eReporters\u003c/em\u003e\u0026rdquo;, while the \u0026ldquo;\u003cem\u003ePartners\u003c/em\u003e\u0026rdquo; were the \u003cem\u003eWorld\u003c/em\u003e. To obtain the data used in this study from the UN Comtrade website, we considered \u003cem\u003eTOTAL Modes of Transport\u003c/em\u003e for \u0026ldquo;Mode of Transports\u0026rdquo;, and \u003cem\u003eTOTAL customs procedure codes\u003c/em\u003e were considered for the \u0026ldquo;Customs code\u0026rdquo;. In addition, the \u0026ldquo;Set your query options\u0026rdquo; feature has the \u0026ldquo;Breakdown Mode\u0026rdquo;, which was considered to be \u003cem\u003ePlus\u003c/em\u003e, while the \u0026ldquo;Aggregate by\u0026rdquo; feature remained with the value \u003cem\u003eNone\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eIn addition to SSBs, this study considered a number of control variables. The latter include trade openness and GDP per capita growth. Data on trade openness were obtained from the World Development Indicators (WDI) of the World Bank and from the website of \u003cem\u003eour World in Data\u003c/em\u003e\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e1\u003c/a\u003e. These data are expressed in terms of the annual percentage of GDP, that is, Trade in terms of % GDP. This trade openness index is computed by summing the imports and exports of goods and services, and this sum is divided by GDP.\u003c/p\u003e \u003cp\u003eWe drew \u003cem\u003eGDP per capita growth\u003c/em\u003e data from the WDI website. It is the annual percentage growth rate of GDP per capita based on constant local currency. This value is computed by taking annual GDP and dividing by the mid-year population. The annual percentage growth rate of GDP per capita is based on a constant local currency. The GDP per capita is the gross domestic product divided by the midyear population. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides the description and summarizes the origin of the data.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of variables and sources of data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSource of data\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependent variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevalence of overweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevalence of overweight children is the percentage of children under age 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epercentage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWDI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndependent variables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImports of juice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal value of imports of juice (USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUN Comtrade\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImports of Milk drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal value of imports of milk drinks (USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUN Comtrade\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImports of Tea and Coffee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal value of imports of Tea and Coffee (USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUN Comtrade\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImports of water, including mineral and aerated drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal value of imports of water, including mineral and aerated drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUN Comtrade\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrade openness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe ratio from the sum of imports and exports divided by GDP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImport\u0026thinsp;+\u0026thinsp;export ratio to GDP expressed in annual percentage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWDI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGDP per capita growth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnnual percentage growth rate of GDP per capita based on constant local currency.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eannual percentage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWDI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis methods\u003c/h2\u003e \u003cp\u003eAs an empirical estimation method, we used the fixed effects approach to investigate the effects of SSB consumption on the prevalence of overweight among children under five years of age in nine EAC countries. The fixed effect model indicates the relationship between dependent and independent variables within a country (considered an entity). With this approach, it is assumed that these entities may have individual observations or characteristics that may or may not have an effect on the outcome and/or predictor variables. These individual characteristics are not random and may influence the dependent or predictor variables. This issue has to be controlled for. Therefore, the impact of independent variables may not be influenced by those fixed observations. Moreover, this fixed effect approach assumes that there is no correlation between the entity\u0026rsquo;s error term and independent variables (predictors). The Hausman test, when performed, indicated the choice of the fixed effect model. The data included 9 countries (n\u0026thinsp;=\u0026thinsp;9), and the time period was 22 years (2000\u0026ndash;2022) (T\u0026thinsp;=\u0026thinsp;22).\u003c/p\u003e \u003cp\u003eThis study estimated the following econometric model, also known as the health production function, with the prevalence of \u003cem\u003eoverweight\u003c/em\u003e as the response variable:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:overweigh{t}_{it}={\\beta\\:}_{0}+{\\beta\\:}_{1}Juic{e}_{it}+{\\beta\\:}_{2}Mil{k}_{it}+{\\beta\\:}_{3}TCoffe{e}_{it}+{\\beta\\:}_{4}Wate{r}_{it}+{\\beta\\:}_{5}{X}_{it}+{ϵ}_{it}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ewhere \u003cb\u003eoverweight\u003c/b\u003e represents the incidence of overweight children under five years of age, for i\u0026thinsp;=\u0026thinsp;1, 2, \u0026hellip;, N indicates the number of countries, and t\u0026thinsp;=\u0026thinsp;1,2..,T indicates the time periods. Betas are coefficients. \u003cb\u003eJuice\u003c/b\u003e represents the total value of imports of juices. \u003cb\u003eMilk\u003c/b\u003e represents the total value of imports of milk drinks. \u003cb\u003eTCoffee\u003c/b\u003e represents the total value of imports of tea and coffee. \u003cb\u003eWater\u003c/b\u003e represents the total value of water, including mineral and aerated drinks. \u003cb\u003eX\u003c/b\u003e represents control variables such as Trade openness and GDP per capita growth.\u003c/p\u003e \u003cp\u003e \u003cem\u003eε\u003c/em\u003e \u003csub\u003e \u003cem\u003eit\u003c/em\u003e \u003c/sub\u003e represents the error term for country \u003cem\u003ei\u003c/em\u003e at time \u003cem\u003et\u003c/em\u003e and is calculated as follows:\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e\n$$\\:{ϵ}_{i}{,}_{t}={\\mu\\:}_{i}+{\\gamma\\:}_{t}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026micro;\u003c/em\u003e \u003csub\u003e \u003cem\u003ei\u003c/em\u003e \u003c/sub\u003e\u0026thinsp;=\u0026thinsp;country-specific fixed effects constant in time, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\gamma\\:}_{t}\\)\u003c/span\u003e\u003c/span\u003e= time-specific fixed effects\u003c/p\u003e \u003cp\u003eAdditionally, to analyze the data, we used Stata version 15 MP. Moreover, because some countries have missing data, interpolation techniques were used to construct a complete dataset. This technique is more reliable than extrapolation because it provides a valid estimate. We performed log-transformation for easy interpretation in terms of elasticity: when the independent variable increases by 1% over time, the dependent variable (y) changes by \u0026#120573;% or elasticity.\u003c/p\u003e \u003cp\u003eMoreover, the study performed OLS regression analysis with the Stata command \u003cem\u003ereg\u003c/em\u003e and panel regression analysis with the \u003cem\u003extreg\u003c/em\u003e command. This command is generally employed for panel data. The study used the \u003cem\u003ereghdfe\u003c/em\u003e command, which estimates regressions with multiple levels of fixed effects.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the summary statistics for the study variables. The analysis was based on balanced panel data; however, for certain variables, data for certain periods of the year (2000\u0026ndash;2023) were missing for all 9 countries. The descriptive analysis revealed that the average incidence of overweight among children under 5 years of age was approximately 5.1% in nine East African countries during the period of 23 years (2000\u0026ndash;2022).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAverage magnitude of the study variables.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStd. Dev.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevalence of overweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJuices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4269802.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2444619.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e484204.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7759806.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMilk drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7165305.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3078010.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2271723.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13083675\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTea Coffee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e191383.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e159065.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14479.625\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e591932.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWater mineral drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4918825.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2965123.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e834614.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10090190\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrade openness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGDP per capita growth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDuring the study period, the average total value of imports of juices in these countries was 4,269,802.3 USD. This amount was 7,165,305.4 USD for milk drinks, 191,383.1 USD for tea and 4,918,825.4 USD for water, including mineral and aerated drinks.. The average trade openness (import\u0026thinsp;+\u0026thinsp;export ratio to GDP) in the nine selected (9) EACs was 0.537 (53.7%), while the average annual percentage growth rate of GDP per capita based on constant local currency was 0.017 (1.7%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelations between child overweight and the selected study variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(7)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eln of prevalence of overweight (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJuices (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMilk drinks (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTea and coffee (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWater mineral drinks (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrade openness (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGDP per capita growth (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e indicate that the incidence of overweight among children under five years of age in the nine EACs during the period 2000\u0026ndash;2022 and the imports of juice are negatively correlated. The same relationship was also observed for the imports of milk drinks, tea and coffee, and water, including mineral and aerated drinks. In contrast, there was a positive correlation between GDP per capita growth and the incidence of overweight. The results reveal that, except for GDP per capita growth, the other study variables were strongly correlated with each other, all of which were considered together.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRelationships between under five years of overweight and the selected variables\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the results of the fixed effect regression analyses. The results suggest that the import of sugar-sweetened beverages (SSBs) did not contribute to an increase in the prevalence of overweight in children under the age of 5 years in the nine EAC. Column (1) of Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the results from the pooled ordinary least squares (OLS) regression, column (2) shows the fixed-effect regression results, and column (3) shows the results of a multiway fixed regression (regditional). Overall, the coefficients are similar, though robust standard errors are different.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegression analyses of the influence of the selected factors on child overweight in EACs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eFull Model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eReduced model\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVARIABLES\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eUsing -reg-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eUsing -xtreg-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eUsing -reghdfe-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eUsing -reg-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eUsing -xtreg-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eUsing -reghdfe-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJuices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.0693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.0693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.0424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.0424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.0424\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.0573)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.0556)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.0556)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.0259)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.0253)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.0253)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMilk drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.0723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.0723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.0132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.0132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.0132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.104)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.101)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.101)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.0206)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.0202)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.0202)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTea and Coffee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.0500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.0500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.0961*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.0961*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.0961*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.0430)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.0418)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.0418)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.0490)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.0481)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.0481)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWater Mineral drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.0807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.0807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.0506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.0506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.0506\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.0488)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.0474)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.0474)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.0302)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.0296)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.0296)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrade openness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.322)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.313)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.313)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGDP per capita growth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0187**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0187**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0187**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.00689)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.00669)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.00669)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.360\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1.684)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(1.684)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.715)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.715)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.863\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.863\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountry Fixed Effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eRobust standard errors in parentheses\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, * p\u0026thinsp;\u0026lt;\u0026thinsp;0.1\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results based on the full model indicate that the imports of juice, imports of milk drinks, imports of tea and coffee, and imports of water are negatively correlated with the prevalence of overweight in children under five years of age, and these effects are not statistically significant.\u003c/p\u003e \u003cp\u003eUnlike the other variables considered, this study revealed that GDP per capita has a positive effect on overweight children under five years of age. The results indicate that when the GDP per capita increases by 1% over time, the incidence of overweight increases by 1.87%.\u003c/p\u003e \u003cp\u003eThe reduced model did not include the variables of trade openness or GDP per capita. The results based on the reduced model showed that the imports of tea and coffee had a statistically negative effect on the prevalence of overweight in individuals under five years old. An increase in the USD in imports of tea and coffee is associated with a decrease in the prevalence of overweight under five years of age by 9.61% over time. When we include the country fixed effect and perform all three models, we observe a decrease in robust standard errors of coefficient estimates.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to investigate the effect of the import of sugar-sweetened beverages on the prevalence of overweight among children under five (U5) in nine (9) East African countries. These countries include Burundi, Malawi, Mozambique, Madagascar, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. We found that the variables of interest, including the imports of juice, milk drinks, tea and coffee, and water (including mineral and aerated drinks), were not significantly different, despite their negative effect on the prevalence of overweight in children under five years old in those countries.\u003c/p\u003e \u003cp\u003eThis study revealed that the GDP growth per capita in these countries has a positive effect on the prevalence of overweight among children under five years of age. Several studies have established that there is a positive relationship between GDP per capita and overweight or obesity (Hu et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These findings corroborate prior evidence of the relationship between economic development and the nutritional status of children, such as obese or overweight children (Egger et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Bu et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). It has been suggested that the prevalence of overweight depends on the increase in economic growth in developing countries (Seyde et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The increase in overweight people around the world is attributed to important economic factors, such as economic development, urbanization and women\u0026rsquo;s empowerment (Fox et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), as well as trade (Giuntella et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, because SSBs are related to overweighting under five children in the context of EAC and because of the negative effects of SSBs, our study aimed to be similar to other studies that have attempted to establish a relationship between trade and health outcomes. Our study also relates to the work of Ag\u0026uuml;ero and Ukil (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), which assessed the effect of Chinese imports on birth weight gain as an infant health outcome in sub-Saharan African countries. These authors found that a significant increase in birth weight was associated with greater exposure to Chinese imports based on a sample of more than 350,000 births from 22 sub-Saharan African nations. Other studies have indicated that there is a positive relationship between SSB consumption and overweight (Yu, et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Freire et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2018\u003c/span\u003e and Ferretti \u0026amp; Mariani, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese studies revealed that these SSBs are typically imported and consumed as part of a meal (Freire et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). However, Freire et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) indicated that the affordability of SSBs, which include noncarbonated drinks (such as ready to drink tea, coffee, and juice, as well as sports/energy and Asian drinks) and soft drinks, has a positive influence on the prevalence of overweight among individuals of both sexes (BMI\u0026thinsp;\u0026ge;\u0026thinsp;25) who are older than 18 years in 150 countries worldwide.\u003c/p\u003e \u003cp\u003eIn addition, several studies and reports indicate that increased consumption of SSBs is linked to a greater incidence of overweight (Keller \u0026amp; Bucher Della Torre, 2015; Rousham et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Yu et al., 2016). The same evidence was found in East African countries. Using data from demographic and health surveys (DHS), Tiruneh et al. (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) reported that overweight was affected by overweight in children under five years old living in affluent households in East African countries such as Malawi, Mozambique, Rwanda, Tanzania, and Uganda. However, in our study, we examined the association between SSB imports and consumption among children under 5 years of age in 9 African countries and found that SSB imports have a negative but not statistically significant effect. However, it was found that GDP per capita has a positive effect on the incidence of overweight in children under five years of age.\u003c/p\u003e \u003cp\u003eThis study revealed that the imports of juices, milk drinks, tea, coffee, and water, including mineral and aerated drinks, have a negative relationship with the prevalence of overweight in individuals under five years of age. However, the causal mechanisms through which SSB imports negatively affect the prevalence of overweight were not identified.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study examined the effect of the import of sugar-sweetened beverages (SSBs) on the prevalence of overweight among underfive children in nine selected EACs, namely, Burundi, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, Madagascar and Zimbabwe. This study bridges the gap in the literature on the potential influence of SSB imports on the prevalence of child overweight within developing regions, especially in eastern African countries. The findings revealed that the underfive overweight population in the study countries cannot be directly explained by the volume of SSB imports, such as juice, milk drinks, tea and coffee as well as mineral water and aerated drinks. The study did not find any evidence that SSB imports in EACs contribute to the prevalence of overweight among children under five years of age. However, GDP growth per capita was accompanied by an increase in the prevalence of child overweight. These findings suggest that the import of SSBs has a significant adverse effect on child health outcomes when access increases considerably. Therefore, trade policies should be enacted considering the effect of economic growth on adverse health outcomes among children under five years of age in EACs.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data were obtained from the World Development Indicators (WDI) of the World Bank (WB) and UN Comtrade and are freely accessible through the following link: https://osf.io/a896w/\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive funding for data collection or manuscript publication. The authors received financial support from the University of Rwanda (UR) World Trade Organization Chairs Programme (WCP) at the University of Rwanda to organize the manuscript writing meetings. No other funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions - provide individual author contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFN, LK, OD, and FU contributed to the study\u0026apos;s conceptualization, data analysis, and manuscript writing.\u0026nbsp;LK acquired the study data and performed the data management and analysis. All the authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Emmanuel Ndagijimana, College of Medicine and Health Sciences, University of Rwanda, for proofreading the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProf. Fran\u0026ccedil;ois NIRAGIRE\u003c/p\u003e\n\u003cp\u003eDepartment of Applied Statistics, College of Business and Economics, University of Rwanda, Kigali, Rwanda\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003eORCID: https://orcid.org/0000-0003-0473-387X\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMr. Lambert KWIZERA\u003c/p\u003e\n\u003cp\u003eDepartment of Economics, College of Business and Economics, University of Rwanda, Kigali, P.O. Box 4285, Kigali, Rwanda\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003eORCID: https://orcid.org/0000-0002-4044-4568\u003c/p\u003e\n\u003cp\u003eMrs. Olive DUSHIMIMANA\u003c/p\u003e\n\u003cp\u003eDepartment of Epidemiology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003eMr. Florent UWACU\u003c/p\u003e\n\u003cp\u003eBusiness Research Centre, Rwanda Private Sector Federation (PSF), Kigali, Rwanda\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAg\u0026uuml;ero JM, Ukil P. (2022). \u003cem\u003eThe Birthweight Gains from Trade: Chinese Imports and Infant Health in Sub-Saharan Africa\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbataineh SR, Badran EF, Tayyem RF. 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This has a connection with international trade and its influence on the increasing availability and consumption of sugar in different forms. This study seeks to identify the effects of the import of sugar-sweetened beverages on the prevalence of overweight among children under five years of age in nine Eastern Africa countries (EAC).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study analyzed data from the UN Comtrade Database and World Development Indicators (WDI) of the World Bank (WB) spanning from 2000\u0026ndash;2022. The East African countries selected are Burundi, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, Madagascar and Zimbabwe. With these panel data, the fixed-effect estimation approach was employed as a technique to study the effect.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe analysis revealed that the imports of sugar-sweetened beverages such as milk drinks, tea and coffee, and water, including mineral and aerated drinks, had a negative effect on the incidence of overweight among children under five years old in the EAC, but the difference was not statistically significant. However, GDP per capita was found to be positively related to the incidence of overweight.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study did not find any evidence that SSB consumption in EACs contributes to the prevalence of overweight among children under five years old. Only GDP growth per capita was found to have a positive effect on the prevalence of child overweight. The findings suggest that international trade policies and agreements should consider the effect of economic growth on adverse health outcomes among children under five years of age in EACs and other similar developing countries.\u003c/p\u003e","manuscriptTitle":"Effect of Sugar-Sweetened Beverage Imports on the Prevalence of Overweight among Underfive Children in Nine Eastern Africa Countries","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-08 11:13:13","doi":"10.21203/rs.3.rs-4697545/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5fc55410-0113-4bf8-92c1-04e26c02fbce","owner":[],"postedDate":"August 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-28T16:38:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-08 11:13:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4697545","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4697545","identity":"rs-4697545","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}