Frequency of TV viewing and prevalence of overweight and obesity among adult women in Bangladesh: a cross-sectional study

Residence-based inequalities in overweight/obesity in sub-Saharan Africa: a multivariate non-linear decomposition analysis

BACKGROUND

Overweight/obesity remains a major risk factor for non-communicable diseases and their associated morbidities and mortalities. Yet, limited studies have comprehensively examined factors contributing to the rural-urban disparities in overweight/obesity among women in sub-Saharan Africa. Thus, our study sought to decompose the rural-urban disparities in overweight/obesity among women in sub-Saharan Africa (SSA) using nationally representative datasets.

METHODS

We performed a cross-sectional analysis of data from the Demographic and Health Surveys of 23 sub-Saharan African countries conducted from 2015 to 2022. A sample of 177,329 women was included in the analysis. Percentages with confidence intervals (CIs) were used to summarize the prevalence of overweight/obesity per rural-urban strata and pooled level. A multivariate non-linear decomposition analysis was used to identify the factors contributing to the rural-urban disparities in overweight/obesity. The results were presented using coefficients and percentages.

RESULTS

The pooled prevalence of overweight/obesity among the women was higher in urban areas (38.9%; 95% CI = 38.2-39.6) than rural areas (19.1%; 95% CI = 18.7-19.6). This pattern was observed in all the countries surveyed, except in South Africa, where women in rural areas (53.1%; 95% CI = 50.0-56.4) had a higher prevalence of overweight/obesity than those in urban areas (46.0%; 95% CI = 43.2-48.9). Approximately 54% of the rural-urban disparities in overweight/obesity was attributable to the differences in the women's characteristics or explanatory variables. More than half of the rural-urban disparities in overweight/obesity would be reduced if the disparities in women's characteristics were levelled. Among the women's characteristics, frequency of watching television (29.03%), wealth index (26.59%), and level of education (9.40%) explained approximately 65% of the rural-urban differences in overweight/obesity.

CONCLUSION

The prevalence of overweight/obesity among women in SSA remains high and skewed towards women in urban areas. Increased frequency of watching television, high wealth index, and higher educational attainment contributed largely to the rural-urban disparities in overweight/obesity among women in SSA. Thus, interventions aimed at reducing overweight/obesity among women in SSA could be targeted at reducing the frequency of television watching as well as promoting physical activities among wealthy women and those with higher education, particularly in urban areas.

Double burden of malnutrition and associated factors among women of reproductive age in sub-Saharan Africa: a multilevel multinomial logistic regression analysis

BACKGROUND

Globally, malnutrition among women of reproductive age is on the rise and significantly contributing to non-communicable disease, deaths and disability. Even though the double burden of malnutrition (DBM) is a common problem among women in sub-Saharan Africa (SSA), there are limited studies examining the factors contributing to underweight, overweight, and obesity at the SSA level.

OBJECTIVE

To determine the factors associated with the DBM, and their relative magnitude, among women of reproductive age in SSA.

DESIGN

Cross-sectional study design.

SETTING

33 SSA countries.

PARTICIPANTS

240 414 women of reproductive age.

PRIMARY AND SECONDARY OUTCOME MEASURES

A multilevel multinomial logistic regression model was applied to identify factors associated with malnutrition. The adjusted relative risk ratio with 95% CI was used to declare the statistical significance of the association.

RESULTS

The pooled prevalence of underweight, overweight and obesity among women in SSA were 8.87%, 16.47% and 6.10%, respectively. Women who are from rural residence and smoke cigarettes were more likely to be underweight. Conversely, women between the age of 24-34 and 35-49, who have higher education, belong to a middle and rich household, are ever married, have high parity, use contraceptives, have media exposure and smoke cigarettes were more likely to be overweight and/or obese.

CONCLUSION

The findings of our study suggest that certain factors such as residence, education status, wealth, marital status, occupation, cigarette smoking, and contraceptive use have a significant assocation with malnutrition among women. Therefore, it is important for public health programs aimed at preventing the double burden of malnutrition to focus on these factors through comprehensive public awareness and cost-effective operational health interventions.

Factors associated with overweight and obesity among women of reproductive age in Cambodia: Analysis of Cambodia Demographic and Health Survey 2021-22

Overweight and obesity are associated with increased chronic disease and death rates globally. In Cambodia, the prevalence of overweight and obesity among women is high and increasing. This study aimed to determine the prevalence and factors associated with overweight and obesity among women of reproductive age (WRA) in Cambodia. We analyzed data from the 2021-22 Cambodia Demographic and Health Survey (CDHS). Data analysis was restricted to non-pregnant women, resulting in an analytic sample of 9,417 WRA. Multiple logistic regressions were performed using STATA V17 to examine factors associated with overweight and obesity. The prevalence of overweight and obesity among WRA was 22.56% and 5.61%, respectively. Factors independently associated with increased odds of overweight and obesity included women aged 20-29 years [AOR = 1.85; 95% CI: 1.22-2.80], 30-39 years [AOR = 3.34; 95% CI: 2.21-5.04], and 40-49 years [AOR = 5.57; 95% CI: 3.76-8.25], women from rich wealth quintile [AOR = 1.44; 95% C: 1.19-1.73], having three children or more [AOR = 1.40; 95% CI: 1.00-1.95], ever drink alcohol [AOR = 1.24; 95% CI: 1.04-1.47], and current drink alcohol [AOR = 1.2; 95% CI: 1.01-1.45]. Women completed at least secondary education were less likely being overweight and obese [AOR = 0.73; 95% CI: 0.58-0.91]. Overweight and obesity remains highly prevalent among WRA in Cambodia. Therefore, there is an urgent need to take interventions that target women from higher socio-demographic status to reduce the risk of life-threatening caused by being overweight and obese through raising awareness of important changing lifestyles.

Socio-demographic predictors of obesity among 12,975 adult ever married Egyptian women of reproductive age group: evidence from nationwide survey

AIM

We aimed to explore the predictors associated with obesity among adult ever-married Egyptian women aged 20-49 years based on the Egyptian Demographic and Health Survey (EDHS).

METHOD

We included adult ever married women from the EDHS conducted in 2014 that initially recruited 21,903 women. Univariate and multivariable analysis was conducted to identify socio-demographic predictors of women's obesity.

RESULT

We included 12,975 Egyptian women. Among them, 76% of the total respondents were obese where as 24% were with normal body mass index (BMI). In multivariable analysis, the results revealed that increasing age, higher wealth index, listening to radio at least once a week and women with primary and secondary education were at significant odds of developing obesity (p < 0.05). However, we found no association between residence of participants and the frequency of watching television upon the development of obesity (p > 0.05).

CONCLUSION

Appropriate and targeted interventions should be implemented among the Egyptian reproductive age women to reduce the obesity as well as non-communicable diseases load associated with obesity. National Health Service policy makers should take multilevel approach targeting high risk sub-groups to raise awareness and to provide prevention against obesity and the subsequent complications.

A multilevel analysis of the triple burden of malnutrition in Indonesia: trends and determinants from repeated cross-sectional surveys

BACKGROUND

Although child malnutrition has been reducing, the coexistence in mothers and children of various forms of malnutrition has continued to rise around the world. In the Indonesian context, a knowledge gap exists on the coexistence of multiple malnutrition burdens. This study examines trends in the coexistence of the triple burden of malnutrition (TBM) among mother-child pairs living in the same house and explores multilevel (individual, household, and community) factors associated with TBM in Indonesia.

METHODS

We used data from the 2013 and 2018 Indonesia Basic Health Research, the nationally representative survey of the Indonesian population, as repeated cross-sectional surveys. Study samples were mothers and children (0-59 months old), who resided in the same household and indicated by the same identifier number. The anthropometric measurements of the mothers and children, and the hemoglobin levels of the children were collected. We employed a multilevel mixed-effects model to consider the hierarchical data structure. The model captured the role of cluster, district, provincial differences, and the individual, household, community-level, and TBM status characteristics.

RESULTS

Of 3,891 mother-child pairs analyzed, 24.9% experienced TBM. Girls had 63% higher odds than boys of TBM (aOR: 1.63; 95% CI: 1.30 to 2.03). Significantly lower odds were found in children of mothers who had a gestational age lower than 37 weeks (aOR: 0.72; 95% CI: 0.55 to 0.94). At the household level, children with a father who had a high-school, primary-school, or no school education had significantly higher odds of TBM than children of fathers who had graduated from academy. Children of mothers who visited Antenatal Care (ANC) no more than 6 times had significantly lower odds (aOR: 0.65; 95% CI: 0.47 to 0.88). Children of mothers who consumed Iron and Folic Acid (IFA) supplements had significantly lower odds.

CONCLUSION

TBM is related to characteristics at not just the individual level but also the family and community levels. To achieve significant outcomes, integrated nutrition interventions in Indonesia should also consider family and community factors.

Double burden of malnutrition and its associated factors among women in low and middle income countries: findings from 52 nationally representative data

BACKGROUND

Double burden of malnutrition (DBM) is an emerging global public health problem. The United Nations member states adopted eradicating all forms of malnutrition as an integral component of the global agenda. However, there is evidence of a high burden of undernutrition among women and rising rates of overweight and obesity, especially in low and middle income countries (LMICs). Therefore, this study aimed to investigate the prevalence and associated factors of underweight, overweight, and obesity among women of reproductive age in LMICs.

METHODS

Data for the study were drawn from a recent 52 Demographic and Health Surveys (DHS) conducted in LMICS. We included a sample of 1,099,187 women of reproductive age. A multilevel multinomial logistic regression model was used to identify factors associated with DBM. Adjusted relative risk ratio (RRR) with a 95% Confidence Interval (CI) was reported to show an association.

RESULTS

The prevalence of underweight, overweight, and obesity in LMICs among women of reproductive age was 15.2% (95% CI: 15.1-15.3), 19.0% (95% CI: 18.9- 19.1), and 9.1% (95% CI: 9.0-9.2), respectively. This study found that women aged 24-34 years, aged ≥ 35 years, with primary, secondary, and above educational level, from wealthy households, using modern contraceptives, exposed to media (radio and television), and with high parity (more than one birth) were more likely to have overweight and obesity and less likely to have underweight. Moreover, the risk of having obesity (RRR = 0.59; 95% CI = 0.58-0.60 and overweight (RRR = 0.78; 95% CI = 0.77-0.79) were lower among rural women, while the risk of being underweight was (RRR = 1.13; 95% CI = 1.11-1.15) higher among rural women compared to urban women.

CONCLUSION

The prevalence of underweight, overweight, and obesity was high among women of reproductive age in LMICs. Underweight, overweight, and obesity are influenced by sociodemographic, socioeconomic, and behavioral-related factors. This study shows that, in order to achieve Sustainable Development Goal 2, a multifaceted intervention approach should be considered to prevent both forms of malnutrition in women of reproductive age. This can be achieved by raising awareness and promoting healthy behaviors such as healthy eating and physical activity, especially among educated women, women from wealthy households, and women exposed to the media.

Quantification of Urbanization Using Night-Time Light Intensity in Relation to Women's Overnutrition in Bangladesh

Urbanization is accelerating in developing countries, which are simultaneously experiencing a rise in the prevalence of overnutrition (i.e., overweight and obesity), specifically among women. Since urbanization is a dynamic process, a continuous measure may better represent it when examining its association with overnutrition. However, most previous research has used a rural-urban dichotomy-based urbanization measure. This study utilized satellite-based night-time light intensity (NTLI) data to measure urbanization and evaluate its association with body weight in reproductive-aged (15-49) women in Bangladesh. Multilevel models estimated the association between residential area NTLI and women's body mass index (BMI) or overnutrition status using data from the latest Bangladesh Demographic and Health Survey (BDHS 2017-18). Higher area-level NTLI was associated with a higher BMI and increased odds of being overweight and obese in women. Living in areas with moderate NTL intensities was not linked with women's BMI measures, whereas living in areas with high NTL intensities was associated with a higher BMI or higher odds of being overweight and obese. The predictive nature of NTLI suggests that it could be used to study the relationship between urbanization and overnutrition prevalence in Bangladesh, though more longitudinal research is needed. This research emphasizes the necessity for preventive efforts to offset the expected public health implications of urbanization.

Correlation of Socio-Economic Factors, Diet, and Ownership of Consumer Electronics with Body Mass Index in Women of Childbearing Age: Insights from the 2016 South African Demographic Health Survey

The available evidence indicates a correlation between owning consumer electronics, such as cellphones and televisions, and a higher risk of obesity and increased adiposity. However, such studies are sparse in South Africa. Thus, the aim of this study is to examine the dietary and sociodemographic factors associated with various BMI categories, including the possession of consumer electronics, among women of reproductive age in South Africa. This is a secondary study of a population registry that includes dietary, BMI, and digital use items among women of reproductive age. The data is from the South Africa Demographic Health Survey (SADHS, 2016). Of the 3363 participants included in the analysis, women of normal weight were (35.5%), pre-obese (34.5%), obese (27.1%) and underweight (2.9%). Age was found to be significantly associated with pre-obesity at a <0.05 confidence interval. Owning a cellphone was significantly associated with being underweight and had 55% increased odds (1–0.45) (OR = 0.45; 95% CI 0.26–0.77, p = 0.004). Using internet almost daily was statistically significant with being underweight and had 55% (1–0.45) increased odds of being underweight (OR = 0.45; 95% CI 0.20–1.01, p = 0.054). Owning a cellphone and internet use was found to be significantly associated with being underweight. More research is needed to understand why cellphone ownership and using internet almost daily are significantly associated with being underweight.

Diarrhea as a Disease of Poverty Among Under-Five Children in Sub-Saharan Africa: A Cross-Sectional Study

The objective of this study was to assess the prevalence of diarrhea among under-five children in low-middle-income countries and identify the sociodemographic factors associated with it. Data of 36 countries in sub-Saharan Africa from demographic and Health Surveys (2006-2018) comprising 251 341 mother-child (singleton) dyads were analyzed to estimate the prevalence and various modifiable and non-modifiable risk factors of diarrhea. Occurrence of diarrhea during the last 2 weeks was the outcome variable which was measured by mothers' observation of the condition. The overall prevalence of having diarrhea during last 2 weeks was 18.44% (19.12% among boys and 17.75% among girls). Boys had higher percentage of having diarrhea than girls in all countries except in Libya. The risk ratios of having diarrhea decreased progressively with higher wealth quintiles; the risks of were respectively 7% [RR = 0.93, 95% CI = 0.91; 0.97], 11% [RR = 0.89, 95% CI = 0.86; 0.92] and 18% [RR = 0.82, 95% CI = 0.78; 0.85] lower for households in the middle, richer and richest households. Rural residency was associated with lower risks [RR = 0.95, 95% CI = 0.93; 0.98] and not having access to improved water [RR = 1.05, 95% CI = 1.03; 1.08] and toilet facilities [RR = 0.04, 95% CI = 1.01; 1.07] were associated with higher risks of diarrhea. Regarding children's characteristics, higher age groups, birth order were associated with higher risks and female sex with lower risks. Children with mothers in the higher age groups and with above secondary level education had lower risks, and primary education had higher risks of diarrhea. Meta-analysis of 36 countries revealed a significantly negative association between wealth quintile and diarrhea (Odds ratio = 0.72, 95% CI = 0.69; 0.74). Findings indicate the presence of a significant wealth gradient in the burden of diarrheal diseases among under-five children in sub-Saharan Africa, and underscores the need for paying special attention to the marginalized communities when designing intervention programs.

Investigating the Factors Affecting Overweight/Obese amidst Non-pregnant Women in Bangladesh: A Multi-level Analysis of Demographic and Health Survey

The primary goal of this study was to investigate the severity of being overweight/obese among non-pregnant women and its trend for change over the last 10 years in Bangladesh. This research featured 16,398 female participants and used the chi-Squared test to investigate the association between different socioeconomic variables and dependent variables. We applied the average annual rate of increase (AARI) to determine the trends of selected variables over the last decade. Next, we applied a multilevel logistic regression model to determine specific trigger factors at the individual and community levels; for this, we used the 2017–2018 data from the Bangladesh Demographic and Health Survey (BDHS). Individually, women between the ages of 40 and 44 years (odds ratio [OR] 5.68; 95% confidence interval [95% CI] 4.68–6.89) with better education (OR 1.55; 95% CI 1.34–1.80) and from the wealthiest households (OR 3.65; 95% CI 3.17–4.20) had a higher risk for being overweight or obese. On the other hand, working women (OR 0.80; 95% CI 0.75–0.87) had a lower risk of becoming overweight or obese. Respondents from affluent communities had a higher probability of being overweight or obese (OR 1.93; 95% CI 1.72–2.18) whereas women in rural areas were less likely (OR 0.63; 95% CI 0.57–0.69) to be overweight or obese. The efforts of both individuals and communities are expected to raise awareness among wealthy and educated women.

Microcredit Membership and Self-Reported Healthcare Autonomy among Bangladeshi Women

Participation in microcredit programs has so far received widespread research and policy attention in the context of health and empowerment among Bangladeshi women. However, not much is known regarding the relationship between participation in microcredit programs and healthcare autonomy (HA) among women. In the present study, we analyzed two nationally representative surveys (Bangladesh Demographic and Health Survey 2004 and 2014), to assess the relationships between MC membership and HA among adult women (n = 29163), while adjusting for various sociodemographic correlates. Self-reported healthcare decision-making autonomy was assessed by asking whether or not the participant had final say on her healthcare. The findings revealed that between 2004 (20.9%, 95%CI = 19.8, 22.0) and 2014 (14.1%, 95%CI = 13.3, 15.0), the proportion of women reporting HA decreased significantly, despite considerable improvements across several socioeconomic indices, including higher education enrollment and labor market participation. Between 2004 and 2014, the percentage of microcredit borrowers decreased for Grameen (18.9% vs. 10.7%) and BRAC (7.9% vs. 7.4%), while it increased for BRDB (0.9% vs. 7.0%). A multivariate regression analysis revealed that Grameen Bank membership was positively associated with reporting HA in both male- (OR = 1.16, 95%CI = 1.09, 1.23) and female-headed households (OR = 1.44, 95%CI = 1.13, 1.85). A positive association between microcredit membership and HA was also observed for BRAC (OR = 1.33, 95%CI = 1.20, 1.47) and BRDB (OR = 1.18, 95%CI = 1.09, 1.29), but in the male-headed households only. Further analysis indicated that membership with Grameen bank was the most important predictor of HA, followed by BRAC, BRDB, and ASA, with the degree of importance varying substantially between male- and female-headed households. In conclusion, these findings suggest the potential of microcredit programs to promote healthcare autonomy among Bangladeshi women and provide insights for further research, as to why certain programs are more effective than others.

Association of overweight and obesity with hypertension, diabetes and comorbidity among adults in Bangladesh: evidence from nationwide Demographic and Health Survey 2017-2018 data

OBJECTIVES

The study aimed to determine the association of overweight and obesity with hypertension, diabetes and comorbidity among the adults of Bangladesh.

STUDY DESIGN

This study used cross-sectional data from the nationally representative Bangladesh Demographic and Health Survey conducted in 2017-2018. The main outcome variables were hypertension, diabetes and comorbidity. Comorbidity was defined as the coexistence of hypertension and diabetes. Overweight and obesity, as measured by body mass index, were the main explanatory variables. The strength of the association was determined using the adjusted multiple logistic regression models.

SETTING

Rural and urban areas in Bangladesh.

PARTICIPANTS

The study included a total of 11 881 adults (5241 men and 6640 women) aged 18 years or older.

RESULTS

The prevalence of hypertension, diabetes and comorbidity among the sample population were 28.5%, 9.9% and 4.5%, respectively. Among the respondents, 20.1% were overweight and 4.1% were obese. The risk of hypertension was 2.47 times more likely in the overweight group (adjusted OR (AOR) 2.47; 95% CI 2.22 to 2.75) and 2.65 times more likely in the obese group (AOR 2.65; 95% CI 2.16 to 3.26) compared with the normal or underweight group. Adults who were overweight and obese had 59% (AOR 1.59; 95% CI 1.37 to 1.84) and 88% (AOR 1.88; 95% CI 1.46 to 2.42) higher odds of having diabetes, respectively, than normal or underweight adults. Moreover, the risk of comorbidity was 2.21 times higher in overweight adults (AOR 2.21; 95% CI 1.81 to 2.71) and 2.86 times higher in obese adults (AOR 2.86; 95% CI 2.09 to 3.91) compared with normal or underweight adults.

CONCLUSIONS

Using large-scale nationally representative data, we found that overweight and obesity were significantly associated with hypertension, diabetes and comorbidity. So, nationally representative data can be used for programme planning to prevent and treat these chronic conditions.

Multilevel exploration of individual- and community-level factors contributing to overweight and obesity among reproductive-aged women: a pooled analysis of Bangladesh Demographic and Health Survey, 2004-2018

OBJECTIVES

Overweight and obesity have been related to a variety of adverse health outcomes. Understanding the overweight and obesity epidemic in Bangladesh, particularly among reproductive-aged women, is critical for monitoring and designing effective control measures. The purpose of this study was to determine the prevalence of overweight and obesity in reproductive-aged women and to identify the risk factors of overweight and obesity.

DESIGN

A total of 70 651 women were obtained from the five most recent and successive Bangladesh Demographic and Health Surveys (BDHS). The multilevel logistic regression model was used to explore the individual- and community-level factors of overweight and obesity.

SETTING

Five most recent nationally representative household surveys across all regions.

PARTICIPANTS

Reproductive-aged (15-49 years) non-pregnant women.

RESULTS

Approximately 35·2 % (95 % CI: 34·9-35·6 %) of women were either overweight or obese in Bangladesh. At the individual- and community-level, higher age (adjusted odds ratio (aOR) = 5·79, 95 % CI: 5·28-6·34), secondary or higher education (aOR = 1·69 [1·60-1·78]), relatively wealthiest households (aOR = 4·41 [4·10-4·74]), electronic media access (aOR = 1·32 [1·26-1·37]) and community high literacy (aOR = 1·10 [1·04-1·15]) of women were significantly positively associated with being overweight or obese. Whereas, rural residents (aOR = 0·79 [0·76-0·82]) from larger-sized households (aOR = 0·80 [0·73-0·87]) and have high community employment (aOR = 0·92 [0·88-0·97]) were negatively associated with the probability of being overweight or obese.

CONCLUSION

Individual- and community-level factors influenced the overweight and obesity of Bangladeshi reproductive-aged women. Interventions and a comprehensive public health plan aimed at identifying and addressing the growing burden of overweight and obesity should be a top focus.

Prevalence and determinants of nutritional status among women and children in Pakistan

Background

Nutrition has been a low-priority area in Pakistan, with low visibility from the political leadership. Despite various efforts, Pakistan has been reported to have one of the highest prevalences of child and women malnutrition compared to other developing counties. Therefore, this study intends to examine the prevalence and determinants of nutritional status of women and children in Pakistan.

Methods

The present study uses the Demographic Health Survey (DHS) data from Pakistan 2012–13 (PDHS-3). The nutritional status of women was examined through Body-Mass Index (Underweight, normal, overweight, & obese), and that of children was examined through stunting (severe and moderate), wasting (severe, moderate, overweight), and underweight (severe, moderate, overweight). Descriptive statistics and bivariate analysis have been used along with multinomial logistic regression.

Results

A higher proportion of children in rural areas were severely stunted (19.6% vs. 12.5%), severe wasted (2.4% vs. 2.2%), and severe underweight (9.4% vs. 6%) than their urban counterparts. A higher proportion of rural women (9.5% vs. 5.5%) were underweight than urban women, whereas a higher proportion of urban women were obese (24.3% vs. 19.0%) than rural women. The odds of severe stunting (OR = 0.24; C.I. = 0.15–0.37), severe underweight (OR = 0.11; C.I. = 0.05–0.22) were lower among children from the richest wealth quintile than their poorest counterparts. The Relative Risk Ratio (RRR) of being overweight (RRR = 3.7; C.I. = 2.47–5.54) and Obese (RRR = 4.35; C.I. = 2.67–7.07) than normal BMI were higher among women from richest wealth quintile than women belonged to poorest wealth quintile.

Conclusion

This study has highlighted determinants associated with maternal and child nutritional status, whereby the child’s nutritional status was measured by stunting, wasting, and underweight, and BMI measured the mother’s nutritional status. The main risk factors for a child’s poor nutritional status include low household wealth, urban residence, and mother’s educational status. Similarly, the main risk factors for women’s poor nutritional status include increasing the women’s age, educational status, rural residence, and household wealth. Poor households should be provided special attention to improve the nutritional status among women and children in poor households.

Socio-economic inequalities in diabetes and prediabetes among Bangladeshi adults

Diabetes and prediabetes are overwhelming public health concerns in Bangladesh. However, there is a paucity of the literature examining and measuring socioeconomic inequalities in the prevalence of diabetes in Bangladesh. To provide reliable data and contribute to a nationwide scenario analysis, this study aims to estimate the inequality in prevalence of diabetes and prediabetes and to identify factors potentially contributing to socioeconomic inequalities in Bangladesh. This study used data from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-18, a nationally representative survey. A regression-based decomposition method was applied to assess the socioeconomic contributors to inequality. The prevalence of diabetes and prediabetes were about 10 and 15% among Bangladeshi adults, respectively. Both diabetes and prediabetes were significantly associated with age, wealth status, suffering from overweight or obesity and administrative divisions of the respondents (p < 0.001). Respondents' household wealth status accounted for about 74 and 81% of the total inequality in diabetes and prediabetes in Bangladesh, respectively. Administrative region contributed 24.85% of the inequality in prediabetes and 12.26% of the inequality in diabetes. In addition, overweight or obesity status contributed 11.37% and exposure to television contributed 5.17% of the inequality in diabetes. Diabetes and prediabetes affect a substantial proportion of the Bangladeshi adult population. Therefore, these findings should be considered in the context of current and proposed policy decision making and for tracking its progression with economic development in Bangladesh.

Prevalence and associated factors of underweight and overweight/obesity among reproductive-aged women: A pooled analysis of data from South Asian countries (Bangladesh, Maldives, Nepal and Pakistan)

BACKGROUND AND AIMS

Underweight and overweight/obesity is a critical public health problem among women in South Asian countries. This study aimed to find the prevalence of underweight and overweight/obesity and discover its associated factors among women of reproductive age in four South Asian countries.

METHODS

Population-representative cross-sectional latest Demographic and Health Survey data from four South Asian countries, considering Bangladesh (2017-18), Maldives (2016-17), Nepal (2016), and Pakistan (2017-18), were pooled for this study. To investigate the factors related with underweight and overweight/obesity in women, a multivariate multinomial logistic regression model was deployed.

RESULTS

The overall prevalence of underweight and overweight/obesity among reproductive-age women in four South Asian countries was 11.8% and 36.3%, respectively. According to adjusted multivariate multinomial logistic regression analysis, women who lived in Pakistan, were older, had a better education, were from the wealthiest home, were currently in union and had media exposure had a considerably decreased probability of being underweight. In contrast, families with a large number of members had a considerably increased risk of becoming underweight. Additionally, women from the Maldives, older age, secondary education, a higher number of children, women from the richest household, currently in the union, the family had media exposure, and pregnant women have been found significantly positively associated with overweight/obesity. However, Nepalese women, large family members, rural residence, and work involvement were significantly negatively associated with overweight/obesity.

CONCLUSION

The problem of being underweight and overweight/obesity still exists in South Asian countries. Focusing on women's age, education, wealth index, and media exposure, different public health intervention approaches are imperative to reduce unhealthy weight conditions.

Trends in television viewing and overweight /obesity among Nepalese women: Findings from 2006, 2011 and 2016 Nepal Demographic and Health Surveys

BACKGROUND AND AIMS

Associations between overweight/obesity and television (TV) viewing have been identified in high-income countries, but little evidence is available from low- and middle-income countries. This study examined the trends and correlates of television viewing and overweight/obesity among Nepalese women between 2006 and 2016.

METHODS AND RESULTS

We analysed the data from 22,161 women aged 15-49 years who took part in Nepal Demographic Health Surveys 2006 (n = 10,115), 2011 (n = 5,881) or 2016 (n = 6,165). Trained staff collected data on TV viewing and sociodemographic attributes from a face-to-face survey while height and weight were measured objectively to determine body mass index. Around 38% of the study participants watched TV at least once a week in 2006, which increased to 49% in 2011 and 46% in 2016. The prevalence of overweight and obesity increased from 8% in 2006 to 14.6% in 2011 and 19.8% in 2016. Compared to those who did not watch TV at all, those watching it at least once a week were at 1.54 (95% CI: 1.02-2.33), 1.79 (95% CI: 1.23-2.60) and 1.46 (95% CI: 1.13-1.88) times higher odds of being overweight/obese in 2006, 2011 and 2016 respectively.

CONCLUSION

The prevalence of TV viewing rose among women in Nepal between 2006 and 2016 and was associated with overweight/obesity, which also increased dramatically over this period. Future studies examining the use of multiple screen devices, daily usage duration and content viewed are recommended to understand better the health impacts of transitions to more sedentary living in Nepal and similar settings.

Individual and community-level determinants of overweight and obesity among urban men: Further analysis of the Ethiopian demographic and health survey

Background

Overweight and obesity have become a serious public health problem in both developed and developing countries, particularly in urban areas. However, there are limited studies conducted to identify the risk factors of overweight and obesity in Ethiopia, especially among men. Therefore, this study aimed to assess individual and community level determinants of overweight and obesity among urban men in Ethiopia.

Methods

This study used the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A weighted sample of 2259 urban men aged 15–59 years were included in this analysis. A multilevel logistic regression model was used to assess the determinants of overweight and obesity among the study participants.

Results

Men aged 30–44 years old (AOR = 3.1, 95% CI: 2.3–4.11), 45–59 years old (AOR = 4.8, 95% CI: 3.4–6.9), married (AOR = 1.7, 95% CI: 1.3–2.2), with secondary education (AOR = 2.7, 95% CI: 1.6–4.7), with higher education (AOR = 3.6, 95% CI: 2.1–6.2), watching television at least once a week (AOR = 1.7, 95% CI: 1.1–2.7), being from high rich communities (AOR = 2.4, 95% CI: 1.5–3.7), and living in three metropolises (Addis Ababa, Harari, Diredawa) were more likely to be overweight or obese (AOR = 1.8, 95% CI: 1.1–2.9). However, currently unemployed men were less likely to be overweight or obese (AOR = 0.5, 95% CI: 0.3–0.7).

Conclusion

Being older age, being married, having higher educational status, having higher frequency of watching television, being residents of three metropolises (Addis Ababa, Harari, and Diredawa), and being from high rich communities were found to be predictors of overweight and obesity in Ethiopian men. Therefore, it is essential to design strategies and programs to reduce or prevent overweight and obesity with special focus on the identified risk factors.

Gender Differences in The Factors associated with Hypertension in Non-Diabetic Saudi Adults-A Cross-Sectional Study

The association between lifestyle practices, obesity and increased BP are under-investigated. We aimed to investigate this association to identify the factors associated with hypertension and prehypertension in Saudis. Non-diabetic adults were recruited from public healthcare centers using a cross-sectional design. Recruits were interviewed using a predesigned questionnaire. Weight, height, waist circumference (WC), hip circumference (HC), neck circumference (NC) and BP were measured. The variables were analyzed by comparing the prehypertensive and hypertensive groups with the normotensive group. A total of 1334 adults were included. The study found that 47.2% of men and 24.7% of women were prehypertensive, and 15.1% of men and 14.4% of women were hypertensive. High BMI, WC, NC, and WC: HC ratios were associated with an increased risk of prehypertension and hypertension in men and women. Low physical activity was associated with an increased risk of elevated BP in men, while sleep duration of ≤6 h and sitting for ≥4 h were associated with increased risk in women. Women from central Asia, southeast Asia, and those of mixed origin had a higher prevalence of hypertension compared to those from Arabian tribes. In conclusion, prehypertension and hypertension increase with age and obesity. Gender differences were apparent in the association between several lifestyle practices and prehypertension or hypertension among various ethnic/racial groups.

Association between television viewing and overweight and obesity among women of reproductive age in Timor-Leste: evidence from the demographic health survey 2016

OBJECTIVE

This study aimed to assess the possible relationship between television viewing and overweight and obesity among Timorese women of reproductive age.

METHODS

This cross-sectional study analysed the Timor-Leste Demographic and Health Survey 2016 dataset. A weighted sample of 11 398 Timorese women aged 15-49 years was chosen using a two-stage stratified random sampling technique. Asian criteria-based body mass index (BMI) cut-offs were used to define overweight (BMI 23.0 to <27.5 kg/m²) and obesity (BMI ≥27.5 kg/m²). Frequency of TV viewing was categorised into three groups: (1) not at all, (2) less than once a week and (3) at least once a week. Multilevel ordered logistic regression was performed to identify the correlates of overweight and obesity. Both crude and adjusted odds ratios (AOR) along with a 95% CI were calculated to show the strength of association.

RESULTS

Among 11 398 respondents, 19.4% were overweight or obese (overweight: 15.7% and obese: 3.8%). Although about half of the respondents reportedly did not watch TV at all, just over two-thirds watched TV at least once a week. Women who watched TV at least once a week were found to have 1.3 times the odds of being overweight or obese compared with those who never watched TV (AOR: 1.3, 95% CI: 1.1 to 1.5; p<0.001). However, when stratified by settlement type, the statistical significance stood for the rural women only (AOR: 1.5, 95% CI: 1.2 to 1.8; p<0.001), after adjusting for the covariates.

CONCLUSION

Watching TV at least once a week was found to be a significant correlate of overweight and obesity in rural Timorese women of reproductive age. Further studies need to be undertaken to assess physical activity, sedentary and dietary patterns to clarify the possible mechanism through which TV viewing may influence BMI in those groups.

Spatial distribution of various forms of malnutrition among reproductive age women in Nepal: A Bayesian geoadditive quantile regression approach

Addressing both the under-and over-nutritional status of women is an eminent challenge for developing countries like Nepal. This paper examined a critical analysis of factors associated with various forms of malnutrition using Bayesian geoadditive quantile regression approach and assessed spatial variations of malnutrition among Nepalese women using Asian cut-off values. Data drawn from the 2016 Nepal Demographic and Health Survey was utilized to assess the spatial distributions of underweight, overweight and obesity at the provincial level. Spatial and nonlinear components were estimated using Markov random fields and Bayesian P-splines, respectively. The analysis of 4,338 women confirmed that women living in extremely urbanized areas and in Province 1, Province 3, and Province 4 were more likely to be overweight/obese. Similarly, the likelihood of being underweight was prominently high among women residing in rural municipality and women residing in Province 2 and Province 7. Women from the richest and richer quintiles, and with primary education were more likely to be obese. Furthermore, currently-working women and women having access to protected water source were less likely to be obese while improved toilet and access to electricity facility were associated with obesity. Women with access to newspaper and radio were less prone to obesity. Inconsistent distribution of under- and over-nutrition existed in Nepal, given that the high prevalence of overweight/obesity among women living in metropolitan and undernutrition among rural women. Specific intervention measures, addressing location-specific nutrition issues are urgent. Rigorous implementation of strategies incorporated in the national nutrition plan is called for to curb the burden of overweight/obesity. Involving mass media to promote healthier lifestyle and nutritious food could be advantageous at the population level, especially in rural municipalities.

Prevalence and factors associated with triple burden of malnutrition among mother-child pairs in India: a study based on National Family Health Survey 2015-16

BACKGROUND

Malnutrition in mothers as well as in children is a significant public health challenge in most of the developing countries. The triple burden of malnutrition is a relatively new issue on the horizon of health debate and is less explored among scholars widely. The present study examines the prevalence of the triple burden of malnutrition (TBM) and explored various factors associated with the TBM among mother-child pairs in India.

METHODS

Data used in this study were drawn from the fourth round of the National Family Health Survey (NFHS-IV) conducted in 2015-16 (N = 168,784). Bivariate and binary logistic regression analysis was used to quantify the results. About 5.7% of mother-child pairs were suffering from TBM.

RESULTS

Age of mother, educational status of the mother, cesarean section delivery, birth size of baby, wealth status of a household, and place of residence were the most important correlates for the triple burden of malnutrition among mother-child pairs in India. Further, it was noted that mothers with secondary education level (AOR: 1.15, CI 1.08-1.23) were having a higher probability of suffering from TBM, and interestingly the probability shattered down for mothers having a higher educational level (AOR: 0.90, CI 0.84-0.95). Additionally, mother-child pairs from rich wealth status (AOR: 1.93, CI 1.8-2.07) had a higher probability of suffering from TBM.

CONCLUSION

From the policy perspective, it is important to promote public health programs to create awareness about the harmful effects of sedentary lifestyles. At the same time, this study recommends an effective implementation of nutrition programs targeting undernutrition and anemia among children and obesity among women.

Determinants of Overweight or Obesity among Men Aged 20-59 Years: A Case-Control Study Based on the 2016 Ethiopian Demographic and Health Survey

BACKGROUND

Evidence shows that overweight or obesity has become a major public health problem in both developed and developing countries. However, there are limited studies conducted to identify the risk factors of overweight or obesity in Ethiopia. Therefore, this study aimed to assess the determinants of overweight or obesity among men aged 20-59 years in Ethiopia.

METHODS

This study used the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A case-control study was conducted based on the EDHS data; cases were men who were overweight or obese, depending on their body mass index, and controls were men with normal body mass index. Bivariate and multivariate binary logistic regression was performed to assess the determinants of overweight or obesity among the study participants.

RESULTS

A total of 610 cases and 2440 controls were included in this study. Men aged 30-39 years (adjusted odds ratio (AOR) = 2.2, 95% CI: 1.6-3.0) and ≥40 years (AOR = 3.4, 95% CI: 2.5-4.7) had higher odds of being overweight or obese compared to men aged 20-29 years old. The likelihood of overweight or obesity was significantly higher among married men (AOR = 1.5, 95% CI: 1.1-2.0), living in urban areas (AOR = 3.1, 95% CI: 2.1-4.4), those in the rich wealth quintile (AOR = 1.9, 95% CI: 1.2-2.9), and those with primary (AOR = 1.6, 95% CI: 1.1-2.3), secondary (AOR = 2.6, 95% CI: 1.7-3.9), and higher education (AOR = 3.6, 95% CI: 2.4-5.6). Additionally, men watching television at least once a week had higher odds (AOR = 1.5, 95% CI: 1.1-2.1) of being overweight or obese.

CONCLUSION

Men in the higher wealth quintile, older age, married, higher educational status, watching television at least once a week, urban dwellers, residents of big cities such as Addis Ababa and Harari, and residents of low land like Afar were more likely to be overweight or obese. Therefore, it is essential to design strategies and programs to reduce or prevent overweight or obesity with a special focus on the identified risk factors.

Interaction between the place of residence and wealth on the risk of overweight and obesity in Bangladeshi women

BACKGROUND

The prevalence of overweight and obesity in women has increased significantly over the last few decades in Bangladesh, a rapidly urbanising developing country. However, little is known regarding the association between the interaction of the place of residence and household wealth with overweight and obesity, particularly in women from developing countries.

OBJECTIVE

The objective of this study is to find the association between the interaction of the place of residence and wealth with overweight and obesity among Bangladeshi women.

METHODS

This study utilised data from the four Bangladesh Demographic Health Surveys conducted in 2004, 2007, 2011 and 2014 with a total of 54337 women aged 15-49 years. Multivariate logistic regression was used for the analyses.

RESULTS

The prevalence of overweight and obesity among women aged 15-49 years in Bangladesh has considerably increased from 9.96% in 2004 to 24.43% in 2014. The interaction between wealth and place of residence has been found to be associated with obesity. Urban wealthy and richest women were 4.23 (OR: 4.23, 95% CI: 1.25-14.34) and 5.99 (OR: 5.99, 95% CI: 1.91-18.74) times more likely to be obese compared to their rural counterparts in the period 2004. Urban richest were 2.94 times (OR: 2.94, 95% CI: 1.20-7.24) more likely to be obese against their rural counterparts for the survey year 2014.

CONCLUSIONS

The place of residence is not associated with obesity, but its interaction with wealth is significant.

Socio-economic inequalities in overweight and obesity among women of reproductive age in Bangladesh: a decomposition approach

BACKGROUND

Overweight and obesity of women is a growing concern all over the world. However, an understanding on the socio-economic inequalities in overweight and obesity of women received little attention, especially in the context of Bangladesh. Therefore, the objective of this study was to measure the inequality in overweight and obesity among women of reproductive age in Bangladesh as well as to explore the effect of various socio-economic factors on this inequality.

METHODS

This study used data from the Bangladesh Demographic and Health Survey 2014 which is a nationally representative data. The concentration index of overweight and obesity was applied to measure the extent of socio-economic inequality. Finally, the concertation index was decomposed in order to understand the contribution of different socio-economic variables in inequality in overweight and obesity of women.

RESULTS

This study included a total of 16,624 women of reproductive age. The study found that the prevalence of overweight was about 29% and the rate of obesity was approximately 11%. The value of concentration index for overweight and obesity was 0.37 (p < 0.001). This study also observed that about 52% inequality was explained by household's wealth status followed by watching television (25%), husband/partner's educational status (around 7%), women's educational status (about 5%), place of residence (approximately 4%).

CONCLUSIONS

This study found notable level of overweight and obesity among the women of Bangladesh. Various socio-economic factors like wealth status, education levels of women and partners, urban settings, women watching television predominantly contributed to the inequality in overweight and obesity among women of reproductive age. Therefore, the study suggests adopting necessary interventions targeting the women of higher socio-economic status to reduce the risk of life-threatening problems caused by overweight and obesity.

Change in nutritional status among women of childbearing age in India (1998-2016)

Introduction

In absolute numbers, India has more undernourished people than all the countries in sub‐Saharan Africa combined. In parallel with the high rates of hunger and undernutrition, the country has been undergoing rapid demographic and dietary transition marked by an increased prevalence of overweight/obesity, particularly among women.

Objective

To measure the changing prevalence of overnutrition during last two decades, as well as to identify the associated sociodemographic correlates among pregnant and non‐pregnant women in India.

Methods

This was a cross‐sectional study based on data from the latest round of National Family Health Survey (2015–2016) conducted among urban and rural women. Participants were 687,876 women (655,850 non‐pregnant and 32,026 pregnant) aged between 15 and 49 years. Nutritional status was assessed in terms of body mass index (BMI) using the cut‐off for Asian population.

Results

Since 1998–1999, the prevalence of underweight has decreased by 9.2%, while that of overweight (BMI = 23–27.4 kg/m²) and obesity (BMI ≥ 27.5 kg/m²) has increased by 6.7% and 3.4%, respectively. Results of multivariable regression analysis revealed significant association between nutritional status and age, parity residency, educational level, religious affiliation, household wealth quintile, and TV watching behaviour. Of those, age and wealth status appeared to be the strongest predictors among both pregnant and non‐pregnant women.

Conclusion

Since 1998, there has been a considerable drop in the prevalence of underweight and rise in the prevalence of overweight and obesity. Significant sociodemographic variations exist in nutritional status, notably age and financial situation, which should be highlighted in national nutrition policymaking and intervention programmes.

SMS-based family planning communication and its association with modern contraception and maternal healthcare use in selected low-middle-income countries

BACKGROUND

The objectives of this study were to 1) measure the percentage of women who received SMS-based family planning communication, and 2) its association with modern contraception and maternal healthcare services among mothers. In recent years, there has been a growing interest surrounding mobile phone-based health communication and service delivery methods especially in the areas of family planning and reproductive health. However, little is known regarding the role of SMS-based family planning communication on the utilisation of modern contraception and maternal healthcare services in low-resource settings.

METHODS

Cross-sectional data on 94,675 mothers (15-49 years) were collected from the latest Demographic and Health Surveys in 14 low-and-middle-income countries. The outcome variables were self-reported use of modern contraception and basic maternal healthcare services (timely and adequate use of antenatal care, and of facility delivery services). Data were analysed using multivariate regression and random effect meta-analyses.

RESULTS

The coverage of SMS-based family planning communication for the pooled sample was 5.4% (95%CI = 3.71, 7.21), and was slightly higher in Africa (6.04, 95%CI = 3.38, 8.70) compared with Asia (5.23, 95%CI = 1.60, 8.86). Among the countries from sub-Saharan Africa, Malawi (11.92, 95%CI = 11.17, 12.70) had the highest percent of receiving SMS while Senegal (1.24, 95%CI = 1.00, 1.53) had the lowest. In the multivariate analysis, SMS communication shown significant association with the use of facility delivery only (2.22 (95%CI = 1.95, 2.83). The strength of the association was highest for Senegal (OR = 4.70, 95%CI = 1.14, 7.33) and lowest for Burundi (OR = 1.5; 95%CI = 1.01, 2.74). Meta analyses revealed moderate heterogeneity both in the prevalence and the association between SMS communication and the utilisation of facility delivery.

CONCLUSION

Although positively associated with using facility delivery services, receiving SMS on family planning does not appear to affect modern contraceptive use and other components of maternal healthcare services such as timely and adequate utilisation of antenatal care.

Trends and determinants of underweight and overweight/obesity among urban Ethiopian women from 2000 to 2016

BACKGROUND

Nutritional, epidemiological and demographic transitions have been associated with the emergence of the double burden of malnutrition globally. In Ethiopia, there has been no nationally representative investigation of trends and determinants of both underweight and overweight/obesity among urban women. This study examined the trends and determinants of underweight and overweight/obesity in urban Ethiopian women from 2000 to 2016.

METHODS

Trends in the prevalence of underweight and overweight/obesity were investigated based on a series of the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n = 2559), 2005 (n = 1112), 2011 (n = 3569), and 2016 (n = 3106). Multivariable multinomial logistic regression was used to investigate the association between socioeconomic, demographic, behavioural, and community-level factors with underweight and overweight/obesity.

RESULTS

The prevalence of underweight in urban Ethiopian women reduced significantly from 23.2% (95% confidence interval [CI]: 20.3, 26.3%) in 2000 to 14.8% (95% CI: 13.1, 16.7%) in 2016, while overweight/obesity increased significantly from 10.9% (95% CI: 9.1, 13.0%) in 2000 to 21.4% (95% CI: 18.2, 25.1%) in 2016. Urban women from rich households and those who had never married were less likely to be underweight. Urban women who were from wealthy households and those who attained at least secondary education were more likely to be overweight/obese. Women who were informally employed and listened to the radio were less likely to be overweight/obese compared to those who were unemployed and did not listen to the radio, respectively.

CONCLUSION

The prevalence of overweight/obesity increased from 2000 to 2016, with a concurrent reduction in the prevalence of underweight. Interventions aiming to reduce overweight and obesity should target urban women with higher education, those who resided in wealthier households and those who watched the television.

Factors associated with underweight, overweight, and obesity in reproductive age Tanzanian women

BACKGROUND

Underweight, overweight, and obesity are major public health challenges among reproductive-age women of lower- and middle-income countries (including Tanzania). In those settings, obesogenic factors (attributes that promote excessive body weight gain) are increasing in the context of an existing high burden of undernutrition. The present study investigated factors associated with underweight, overweight, and obesity among reproductive age women in Tanzania.

METHODS

This study used 2015-16 Tanzania Demographic and Health Survey data (n = 11735). To account for the hierarchical nature of the data (i.e., reproductive age women nested within clusters), multilevel multinomial logistic regression models were used to investigate the association between individual-level (socioeconomic, demographic and behavioural) and community-level factors with underweight, overweight, and obesity.

RESULTS

Reproductive age women who were informally employed (relative risk ratio [RRR] = 0.79; 95% confidence interval [CI]: 0.64, 0.96), those who were currently married (RRR = 0.59; 95% CI: 0.43, 0.82) and those who used contraceptives (RRR = 0.70; 95% CI: 0.54, 0.90) were less likely to be underweight. Reproductive age women who attained secondary or higher education (RRR = 1.48; 95% CI: 1.11, 1.96), those who resided in wealthier households (RRR = 2.31; 95% CI: 1.78, 3.03) and those who watched the television (RRR = 1.26; 95% CI: 1.06, 1.50) were more likely to be overweight. The risk of experiencing obesity was higher among reproductive age women who attained secondary or higher education (RRR = 1.79; 95% CI: 1.23, 2.61), those who were formally employed (RRR = 1.50; 95% CI: 1.14, 1.98), those who resided in wealthier households (RRR = 4.77; 95% CI: 3.03, 7.50), those who used alcohol (RRR = 1.43; 95% CI: 1.12, 1.82) and/or watched the television (RRR = 1.70; 95% CI: 1.35, 2.13).

CONCLUSION

Our study suggests that relevant government jurisdictions need to identify, promote, and implement evidence-based interventions that can simultaneously address underweight and overweight/obesity among reproductive age women in Tanzania.

A multilevel analysis of overweight and obesity among non-pregnant women of reproductive age in Malawi: evidence from the 2015-16 Malawi Demographic and Health Survey

BACKGROUND

Overweight and obesity are well-known risk factors for non-communicable diseases such as cardiovascular disease, diabetes, some cancers and musculoskeletal disorders. In Malawi, the proportion of women who are overweight/obese has doubled, from 10% in 1992 to 21% in 2015-16. Therefore we aimed to explore the individual- and community-level factors associated with overweight and obesity among non-pregnant women of child-bearing age.

METHODS

Secondary analysis of the 2015-16 Malawi Demographic and Health Survey was conducted. Overweight was defined as a body mass index (BMI) of 25 to <30 kg/m2, while obesity was defined as a BMI ≥30 kg/m2. Two-level multilevel multivariable logistic regression models were constructed using a logit-link function with a binomial distribution on 7326 women living in 850 different communities.

RESULTS

At the individual level, the adjusted multilevel regression results showed that women 15-19 y of age as well as women from the poorest households had reduced odds of being overweight/obese. However, women with white collar jobs and women who were affiliated with the Church of Central Africa Presbyterian and the Roman Catholic church had increased odds of being overweight/obese. At the community level, women from urban areas and women who resided in communities with a low percentage of media exposure had increased odds of being overweight or obese. While women from poor communities had reduced odds of being overweight and obese, the proportion change in variance showed that 56, 77 and 78% of total variations in the odds of overweight, obese and overweight/obese across the communities were explained by both individual- and community-level factors. The median odds ratio showed that the likelihood of maternal overweight, obese and overweight/obese increased by 63, 39 and 84% when the women moved from low- to high-risk neighbourhoods.

CONCLUSIONS

Older women, Christian women, women with white collar jobs and women from the richest households should be targeted during policy formulation. At the community level, media coverage should be spread evenly so that health awareness messages, consequences and means of overweight and obesity prevention are getting to the targeted women. Our study revealed evidence of clustering effects of overweight and obesity at the community level, hence neighbourhood variations with respect to maternal overweight and obesity should be taken into account when designing nutritional policies.

Association between body mass index and ready-to-eat food consumption among sedentary staff in Nay Pyi Taw union territory, Myanmar

BACKGROUND

Ready-to-eat (RTE) food consumption has become popular in the working community with the increase in full-time jobs and the limited time to prepare food. Although RTE food is essential for this community, its consumption causes obesity. In Myanmar, obesity is a modifiable risk factor for non-communicable diseases, causing increases in morbidity and mortality. This study aimed to identify the association between body mass index (BMI) and RTE food consumption among sedentary staff in Nay Pyi Taw Union Territory, Myanmar.

METHODS

A cross-sectional study was conducted in 2018, in which 400 respondents participated in face-to-face interviews. The study area was selected using simple random sampling and drawing method. Measuring tape and digital weighing scale were used to measure the height and weight of the respondents. BMI was calculated by dividing the weight by height squared (kg/m2). Overweight and obesity were categorized by World Health Organization cut-off points. The collected data were analyzed using multiple logistic regression to estimate the adjusted odds ratio (AOR), and the 95% confidence interval (CI).

RESULTS

This study revealed that sedentary staff who consumed RTE food once or more per month were nearly five times more likely to be overweight and obese (AOR = 4.78, 95% CI 1.44-15.85) than those who consumed RTE food less frequently. In addition, five factors namely being older than 32 years (AOR = 3.97, 95% CI 1.82-8.69), preference for RTE food (AOR = 8.93, 95% CI 2.54-31.37), light-intensity of physical exercise (AOR = 3.55, 95% CI 1.63-7.73), sedentary leisure activities (AOR = 3.32, 95% CI 1.22-9.03), and smoking (AOR = 5.62, 95% CI 1.06-29.90) were positively associated with overweight and obesity.

CONCLUSION

Frequent consumers of RTE food and less physically active sedentary staff were more likely to be overweight and obese. This study highlights the urgent need to raise awareness regarding healthy lifestyle behaviors among the working community to reduce the burden of obesity-related chronic diseases. Moreover, sedentary workers should be aware of the food-based dietary guidelines of the country. Policy makers should strictly enforce nutritional labeling of RTE food, and strictly prohibit over-branding of RTE food.

Association between the frequency of television watching and overweight and obesity among women of reproductive age in Nepal: Analysis of data from the Nepal Demographic and Health Survey 2016

Background

The prevalence of overweight and obesity, particularly among women, is increasing in Nepal. Previous studies in the South Asia have found television watching to be a risk factor for overweight and obesity among women of reproductive age. However, this association had not been studied in the context of Nepal. This study aims to identify the association between frequency of television watching and overweight and obesity among Nepalese women of reproductive age.

Methods

This cross-sectional study utilized the Nepal Demographic and Health Survey 2016 (NDHS 2016) data. A total weighted sample of 6,031 women were included in the final analyses. The women were 15–49 years of age and were either not pregnant or had not delivered a child within the two months prior to the survey. Body mass index (BMI) was the primary outcome of this study, which was categorized using an Asia-specific cutoff value. Normal and/or underweight was defined as a BMI <23.0 kg/m², overweight was defined as a BMI between 23.0 kg/m² and <27.5 kg/m², and obesity was defined as a BMI ≥27.5 kg/m². Frequency of watching television was the main independent variable of this study, which was divided into the following three categories: not watching television at all, watching television less than once a week, and watching television at least once a week. Multilevel ordered logistic regression was conducted to find the factors associated with overweight and obesity. A p-value <0.05 was considered significant in the final model.

Results

Around 35% of the participants were overweight or obese (overweight: 23.7% and obese: 11.6%). A majority of the study participants was aged between 15 and 24 years (36.5%), and resided in an urban area (63.2%), Province No. 3 (22.3%), and the Terai ecological region (49.5%). Around one-third (34.0%) of the participants received no formal education while an almost similar proportion (35.5%) completed secondary education. Approximately half of the study participants (50.6%) reported watching television at least once a week, whereas more than a quarter (28.7%) of them did not watch television at all. Women who watched television at least once a day had a higher prevalence of overweight and obesity than the other groups (p-value <0.0001). Women who watched television at least once a week were 1.3 times more likely to be overweight or obese in comparison to women who never watched television (Adjusted Odds Ratio (AOR): 1.3, 95% CI: 1.0–1.7; p-value <0.05). In the urban areas, women who watched television at least once a week were 40% more likely to be overweight or obese than those who did not watch television at all (AOR: 1.4, 95% CI: 1.1–1.7; p-value <0.01). No significant association between overweight and obesity and the frequency of viewing television was observed in the rural area.

Conclusions

Watching television at least once a week is associated with overweight and obesity in women of reproductive age living in the urban areas of Nepal. Public health promotion programs should raise awareness among women regarding harmful health consequences of sedentary lifestyle due to television watching.

Does the Frequency of Watching Television Matters on Overweight and Obesity among Reproductive Age Women in Ethiopia?

BACKGROUND

Studies in developed countries have revealed an association of different magnitudes between watching television and the risk of being overweight and obese among reproductive age women. Even so, there is no evidence of such an association in the context of the Ethiopian population. Hence, the study aimed to assess the association between watching television with overweight and obesity in a nationally representative sample of Ethiopian women.

METHODS

A cross-sectional study was conducted by using secondary data analysis from 2016 Ethiopia demographic and health survey among women aged from 15 to 49 years. The samples were selected using a two-stage stratified cluster sampling technique. A total of 10,074 women were included in the analysis. The outcome variables were both overweight and obesity, whereas the main exposure variable was the frequency of watching television. Multivariate logistic regression analysis was performed for adjusting potential confounders. Adjusted odds ratio (AOR) with 95% confidence intervals was used to declare a statistically significant association.

RESULTS

The study found that watching television at least once a week was significantly associated with both overweight (AOR: 1.79; 95% CI: 1.20-2.73) and obesity (AOR: 3.76; 95% CI: 2.04-6.95). The study also divulged that the odds of overweight were higher among women aged 25-39 years (AOR: 2.17; 95% CI: 1.25-3.77) and 40-49 years (AOR: 2.69; 95% CI: 1.45-5.00), urban residents (AOR: 1.76; 95% CI:1.17-2.65), attended higher education (AOR:2.11; 95% CI: 1.22-3.65), and richest in the wealth index (AOR: 2.83; 95% CI:1.71-4.68). Similarly, the odds of obesity were higher among women aged 25-39 years and 40-49 years, attended higher education, and the richest in wealth index.

CONCLUSIONS

The results from this study demonstrated that watching television at least once a week is associated with obesity among reproductive age women in Ethiopia. Therefore, a social behavioral change communication campaign needs to be taken to improve awareness regarding the harmful consequences of watching television for long hours. Further research studies should be conducted among men and adolescents to determine whether this positive association exists among that target population as well.

Physical activity and sedentary behaviour in Bangladesh: a systematic scoping review

OBJECTIVES

Lack of physical activity (PA) contributes to increasing prevalence of non-communicable diseases (NCDs) globally. However, little is known about PA and sedentary behaviour (SB) among populations in low- and middle-income countries (LMICs). This systematic review examined prevalence of PA and SB in Bangladesh.

STUDY DESIGN

Systematic review of the literature.

METHODS

A systematic electronic search in eight databases and a manual search of retrieved articles' references were conducted. Original research conducted in Bangladesh with PA- and/or SB-related outcome(s) were included.

RESULTS

Out of 1,162 retrieved titles, 33 articles (32 cross-sectional and one case-control study) met the inclusion criteria. Twenty-nine studies were with healthy populations: adults (n = 19); children and adolescents (n = 7); and children, adolescents and adults (n = 3). Five studies used nationally representative samples of adults and one of adolescents. Most studies (n = 26) assessed PA only; three only SB, and four both PA and SB. All studies used self-reported measures. Among healthy adults, prevalence of insufficient PA ranged from 5% to 83%. Occupational and transport-related PA contributed the most towards total PA with negligible contribution of recreational PA. Among children and adolescents, the prevalence of insufficient PA ranged between 20% and 67%. Females engaged in less PA compared to males. Limited evidence currently exists about the prevalence of SB, especially among adults.

CONCLUSIONS

PA and SB research has received little attention in Bangladesh. Critical knowledge gaps identified in this review should be taken into account when designing new research and programmes in Bangladesh and other LMICs with similar socio-economic and cultural settings.

Association of frequency of television watching with overweight and obesity among women of reproductive age in India: Evidence from a nationally representative study

Background

For women of reproductive age, overweight and obesity are an established risk factor for several medical complications. To address the increasing rate of obesity in India through public health awareness programs, the association between common behaviors and overweight and obesity needs to be investigated. This study aims to determine whether there is any association between the frequency of television watching and overweight and obesity among women of reproductive age (15–49 years) in India.

Methods

This is a cross-sectional study that utilized data from the National Family Health Survey (NFHS-4), which utilized a nationally representative sample from all 29 states and 7 union territories of India. The survey itself followed a two-staged stratified random sampling technique. The primary outcome of interest was overweight (23.0 kg/m² to <27.5 kg/m²) and obesity (≥27.5 kg/m²), measured by using the Asian body mass index cut-off. The major explanatory variable was the frequency of television watching, measured in days per week. Sample weight of NFHS-4 was adjusted during the analysis. Multilevel ordered logistic regression was conducted to identify the factors associated with overweight and obesity. To show the strength of association, both the unadjusted Crude Odds Ratio (COR) and the Adjusted Odds Ratio (AOR) were reported with a 95% confidence interval (CI). A p-value<0.05 was considered statistically significant.

Results

The analysis included weighted data from 644,006 Indian women of reproductive age (15–49 years). Among the respondents, 33.5% were overweight or obese (BMI ≥23.0 kg/m²). The prevalence of overweight and obesity increased with age (p-value <0.0001) and almost half of the women aged 35–49 years were either overweight or obese (48.6%). The prevalence was significantly higher among those living in an urban area compared to a rural area (urban 46.5% vs. rural 26.5%; p-value <0.001). The prevalence of overweight and obesity increased with the frequency of watching television and was the highest among the individuals who reported watching television almost every day (p-value <0.0001). Women watching television almost every day had 24% (AOR: 1.24, 95% CI: 1.21–1.26; p-value <0.001) increased odds of being overweight and obese compared to their counterparts who never watched television.

Conclusions

This study found that the likelihood of being overweight and obese significantly increased with the frequency of watching television; likely due to physical inactivity during leisure time. Further studies should examine the physical activity and food habits of this target group. Public health promotion programs in India should raise awareness regarding the harmful effects of the sedentary lifestyle associated with watching television.

Increase in Obesity Among Women of Reproductive Age in Zambia, 2002-2014

Objective: To describe trends in obesity in Zambian women of reproductive age and to identify factors that may have contributed to changes in trends and nutrition outcomes. Materials and Methods: We obtained data on body mass index and individual factors of women from the Zambia Demographic and Health Survey for the period 2002 to 2014. From these data, we calculated descriptive statistics and examined the extent to which factors link to the odds of obesity over time. We also reviewed primary and secondary data sources, such as government documents, theses, and search engines to identify factors that may have contributed to trends and changes in nutrition outcomes. Results: The proportion of obesity doubled from 2002 (12.5%) to 2014 (22.3%). The odds were higher among educated, currently married and wealthy women, and it increased with age. Rural residence and working in agricultural-related jobs were linked to lower odds for obesity. This disparity varies by province. In addition, despite the presence of many nutrition policies and strategies, the increase in obesity occurred within the past two decades when urbanization and other factors (e.g., sedentary work, a proliferation of fast food restaurants, and advertisements) may have affected changes in nutrition outcomes for women. Conclusions: We identified increasing trends in obesity in women of reproductive age over time. The rapid urbanization and other factors that occurred in Zambia during this period are significant risk factors for obesity in Zambian women. The findings will be of interest to countries that are undergoing a nutrition transition.

Trend in overweight and obesity among women of reproductive age in Uganda: 1995-2016

Countries in Sub-Saharan Africa (SSA) are experiencing rising burdens of overweight/obesity and associated non-communicable diseases. As in other developing regions, this epidemiological transition in African countries is believed to be resulting from changes in dietary, sociodemographic structure and lifestyle factors. To date, not much is known about the prevalence and sociodemographic patterns of overweight/obesity in Uganda, especially among women of reproductive age. Therefore, this study aimed to address this research gap by using nationally representative data on women of this age group in Uganda.

METHODS

This study involved analysis of cross-sectional data on 19,395 women aged between 15 and 49 years from Uganda Demographic and Health Survey for the years 1995-2016. Overweight/obesity was measured using body mass index as per World Health Organization guidelines, and logistic regression methods were used to identify the sociodemographic predictors.

RESULTS

There has a been significant rise in the prevalence of overweight (9.77% in 1995 vs. 16.21% in 2016) and obesity (1.99% in 1995 vs. 6.21% in 2016) since the first survey in 1995, with the most noticeable increase occurring in the central region that accounted for a combined prevalence of 17.22% in 1995 compared with 37. 21% in 2016. Multivariate analysis showed an increased likelihood of having overweight/obesity among women who live in the urban areas, have primary and above primary education, from non-poor households and users of radio and TV.

CONCLUSION

During the last two decades, there has been a slow but steady rise in the prevalence of overweight and obesity among women of reproductive age in Uganda. The present findings highlight the need for an enhanced attention on growing overweight/obesity within the broader goal improving maternal and child health in the country.

Subjective health and quality of life among elderly people living with chronic multimorbidity and difficulty in activities of daily living in rural South Africa

Background: South Africa has been experiencing a growing proportion of elderly population with rapid increases in the burden of non-communicable diseases (NCDs) characteristic of population aging. Rural areas in South Africa represent a far smaller fraction of the population, however, share a relatively higher burden of NCDs. In the current literature, there is limited evidence on rural studies in the context of chronic diseases and activities of daily living (ADLs) among the elderly population (60 years and above) in South Africa.

Purpose: In this regard, we undertook the present study with the objective of examining the demographic, behavioral, and socioeconomic predictors of subjective health, depression, and quality of life among elderly men and women living in the rural areas (n=2,627).

Methods: Data for this study were collected from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). Main explanatory variables were self-reported NCDs and difficulties in ADLs. The predictors of subjective health, depression, and quality of life were assessed using multivariable regression methods.

Results: We found that the proportion of participants who reported good health, not having depression, and good quality of life was respectively 44.7%, 81.3%, and 63%. Women in the oldest age group (80+ years) were significantly less likely to report good health (OR=0.577, 95% CI=0.420, 0.793) and quality of life (OR=0.709, 95% CI=0.539, 0.933) compared with those in the youngest group. Having more than one chronic condition and ADL difficulties significantly lowered the odds of good health, having no depression, and quality of life among men and women.

Conclusion: The present findings suggest the involvement of sociodemographic factors in health and quality of life outcomes among elderly South Africans, and call for enhanced efforts to address these health limiting conditions such as ADLs and chronic multimorbidity.

Alcohol and Tobacco Use among Men in Zambia and Zimbabwe

Background

To date, there is no country-representative study on tobacco and alcohol use in Zambia and Zimbabwe despite the fact that these two countries rank among the top producers of tobacco worldwide. To fill this research gap, we conducted this study to measure the prevalence of tobacco and alcohol consumption among adolescent and adult men in Zambia and Zimbabwe. Special attention was given to the age differential in the prevalence of smoking and drinking.

Methods

Country-representative data on alcohol and tobacco use along with relevant sociodemographic parameters were collected from Demographic and Health Surveys. Sample population were 23,169 men (14,773 from Zambia and 8,396 from Zimbabwe) aged 15-54 years. Data were analysed using multivariate regression techniques.

Results

Prevalence of tobacco use was 19.9% (19.0-20.9) in Zambia and 18.4% (17.4-19.5) in Zimbabwe, and that of alcohol was 37.6% (36.4-38.9) in Zambia and 50.5 (48.9-52.1) in Zimbabwe. In both of the countries, the majority of the tobacco and alcohol users were aged between 24-39 years. Results of multivariate regression analysis showed a significant positive association between tobacco and alcohol use with age, place of residence, religious affiliation, marital status, education and wealth quintile.

Conclusion

Nearly one-fifth of all men in the age group of 15-54 years smoke tobacco in Zambia and Zimbabwe, with the prevalence being most pronounced among those aged between 25-39 years. The predominantly young age structure of alcohol and tobacco users warrant demographically tailored anti-tobacco and alcohol controlling programmes.

Trends in the prevalence and care-seeking behaviour for acute respiratory infections among Ugandan infants

Background

Acute Respiratory Infections (ARIs) as a group of diseases/symptoms constitute a leading cause of pediatric morbidity and mortality in sub-Saharan Africa where over 10 % of all children die before reaching their fifth birthday. Although the burden of ARIs is highest in the African countries, there is little evidence in the current literature regarding their prevalence and treatment seeking. The objective of this study was therefore to assess the secular trend in the prevalence of ARIs as well as their treatment seeking-behaviour among Ugandan infants.

Methods

This cross-sectional study was based on data from Uganda Demographic and Health Surveys (conducted between 1995 and 2016) on 26,974 singleton infants aged 0–5 months. Mothers (aged 15–49 years) were interviewed to collect information on the prevalence of recent occurrences of fever, cough and dyspnea. The adjusted trend in the prevalence and predictors of ARIs and care seeking were measured by multivariate regression methods.

Results

In 2016, the prevalence of fever, cough and dyspnea was respectively 36.23, 42.55 and 19.27%. The prevalence of all three symptoms has been declining steadily since 1995, and the percentage of children receiving treatment for fever/cough has also more than doubled during the same time. In multivariable analysis, several sociodemographic factors emerged as significant predictors of ARIs including child’s age and high birth order, mother’s age, educational level, occupation, intendedness status of the child, BMI, household wealth status, and place of residency.

Conclusions

The overall prevalence common ARIs (fever, cough, dyspnea) has been declining at a slow but steady rate, however, remains noticeably high in comparison with countries with similar level of per capita GDP in Africa. Findings of this study has important implications for health policy making regarding the prevention of ARIs among infants in the country.

Frequency of television viewing and association with overweight and obesity among women of the reproductive age group in Myanmar: results from a nationwide cross-sectional survey

OBJECTIVES

This study aimed to discern the association between the frequency of television viewing and overweight and obesity among reproductive age women of Myanmar.

DESIGN

This was a cross-sectional study.

SETTING

This study used Myanmar Demographic and Health Survey (2015-2016) data.

PARTICIPANTS

Total of 12 021 women both aged 15-49 years and also not pregnant or did not deliver a child within the 2 months prior to the survey were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was overweight (23.0 kg/m² to <27.5 kg/m²) and obesity (≥27.5 kg/m²), which was measured using the Asian body mass index cut-off. Ordered logistic regression analysis was conducted to find the association between the explanatory and outcome variables. The potential confounders controlled in the multivariable analyses were age, place of residence, region of residence, highest educational status, current employment status, wealth index, parity and number of household members.

RESULTS

The prevalence of overweight was 26.5% and obesity was 12.2% among the study participants. The odds of being overweight and obese were 20% higher (adjusted OR (AOR) 1.16, 95% CI 1.02 to 1.32; p=0.023) among those who watched television at least once a week compared with those who did not watch television at all. Rural women who watched television at least once a week were 1.2 times more likely to be obese (AOR 1.16, 95% CI 1.01 to 1.34; p=0.040) compared with those who did not watch television at all.

CONCLUSIONS

Frequent television watching was associated with obesity among rural women of reproductive age in Myanmar.

Subjective Happiness, Health and Quality of Life and Their Sociocultural Correlates among Younger Population in Malawi

Public health research and policy in sub-Saharan Africa are generally disease-oriented, with the focus being largely confined within the biological determinants of health. So far, little attention has been given to developing a more health-oriented approach by emphasising the psychosocial dimensions of health, especially among the younger population. To this regard, we conducted the present study to assess the prevalence and sociocultural correlates of perceived happiness, health, and life satisfaction among the adolescent and young (15–24 years) population in Malawi. We analysed cross-sectional data on 12,610 men and women based on a Malawi multiple indicator cluster survey conducted in 2013–2014. Data were analysed using descriptive and multivariable regression methods. According to the findings, more than 80% of the men and women reported being satisfied about happiness, health, and life. Multivariate analysis showed an inverse relationship between being currently or formerly married and perceived happiness. Ethnic disparities in perceived health and happiness were more pronounced in men, whereas that of life satisfaction was more pronounced in women. Living in households of the highest wealth quintile was positively associated with health and life satisfaction, but not with happiness. These findings highlight the need for prioritising the psychosocial needs of the adolescent and youth populations in designing health and social policy in Malawi. The findings need to be interpreted in light of the factors specific to the sociocultural environment in Malawi.

Prevalence of Overweight and Obesity in Bangladesh: a Systematic Review of the Literature

PURPOSE OF REVIEW

The increasing prevalence of overweight/obesity is a leading public health concern in high-, middle-, and low-income countries. Our study aimed to present published data on the prevalence of overweight and obesity in Bangladeshi children, adolescents, and adults. In this systemic literature review, electronic search engines of PubMed, Google Scholar, Scopus, and the Bangladesh Journals Online were used to find relevant articles published between 2007 and 2017 based on predefined inclusion/exclusion principles. This study included 14 studies on the topic which were available in full text and met the inclusion criteria.

RECENT FINDINGS

The outcomes from the included study indicated an increasing trend in overweight and obesity among Bangladeshi children, adolescents, and adults over time. The prevalence of overweight and obesity is much higher in girls than in boys among children and adolescents, and also prevalence rates are higher in females than in males in the adults. Prevalence rates of overweight and obesity are also higher in urban peoples compared to rural peoples living in Bangladesh. Globally, overweight/obesity is considered the risk of the increasing various chronic diseases like diabetes, hypertension, and cardiovascular diseases. So we need to ennoble our healthy lifestyle to efficiently address the increasing comorbidities of overweight and obesity.

Media use and excess body weight among women in Nigeria: a cross-sectional study

OBJECTIVES

To investigate the (1) time trends in body mass index (BMI) and (2) relationship between media use and body weight status among adult women in Nigeria. We hypothesise that higher frequency of media use is associated with higher likelihood of being overweight and obesity among adult women.

STUDY DESIGN

Cross-sectional.

SETTING

Urban and rural settings in Nigeria.

PARTICIPANTS

Adult non-pregnant women aged between 15 and 49 years.

METHODS

Data were derived from Nigeria Demographic and Health Surveys conducted in 2003, 2008 and 2013. The outcome variable was excess body weight (overweight and obesity), and main explanatory variables were frequency of reading newspaper, listening to radio and television (TV) viewing. Datasets were merged to perform pooled analysis, and were analysed using bivariate and multivariable regression techniques.

RESULTS

Of the 69 401 participants, 16.2% had a BMI of 25.0-29.9 kg/m² (95% CI 15.8 to 16.6) and 6.6% had >30 kg/m² (95% CI 6.3 to 6.9). Between 2003 and 2013, the prevalence of overweight women increased by 4.1%, and that of obesity by 2.2%. Overall, radio was the most popular media followed by TV and newspaper. Respectively, 15.6% and 11.7% of the women reported using radio and TV almost every day and 30.6% and 25.1% at least once a week. In multivariable analysis, watching TV almost every day and at least once a week were associated with, respectively, 1.6 and 1.2 times higher odds of being overweight, and 2.7 and 1.5 times higher odds of being obese compared with those who never used radio. Similarly, significant associations were observed for newspaper and radio use as well.

CONCLUSION

The prevalence of overweight and obesity is noticeably high among Nigerian women and has been increasing steadily over the past decade. A statistically significant association exists between BMI and the use of newspaper, radio and TV. Further studies are required to develop a better understanding of the mechanisms that underlie this relationship.

Mass media exposure and its impact on malaria prevention behaviour among adult women in sub-Saharan Africa: results from malaria indicator surveys

BACKGROUND

Mass media exposure plays a pivotal role in health communication and adoption of a healthy lifestyle. In this study, we aimed to measure the prevalence of malaria prevention behaviour among adult women in eight malaria-endemic countries in sub-Saharan Africa (SSA), and assess the influence of mass media exposure in the adoption of those behaviours.

METHODS

For this study, we collected cross-sectional data on 46,822 women aged between 15 and 49 years from the Malaria Indicator Surveys (MIS) conducted in Burkina Faso, Ghana, Mali, Malawi, Kenya, Nigeria, Sierra Leone and Uganda. As the outcome variable, malaria prevention behaviour was proxied by the use of insecticide treated nets (ITNs) and uptake of antimalarial drugs in last pregnancy.

RESULTS

The overall prevalence of sleeping under ITN and that of taking antimalarial drug during the last pregnancy was respectively 67.9% (95%CI = 66.6-69.2) and 72.8% (95%CI = 71.3-74.2). However, there were disparities in the prevalence of using ITN and antimalarial drug use across the study countries. In the multivariable regression analysis, not receiving malaria related information from radio, poster/billboards, community events, and health workers were found to be significantly associated with reduction in the odds of using ITN the previous night. For the use of antimalarial drugs during last pregnancy, the odds were 23% [OR = 0.773, 95%CI = 0.625-0.956] lower for those who did not receive malaria information on radio compared with those who received.

CONCLUSIONS

These findings indicate a potentially important role of malaria information received through mass media on utilisation of ITN among women in SSA. More research is needed to explore the factors that limit the accessibility to malaria information through mass media.

Prevalence of Smoking among Men in Ethiopia and Kenya: A Cross-Sectional Study

While tobacco use remains the largest single cause of premature death in the industrialized countries, low-and-middle income countries are also experiencing a rising burden of the tobacco epidemic and are making various programmatic efforts to tackle the issue. Evidence-based policy making is critical to the long-term success of tobacco intervention programs and is reliant on regular monitoring of the trends and prevalence rates of tobacco use though population-based surveys, which are sparse for countries in eastern Africa. Therefore, in the present study we aimed to (1) estimate the trends in the prevalence of self-reported smoking status; and (2) explore the sociodemographic factors associated with smoking among adult men in Ethiopia and Kenya. Methods: Subjects were 26,919 adult men aged between 15 and 59 years from Ethiopia and Kenya. Nationally representative cross-sectional data on self-reported smoking and relevant sociodemographic indicators were collected from the Demographic and Health Surveys (DHS) conducted in these two countries. Data analysis was performed by descriptive, bivariate, and multivariable methods. Results: In Ethiopia, the prevalence rate of smoking increased from 8.5% in 2005 to 11.7% in 2011. While in Kenya, the rate declined albeit slowly from 22.9% in 2003 to 18.8% in 2008–2009 and 17% in 2014. The prevalence was significantly different in urban and rural areas. In majority of the surveys, prevalence of smoking was highest in the age group of 25–34 years. The prevalence of smoking varied widely across several socioeconomic characteristics. Conclusions: The findings indicate a high rate of smoking among men especially in urban areas, and call for policy actions to address the socioeconomic factors as a part of the policy to strengthen tobacco-control efforts.

Improving Water, Sanitation and Hygiene Practices, and Housing Quality to Prevent Diarrhea among Under-Five Children in Nigeria

Sub-Saharan Africa as a region accounts for the bulk of the global under-five mortality rate, to which diarrhea is major contributor. Millions of children die from diarrheal diseases each year and those who survive often do so facing suboptimal growth. Preventing the common pathways of transmission for diarrhea-causing pathogens, including improved water, sanitation, and hygiene (WASH) are regarded as the most cost-effective measures for tackling this life-threatening disease. This study aimed to quantitatively assess the quality of living arrangement and access to WASH, and their impact on diarrheal outcomes among under-five children in Nigeria. Methods: Data were collected from the 2013 Nigeria Demographic and Health survey (NDHS). Study participants included 28,596 mother-child pairs. Household construction material for wall, floor, and ceiling, access to electricity, and improved water and toilet, were included as the main explanatory variables. Data were analyzed using descriptive and multivariable regression methods. Results: The prevalence of diarrhea was 11.3% (95% CI = 10.2⁻12.6), with the rate being markedly higher in rural (67.3%) as compared to urban areas (32.7%). In the regression analysis, lacking access to improved toilet and water facilities were associated with 14% and 16% higher odds, respectively, of suffering from diarrhea as compared to those who had improved access. Conclusion: There is evidence of a weak, but statistically significant, relationship between the quality of living environment, including water and sanitation facilities, and diarrhea among under-five children in Nigeria. The study concludes that investing in living conditions and WASH may have potential benefits for child mortality prevention programs in the country.