Health and wealth in Uzbekistan and sub-Saharan Africa in comparative perspective

Taller but thinner: trends in child anthropometry in Senegal, 1990-2015

OBJECTIVE

To investigate trends in child anthropometry in Senegal between 1990 and 2015 and relate them with potential causes. Several hypotheses were tested: changes in health status, income, diet and socio-economic status.

DESIGN

Statistical analysis of trends in anthropometric data: height, weight, BMI and associated Z-scores calculated with the CDC-2000 standard (Centers for Disease Control and Prevention): height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ). Trends were fitted with linear regression models and were related with changes in health and socio-economic status.

SETTING

Nine nationally representative samples of Senegalese children aged 12-59 months, taken between 1986 and 2017 by Demographic and Health Surveys (DHS).

PARTICIPANTS

Children aged 12-59 months.

RESULTS

Over the 25 years of investigation, the average height of children increased by +1·88 cm, their average weight by +0·10 kg, but their BMI decreased by -0·53 kg/m2. Corresponding changes expressed in Z-scores were +0·454 in HAZ, +0·109 in WAZ and -0·302 in WHZ. This pattern of decreasing stunting while increasing wasting was correlated with decreasing child mortality, despite small changes in income per capita and in adult heights or BMI. Largest improvements in HAZ were among the lower socio-economic strata, while largest declines in WHZ were among higher socio-economic strata.

CONCLUSIONS

Decline in stunting appeared associated primarily with the control of infectious diseases, also responsible for the mortality decline. Increase in wasting was surprising. It appears associated with small changes in income per capita, and therefore in diet, in a context of increasing height.

THE ENIGMA OF ETHIOPIAN SEX RATIOS AT BIRTH

This study analysed sex ratios at birth (defined as the number of male births per 100 female births) using data on children ever-born from three censuses conducted in Ethiopia in 1984, 1994 and 2007. The results showed very high values by any standard, with an average of 108.4 for a sample of some 8.2 million births, with somewhat lower values in urban areas. Analysis of socioeconomic correlates revealed that the sex ratio varied very much by household wealth, from about 110 for very poor women to about 102 for wealthier women. The high value of the sex ratio at birth in Ethiopia could be explained by poverty, used as a proxy for poor nutritional status. In multivariate analysis, the effects of living in urban areas and of maternal education were less important than household wealth. Among the many ethno-linguistic groups, the Nilotic family had higher sex ratios than other groups. The results were confirmed using data from DHS surveys conducted in the country, and by the analysis of children still living at time of census.

Overweight status of the primary caregivers of orphan and vulnerable children in 3 Southern African countries: a cross sectional study

BACKGROUND

Africa is facing a nutritional transition where underweight and overweight coexist. Although the majority of programs for orphan and vulnerable children (OVC) focus on undernourishment, the association between OVC primary caregiving and the caregivers' overweight status remains unclear. We investigated the association between OVC primary caregiving status with women's overweight status in Namibia, Swaziland and Zambia.

METHODS

Demographic Health Survey (DHS) cross-sectional data collected during 2006-2007 were analyzed using weighted marginal means and logistic regressions. We analyzed data from 20-49 year old women in Namibia (N 6638), Swaziland (N 2875), and Zambia (N 4497).

RESULTS

The overweight prevalence of the primary caregivers of OVC ranged from 27.0% (Namibia) to 61.3% (Swaziland). In Namibia, OVC primary caregivers were just as likely or even less likely to be overweight than other primary caregivers. In Swaziland and Zambia, OVC primary caregivers were just as likely or more likely to be overweight than other primary caregivers. In Swaziland and Zambia, OVC primary caregivers were more likely to be overweight than non-primary caregivers living with OVC (Swaziland AOR = 1.56, Zambia AOR = 2.62) and non-primary caregivers not living with OVC (Swaziland AOR = 1.92, Zambia AOR = 1.94). Namibian OVC caregivers were less likely to be overweight than non-caregivers not living with an OVC only in certain age groups (21-29 and 41-49 years old).

CONCLUSIONS

African public health systems/OVC programs may face an overweight epidemic alongside existing HIV/AIDS, tuberculosis and malaria epidemics. Future studies/interventions to curb overweight should consider OVC caregiving status and address country-level differences.

Associations Between Orphan and Vulnerable Child Caregiving, Household Wealth Disparities, and Women's Overweight Status in Three Southern African Countries Participating in Demographic Health Surveys

This study examines whether orphan and vulnerable children (OVC) primary caregivers are facing absolute household wealth (AWI) disparities, the association between AWI and women's overweight status, and the modifying role of OVC primary caregiving status on this relationship. Demographic Health Surveys data (2006-2007) from 20 to 49 year old women in Namibia (n = 6,305), Swaziland (n = 2,786), and Zambia (n = 4,389) were analyzed using weighted marginal means and logistic regressions. OVC primary caregivers in Namibia and Swaziland had a lower mean AWI than other women in the same country. In Zambia, OVC primary caregivers had a lower mean AWI score than non-primary caregivers living with an OVC but a higher mean AWI score than non-OVC primary caregivers. In Swaziland and Zambia, even small increases in household wealth were associated with higher odds for being overweight regardless of women's caregiving status. Only in Namibia, OVC primary caregiving modified the effect of the previous association. Among Namibian OVC primary caregivers, women who had at least medium household wealth (4 or more AWI items) were more likely to be overweight than their poorest counterparts (0 or 1 AWI items). OVC primary caregivers are facing household wealth disparities as compared to other women from their communities. Future studies/interventions should consider using population-based approaches to reach women from every household wealth level to curb overweight in Swaziland and Zambia and to focus on specific household wealth characteristics that are associated with OVC primary caregivers' overweight status in Namibia.

Anthropometric measurements by ethnicity in Colombia, 1965-1990

We analyzed the evolution of height in Colombia of cohorts born in the period 1965-1990 by ethnic groups. We found that Afro-Colombian men and women were the tallest: 6cm taller than indigenous people and 2cm taller than the rest of the population. We also found that the height gap between Afro-Colombians and others decreased during the period under study by 0.7cm for both men and women. While improvements were noticeable among the Afro-Colombians and those who chose not to be classified by ethnicity, in the case of the indigenous population only female cohorts registered an average-height increase of 1.5cm. Moreover, we found that indigenous Colombians were more likely than other ethnic groups to experience an increase in biological well-being as a consequence of an improvement in their socio-economic status, thereby reducing the average-stature gap between them and the rest of the population by 2.1 and 3.6cm for men and women, respectively.