Diversity of Rickettsia spp. in ticks from wild mammals of Morocco and Mauritania.

Ticks are known as vectors and reservoirs of rickettsiae and, wildlife vertebrate hosts as suitable dispersers of ticks contributing to the life cycle of rickettsial agents in nature. In the herein study, the presence of rickettsiae was investigated in ticks from wild mammals (Gerbillus and Jaculus, Vulpes rueppellii, Canis anthus, Felis lybica and Felis margarita) in Mauritania and Morocco. Morphological and molecular analysis of ticks allowed their identification as Rhipicephalus sanguineus sensu lato and Hyalomma impeltatum. A total of 126 partially engorged adult ticks, collected from 40 animals, were screened for the presence of rickettsial DNA by conventional PCR targeting the ompB gene, followed by ompA and gltA targets and bidirectional sequencing. As a result of the sequence analyses, that at least three different species of pathogenic spotted fever group rickettsiae were detected. Rickettsia parkeri-like was detected in a R. sanguineus s.l. (n=1) collected from an African wildcat from Morocco. Rickettsia aeschlimannii was detected in a H. impeltatum (n=1) collected from a gerbil rodent. Rickettsia massiliae was detected in R. sanguineus s.l. ticks (n=5) collected from two Ruppells' foxes. The herein study demonstrates that pathogenic Rickettsia species are circulating in Morocco and Mauritania wildlife.

[Analysis of national leprosy surveillance data in Mauritania from 2009 to 2019]. / Analyse des données nationales de surveillance de la lèpre en Mauritanie de 2009 à 2019.

Introduction: Leprosy is a chronic infectious disease that mainly affects the skin, mucous membranes and the peripheral nervous system. Its elimination as a public health problem seems to lead to its ignorance and therefore to a risk of late diagnosis. An analysis of leprosy surveillance data in Mauritania was conducted to determine epidemiological trends and clinical forms of reported cases. Material and method: The retrospective study was based on the epidemiological records of leprosy in Mauritania from 2009 to 2019. The diagnosis of leprosy was made on the basis of the diagnostic criteria of the World Health Organization (WHO). Data were analyzed using Epi Info version 7.2.5.0. The frequencies, proportions, and rates were calculated. Results: Over the past 11 years, 164 cases have been notified. Among the notified cases, 96/164 (58.5%) were males and 68/164 (41.5%) females, with a sex ratio of 1.4. The mean age (± standard deviation) was 44.0 ± 17.1 years [range, 9 - 86 years], and the median was 45 years [interquartile range, 32.5; 57.5]. Children under the age of 16 accounted for 9/164 (5.5%). The wilayas (i.e. "regions") of Nouakchott were the most endemic regions in the country. The multibacillary form (MB) represented 109/164 (66.5%) cases among the observed clinical forms. The average annual incidence was 0.3 case/100,000 population for MB and 0.1 case/100,000 for PB (paucibacillary). All reported cases were treated with multidrug therapy. Conclusion: The results of leprosy surveillance showed a persistence of this disease in Mauritania. It is necessary to relaunch leprosy services at all levels in order to continue to reduce the morbidity associated with this disease, and eventually eliminate it from the country.

Seroprevalence of Alphaviruses (Togaviridae) among Urban Population in Nouakchott, Mauritania, West Africa.

The presence of alphaviruses, such as chikungunya virus (CHIKV), has never been reported in Mauritania. We assessed the seroprevalence of CHIKV among Nouakchott residents. A cross-sectional study involving 1300 non-febrile patients consulting at the Nouakchott hospital center was conducted between January and June 2021. The presence of anti-CHIKV IgG and neutralizing antibodies against CHIKV, O'nyong-nyong virus (ONNV), and Semliki Forest virus (SFV) was determined by an enzyme-linked immunosorbent assay (ELISA) and a serum neutralization test, respectively, and the associated risk factors were investigated. Of the 1300 study participants, serological evidence of previous exposure to CHIKV was observed in 37 individuals (2.8%). Sex, age, reported use of repellants, and bed net ownership and usage were not associated with CHIKV seropositivity. Our results showed the co-circulation of two other alphaviruses, ONNV and SFV, in Nouakchott in 30 (2.3%) individuals. This is the first study that documents the co-circulation of CHIKV, ONNV, and SFV in Mauritania, albeit at low prevalence. Surveillance and routine testing for alphaviruses and other arboviruses in symptomatic patients should be implemented in health facilities to assess the health burden associated with these viruses. Efforts should also be made to strengthen the vector control measures.

Malaria prevalence in Mauritania: a systematic review and meta-analysis.

BACKGROUND: Understanding malaria epidemiology is a critical step toward efficient malaria control and elimination. The objective of this meta-analysis was to derive robust estimates of malaria prevalence and Plasmodium species from studies conducted in Mauritania and published since 2000. METHODS: The present review followed the PRISMA guidelines. Searches were conducted in various electronic databases such as PubMed, Web of Science, and Scopus. To obtain pooled prevalence of malaria, meta-analysis was performed using the DerSimonian-Laird random-effects model. Methodological quality of eligible prevalence studies was assessed using Joanna Briggs Institute tool. Inconsistency and heterogeneity between studies were quantified by the I2 index and Cochran's Q test. Publication bias was assessed with funnel plots and Egger's regression tests. RESULTS: A total of 16 studies with a good individual methodological quality were included and analysed in this study. The overall random effects pooled prevalence of malaria infection (symptomatic and asymptomatic) across all included studies was 14.9% (95% confidence interval [95% CI]: 6.64, 25.80, I2 = 99.8%, P < 0.0001) by microscopy, 25.6% (95% CI: 8.74, 47.62, I2 = 99.6%, P < 0.0001) by PCR and 24.3% (95% CI: 12.05 to 39.14, I2 = 99.7%, P < 0.0001) by rapid diagnostic test. Using microscopy, the prevalence of asymptomatic malaria was 1.0% (95% CI: 0.00, 3.48) against 21.46% (95% CI: 11.03, 34.21) in symptomatic malaria. The overall prevalence of Plasmodium falciparum and Plasmodium vivax was 51.14% and 37.55%, respectively. Subgroup analysis showed significant variation (P = 0.039) in the prevalence of malaria between asymptomatic and symptomatic cases. CONCLUSION: Plasmodium falciparum and P. vivax are widespread in Mauritania. Results of this meta-analysis implies that distinct intervention measures including accurate parasite-based diagnosis and appropriate treatment of confirmed malaria cases are critical for a successful malaria control and elimination programme in Mauritania.

Identification a novel pathogenic LRTOMT mutation in Mauritanian families with nonsyndromic deafness.

PURPOSE: Although recessive mutations in GJB2 are the common genetic etiology of sensorineural hearing impairment (SNHI), variants in LRTOMT gene were also identified, mostly in Middle East and North African populations. METHODS: Using Sanger sequencing we screened the exon 7 of LRTOMT in a cohort of 128 unrelated Mauritanian children with congenital deafness. RESULTS: Only one biallelic missense mutation, predicted as pathogenic (c.179 T > C;p.Leu60Pro) was found at homozygous state in four families. This variant, not reported before, showed a deleterious effect by SIFT (score: 0.01) and a disease-causing effect by Mutation Taster (prob: 1). Exploration of the encoded protein 3D structure revealed a disruption from an organized α helix (in the normal protein structure) into a random conformation. Early fitting of a cochlear implant seemed to improve the audition ability of the mutation carrier. CONCLUSION: Further screening using a panel of deafness genes may expose other variants underlying hearing impairment in our population.

A pharmaceutical monitoring system to assess the quality of antituberculosis drug products used in Mauritania.

The quality of drug products may be affected from manufacture to dispensing, particularly at high temperature and humidity as in Mauritania. This country is not included in the World Health Organization reports on poor quality products due to the lack of a qualified laboratory and monitoring system. Ensuring the quality of medicine is even more relevant in the case of diseases such as Tuberculosis, due to its high prevalence, complex treatment and continuous bacterial resistance. The aim was to develop a monitoring system to assess the quality of antituberculosis drugs products, by the substandard detection based on European and United States Pharmacopeial recommendations regarding quality control. In addition to studying the influence of accelerated storage conditions (40 ± 2°C/75 ± 5% relative humidity) on their qualities and comparing the dissolution profiles to contrast the quality. 18 antituberculosis drug products were taken from Europe and Mauritania, and quality was studied through visual inspection and according to the compliance of the mass uniformity, uniformity of dosage units, dissolution, disintegration and friability pharmacopeial tests. Furthermore, a dissolution profile comparison was carried out to examine quality. A stability study was conducted to assess the influence of climatic conditions on the content and the dissolved amount of the active pharmaceutical ingredients, which were determined by an ultra-performance liquid chromatography system. As result, 69.3% of 13 Mauritanian formulations had a substandard quality mainly due to non-compliance with the test for friability or content uniformity of these medicines. All European drug products complied with pharmacopeia specifications. In addition, storage conditions affected the dissolution rate of ethambutol and the uniformity of the 4 antituberculosis combination drug products.

Changing epidemiology of Plasmodium vivax malaria in Nouakchott, Mauritania: a six-year (2015-2020) prospective study.

BACKGROUND: Plasmodium vivax malaria is one of the major infectious diseases of public health concern in Nouakchott, the capital city of Mauritania and the biggest urban setting in the Sahara. The assessment of the current trends in malaria epidemiology is primordial in understanding the dynamics of its transmission and developing an effective control strategy. METHODS: A 6 year (2015-2020) prospective study was carried out in Nouakchott. Febrile outpatients with a clinical suspicion of malaria presenting spontaneously at Teyarett Health Centre or the paediatric department of Mother and Children Hospital Centre were screened for malaria using a rapid diagnostic test, microscopic examination of Giemsa-stained blood films, and nested polymerase chain reaction. Data were analysed using Microsoft Excel and GraphPad Prism and InStat software. RESULTS: Of 1760 febrile patients included in this study, 274 (15.5%) were malaria-positive by rapid diagnostic test, 256 (14.5%) were malaria-positive by microscopy, and 291 (16.5%) were malaria-positive by PCR. Plasmodium vivax accounted for 216 of 291 (74.2%) PCR-positive patients; 47 (16.1%) and 28 (9.6%) had P. falciparum monoinfection or P. vivax-P. falciparum mixed infection, respectively. During the study period, the annual prevalence of malaria declined from 29.2% in 2015 to 13.2% in 2019 and 2.1% in 2020 (P < 0.05). Malaria transmission was essentially seasonal, with a peak occurring soon after the rainy season (October-November), and P. vivax infections, but not P. falciparum infections, occurred at low levels during the rest of the year. The most affected subset of patient population was adult male white and black Moors. The decline in malaria prevalence was correlated with decreasing annual rainfall (r = 0.85; P = 0.03) and was also associated with better management of the potable water supply system. A large majority of included patients did not possess or did not use bed nets. CONCLUSIONS: Control interventions based on prevention, diagnosis, and treatment should be reinforced in Nouakchott, and P. vivax-specific control measures, including chloroquine and 8-aminoquinolines (primaquine, tafenoquine) for treatment, should be considered to further improve the efficacy of interventions and aim for malaria elimination.

Sickle Cell Disease in Mauritania: epidemiological, clinical and therapeutic aspects about 135 cases.

OBJECTIVE: To describe the epidemiological, clinical and therapeutic characteristics of a series of sickle cell disease cases collected in Mauritania over a three-year period. METHODS: This is a descriptive study of the profile of sickle cell disease, diagnosed in Mauritania, from January 1, 2015 to December 31, 2017, at the outpatient clinics of the National Hospital Center and at the Mauritanian Association for the Support of Sickle Cell Patients. Patients were included following diagnostic confirmation by hemoglobin electrophoresis. RESULTS: During the study period, a total of 135 patients were included (79 female and 56 male), i.e. a sex ratio of 0.7 and an average age of 24 years (extremes: 9 months -77 years). All Mauritanian ethnic groups were affected by sickle cell disease, mainly the Peulths (63.7%). Sickle cell disease was found in eight wilayas, particularly Brakna (39%). The age of diagnosis was between 3 and 5 years, in 48% of patients. Sickle cell disease was discovered at the stage of complications in twelve patients. There are three types of sickle cell phenotypes: SS (54%), AS (40%) and SC (6%). In addition to transfusion, preventive treatment consisted of folic acid (n=53), hydroxyurea (n=14), and long-term antibiotic prophylaxis (n=3). CONCLUSION: The profile of sickle cell disease in Mauritania remains attributed to the lack of an active screening strategy and rapid diagnosis, hence the importance of developing a national program for early detection and management.

Epidemiological and molecular study of hemoglobinopathies in Mauritanian patients.

BACKGROUND: Hemoglobinopathies, inherited disorders of hemoglobin (Hb), are the most common hereditary monogenic diseases of the red cell in the world. Few studies have been conducted on hemoglobinopathies in Mauritania. Therefore, the aim of this work is to establish the molecular and epidemiological basis of hemoglobinopathies in a cohort of Mauritanian patients and to determine the haplotype of the ß-globin gene cluster in sickle cell subjects. METHODS: The molecular screening of Hb disorders in 40 Mauritanian patients was done by a polymerase-restriction fragment length polymorphism (RFLP) for the sickle cell disease (SCD) mutation, a PCR/sequencing method for ß-thalassemia mutations, and by the multiplex polymerase chain reaction method for the α-thalassemia. The exploration of eight polymorphic sites (SNPs) within the ß-globin gene cluster was conducted by PCR/RFLP method, to identify the HbS haplotypes from the sickle cell subjects. RESULTS: The epidemiological study of our patients showed a high incidence in the Senegal River area (52.5%) and a high ethnic prevalence for the Heratin (47.5%) and the Pular (35%). Molecular study allowed us to identify eight different mutations in our sample analyzed. They are respectively: HbS (HBB:c.20A>T) (68.75%), Cd44 -C (HBB:c.135delC) (8.75%), -29A>G (HBB:c.-79A>G) (4.8%), -α-3.7 (g.34164_37967del3804) (3.75%), IVS-II-849A>G (HBB:c.316-2A>G) (2.25%) and Cd24T>A (HBB:c.75T>A), Hb Siirt (HBB:c.83C>G) and HbC (HBB:c.19G>A) each with (1.25%). Six different haplotypes are being explored among the SCD subjects with the Senegal haplotype as the most prevalent (66.7%), followed by Benin (10%), Arab-Indians (6.7%), Bantu (3.3%), and two atypical haplotypes. CONCLUSION: Our findings enrich the epidemiological data in our population and could contribute to the establishment of a strategy of prevention and management through screening, genetic counseling, and prenatal diagnosis of Hemoglobinopathies in the Mauritanian population.

Characterization of a cluster of COVID-19 cases linked to the Omicron variant, in Mauritania.

OBJECTIVE: To describe the epidemiological and genomic profile of COVID-19 during the 4th epidemic wave in Mauritania. METHODS: This is a cross-sectional study in Mauritania, from October 1, 2021, to February 28, 2022. Were included all people in the process of travel, performing an RT-PCR, at the level of the National Research Institute in Public Health and patients who have been sampled for sequencing by teams from the Department of Strategic Information and Epidemiological Surveillance. RESULTS: Out of 37,574 RT-PCR tests collected on March 3, 2022, during the study period, 1,465 cases were diagnosed positive for COVID-19 (3.9%), with an average age of 39±14,6 years and a sex ratio of 2.08. Of the 112 genomic sequences performed, 75 were of the Omicron variant (66.9%). The average age was 40±15 years, with extremes of 15 to 82 years and a sex ratio of 0.97. The vaccination status was assured in 67.7% of patients and the peak of the Omicron variant was reached during the first week of January 2022. CONCLUSION: The Omicron variant was predominant during the 4th wave in Mauritania. As part of its response plan against COVID-19, the installation of new sequencing units inside the country and the strengthening of the training of technicians in the virology laboratory will be essential.

Diversity, distribution and conservation of land mammals in Mauritania, North-West Africa.

Detailed knowledge about biodiversity distribution is critical for monitoring the biological effects of global change processes. Biodiversity knowledge gaps hamper the monitoring of conservation trends and they are especially evident in the desert biome. Mauritania constitutes a remarkable example on how remoteness and regional insecurity affect current knowledge gaps. Mammals remain one of the least studied groups in this country, without a concerted species checklist, the mapping of regions concentrating mammal diversity, or a national assessment of their conservation status. This work assessed the diversity, distribution, and conservation of land mammals in Mauritania. A total of 6,718 published and original observations were assembled in a spatial database and used to update the occurrence status, distribution area, and conservation status. The updated taxonomic list comprises 107 species, including 93 extant, 12 Regionally Extinct, and 2 Extinct in the Wild. Mapping of species distributions allowed locating concentrations of extant mammal species richness in coastal areas, along the Senegal River valley, and in mountain plateaus. Recent regional extinction of large-sized Artiodactyla and Carnivora has been very high (11% extinct species). From the extant mammals, 11% are threatened, including flagship species (e.g., Addax nasomaculatus and Panthera pardus). Species richness is poorly represented by the current protected areas. Despite the strong advances made, 23% of species categorise as Data Deficient. Persisting systematics and distribution uncertainties require further research. Field surveys in currently unexplored areas (northern and south-eastern regions) are urgently needed to increase knowledge about threatened mammals. The long-term conservation of land mammals in Mauritania is embedded in a complex web of socioeconomic and environmental factors that call for collaborative action and investment in sustainable human development. The current work sets the baseline for the future development of detailed research studies and to address the general challenges faced by mammals and biodiversity in the country.

Screening of BRCA1/2 variants in Mauritanian breast cancer patients.

BACKGROUND AND STUDY AIM: Carrying a pathogenic BRCA1/2 variant increases greatly young women's risk of developing breast cancer (BC). This study aimed to provide the first genetic data on BC in Mauritania. METHODS: Using NGS based screening; we searched for BRCA1/2 variants in DNA samples from 137 patients diagnosed for hereditary BC. RESULTS: We identified 16 pathogenic or likely pathogenic (PV) variants carried by 38 patients. Two predominant BRCA1 PV variants were found: c.815_824dup and c.4986 + 6 T > C in 13 and 7 patients, respectively. Interestingly, three novels BRCA1/2 predicted pathogenic variants have also been detected. Notably, no specific distribution of BRCA1/2 variants was observed regarding triple negative breast cancer (TNBC) or patient gender status. CONCLUSIONS: In this first genetic profiling of BC in Mauritania, we identified a substantial number of BRCA1/2 pathogenic variants. This finding could be important in the future diagnosis and prevention policy of hereditary BC in Mauritania.

Impact of Carotid atheroma on cardiovascular risk in Mauritanian hypertensive patients.

AIM: To determine the prevalence of carotid atheroma in hypertensive patients and assess the levels of cardiovascular risk. METHODS: This is a prospective study that took place in the outpatient department of the National Cardiology Center of Nouakchott over a period of 6 months (October 2019 to March 2020). Patients with hypertension without complications were included. Patients lost to followup and those whose records were incomplete were excluded from the study. RESULTS: Out of a total of 171 patients, a total of 93 patients (54.38%) was collected, of which 54.8% were women, 55.9% of the patients in the series were over 50 years old.The associated cardiovascular risk factors were dominated by dyslipidemia (27.9%), diabetes (20.4%), smoking (26.8%). hypertension was grade 2 in 47.3% of patients and grade 3 in 52.7% of patients. Left ventricular hypertrophy was noted in 77.4% of patients. Echo-Doppler of the supra-aortic trunks revealed atherosclerotic plaques in 63.4% of patients. CONCLUSION: The prevalence of carotid atheroma in hypertensive patients at high cardiovascular risk level was frequent in our series, it follows from this to recommend early detection for optimal management.

Mosquito survey in Mauritania: Detection of Rift Valley fever virus and dengue virus and the determination of feeding patterns.

In Mauritania, several mosquito-borne viruses have been reported that can cause devastating diseases in animals and humans. However, monitoring data on their occurrence and local distribution are limited. Rift Valley fever virus (RVFV) is an arthropod-borne virus that causes major outbreaks throughout the African continent and the Arabian Peninsula. The first Rift Valley fever (RVF) epidemic in Mauritania occurred in 1987 and since then the country has been affected by recurrent outbreaks of the disease. To gain information on the occurrence of RVFV as well as other mosquito-borne viruses and their vectors in Mauritania, we collected and examined 4,950 mosquitoes, belonging to four genera and 14 species. The mosquitoes were captured during 2018 in the capital Nouakchott and in southern parts of Mauritania. Evidence of RVFV was found in a mosquito pool of female Anopheles pharoensis mosquitoes collected in December on a farm near the Senegal River. At that time, 37.5% of 16 tested Montbéliarde cattle on the farm showed RVFV-specific IgM antibodies. Additionally, we detected IgM antibodies in 10.7% of 28 indigenous cattle that had been sampled on the same farm one month earlier. To obtain information on potential RVFV reservoir hosts, blood meals of captured engorged mosquitoes were analyzed. The mosquitoes mainly fed on humans (urban areas) and cattle (rural areas), but also on small ruminants, donkeys, cats, dogs and straw-colored fruit bats. Results of this study demonstrate the circulation of RVFV in Mauritania and thus the need for further research to investigate the distribution of the virus and its vectors. Furthermore, factors that may contribute to its maintenance should be analyzed more closely. In addition, two mosquito pools containing Aedes aegypti and Culex quinquefasciatus mosquitoes showed evidence of dengue virus (DENV) 2 circulation in the city of Rosso. Further studies are therefore needed to also examine DENV circulation in Mauritania.

Changes in Inequality in Use of Maternal Health Care Services: Evidence from Skilled Birth Attendance in Mauritania for the Period 2007-2015.

Skilled birth attendance is critical to reduce infant and maternal mortality. Health development plans and strategies, especially in developing countries, consider equity in access to maternal health care services as a priority. This study aimed to measure and analyze the inequality in the use of skilled birth attendance services in Mauritania. The study identifies the inequality determinants and explores its changes over the period 2007-2015. The concentration curve, concentration index, decomposition of the concentration index, and Oaxaca-type decomposition technique were performed to measure socioeconomically-based inequalities in skilled birth attendance services utilization, and to identify the contribution of different determinants to such inequality as well as the changes in inequality overtime using data from Mauritania Multiple Indicator Cluster Surveys (MICS) 2007 and 2015. The concentration index for skilled birth attendance services use dropped from 0.6324 (p < 0.001) in 2007 to 0.5852 (p < 0.001) in 2015. Prenatal care, household wealth level, and rural-urban residence contributed most to socioeconomic inequality. The concentration index decomposition and the Oaxaca-type decomposition revealed that changes in prenatal care and rural-urban residence contributed positively to lower inequality, but household economic status had an opposite contribution. Clearly, the pro-rich inequality in skilled birth attendance is high in Mauritania, despite a slight decrease during the study period. Policy actions on eliminating geographical and socioeconomic inequalities should target increased access to skilled birth attendance. Multisectoral policy action is needed to improve social determinants of health and to remove health system bottlenecks. This will include the socioeconomic empowerment of women and girls, while enhancing the availability and affordability of reproductive and maternal health commodities. This policy action can be achieved through improving the availability of obstetric service providers in rural areas; ensuring better distribution and quality of health infrastructure, particularly health posts and health centers; and, ensuring user fees removal for equitable, efficient, and sustainable financial protection in line with the universal health coverage objectives.

Trends in socio-economic, sex and geographic disparities in childhood underweight in Mauritania: evidence from Multiple Indicator Cluster Surveys (2007-2015).

BACKGROUND: Underweight is one of the largest contributors to child morbidity and mortality and is considered to be the largest contributor to the global burden of diseases in low-and middle-income countries. In Mauritania, where one-fifth of children are underweight, there is a dearth of evidence on socio-economic, sex and geographic disparities in childhood underweight. As a result, this study aimed at investigating the socio-economic, sex and geographic disparities in childhood underweight in Mauritania. METHODS: Using the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the Mauritania Multiple Indicator Cluster Surveys (MICSs) conducted between 2007 and 2015 were analysed. Childhood underweight was disaggregated by five equity stratifiers: education, wealth, residence, region and sex. In addition, absolute and relative inequality measures, namely difference (D), population attributable risk (PAR), ratio (R) and population attributable fraction (PAF) were calculated to understand inequalities from wider perspectives. Corresponding 95% confidence intervals (CIs) were computed to measure statistical significance. RESULTS: Substantial absolute and relative socio-economic, sex and geographic disparities in underweight were observed from 2007 to 2015. Children from the poorest households (PAR=-12.66 [95% CI -14.15 to -11.16]), those whose mothers were uneducated (PAF=-9.11 [95% CI -13.41 to -4.81]), those whose mothers were rural residents (R=1.52 [95% CI 1.37 to 1.68]), residents of HodhCharghy (PAF=-66.51 [95% CI -79.25 to -53.76]) and males (D=4.30 [95% CI 2.09 to 6.52]) experienced a higher burden of underweight. Education-related disparities decreased from 2007 to 2015. The urban-rural gap in underweight similarly decreased over time with the different measures showing slightly different reductions. Wealth-driven disparities decreased marginally from 2011 to 2015. The sex-based and regional disparities increased, at least on average, over the 8-y intersurvey period. CONCLUSIONS: The burden of underweight was significantly higher among children from disadvantaged subpopulations, those with uneducated and poorest/poor mothers, those living in rural areas and those living in HodhCharghy. Special nutrition intervention and efforts focused on these deprived subpopulations are required to reduce childhood morbidity and mortality associated with underweight and help achieve the Sustainable Development Goals.