Correlates of the double burden of malnutrition among women: an analysis of cross sectional survey data from sub-Saharan Africa

Multilevel factors associated with overweight and obesity in East Africa: Comparative analysis in five countries from 2003 to 2016

Rising rates of overweight/obesity in sub-Saharan Africa (SSA) are a growing concern. Regional analysis of sociodemographic factors associated with overweight/obesity, as is common, may mask nationally specific associations. We examine the spatiotemporal trends of overweight/obesity in women (15-49 years) using 13 years of data (2003-2016) from Demographic and Health Surveys in five East African countries. Multivariable logistic regression reveals that urbanization and individual education, wealth, employment, marital status, and age are linked to overweight/obesity in the region, but their influence varied between nations. Variations in sociodemographic risk factors across nations underscore the need for tailored surveillance and interventions to address the increasing burden of overweight/obesity in East Africa.

Socioeconomic determinants of the double burden of malnutrition among women of reproductive age in sub-Saharan Africa: A cross-sectional study

Background and Aim

The positioning of eliminating all forms of malnutrition within the spirit of the Sustainable Development Goals and the adoption of the United Nations resolution for a Decade of Action on Nutrition are a testament to strong global commitment to combat the double burden of malnutrition (DBM). Yet, there is a knowledge gap in sub-Saharan Africa (SSA) regarding the influence of socioeconomic status on DBM. We investigated the associative effect of socioeconomic status on DBM in SSA.

Methods

Data for the study were extracted from the most recent Demographic and Health Surveys (DHS) of 29 countries in SSA conducted from 2010 to 2020. Bivariate and multivariate logistic regression models were fitted to examine the association between socioeconomic status and DBM. The results were presented using adjusted odds ratio (aOR) and 95% confidence interval (CI).

Results

Children of obese mothers were less likely to be stunted compared to those born to mothers who were not overweight/obese [aOR = 0.70; 95% CI = 0.66-0.77]. The odds of stunting increased with wealth index, with children born to poorest mothers having the highest odds compared to those born to richest mother [aOR = 1.79; 95% CI = 1.64-1.95]. The odds of stunting among children was highest among those born to mothers with no formal education compared to those whose mothers had higher education [aOR = 2.73; 95% CI = 2.34-3.18].

Conclusion

DBM among children in SSA is predicted by maternal level of education, and wealth status. These results underscore the urgency of tailored interventions and policies that address DBM among women of reproductive age, with a particular focus on the socioeconomic disparities in SSA. To effectively combat this pressing public health issue, it is imperative to direct efforts towards empowering women to attain higher levels of education and to implement strategies that consider the specific needs of women across varying socioeconomic statuses.

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.

Understanding the national evidence on the double burden of malnutrition in Ethiopia for the implications of research gap identifications: a scoping review

BACKGROUND

Owing to the unavoidable consequences of nutritional transition, the double burden of malnutrition (DBM) is an emerging public health problem. An increasing number of studies have found that Ethiopians face a DBM. However, country-level evidence has not yet been summarised using a scoping review study design.

OBJECTIVE

The main objective of this review was to map the national evidence on DBM in Ethiopia for the implications of research gap identifications.

ELIGIBILITY CRITERIA

The population, concept and context approach was used. All age groups, box sexes, all dates of publication and articles in English language focused on DBM conducted in Ethiopia were included.

SOURCES OF EVIDENCE

Primary research articles, systematic reviews, meta-analyses and scoping reviews searched from electronic databases such as PubMed, ScienceDirect, Cochrane Library, Wiley Online Library, Google Scholar and Google were the sources of evidence.

CHARTING METHODS

The Joanna Briggs Institute Reviewer's manual was used as a review methodology. The authors, publication year, region, study design, sample size, population group, measured outcomes and main findings were charted in a table.

RESULTS

A total of 35 articles met the inclusion criteria among 124 426 participants. The average summarised prevalence of DBM was 33.6%, with the average proportions of undernutrition and overnutrition at 21.5% and 12.1%, respectively. The major factors that influenced the DBM were categorised as child, maternal, adolescent, household and adult-related factors.

CONCLUSION

In Ethiopia, the overall prevalence of DBM is high, which makes one-third of the population affected by DBM. The foremost determinant factors that influenced the DBM were characterised as child, maternal, adolescent, household and adult-related factors. Therefore, a double-duty interventions should be used to address DBM, considering multilevel factors at the individual, community and societal levels.

PROTOCOL REGISTRATION

This review was registered on the figshare website on 28 February 2021, with DOI number https://doi.org/10.6084/m9.figshare.14131874. The review protocol was published with a DOI number http://dx.doi.org/10.1136/bmjopen-2021-050805.

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.

Prevalence and factors associated with underweight among 15-49-year-old women in Sierra Leone: a secondary data analysis of Sierra Leone demographic health survey of 2019

BACKGROUND

Women are at higher risks of being underweight than men due to biological, socio-economic, and cultural factors. Underweight women have high risks of poor obstetric outcomes. We aimed to determine the prevalence and factors associated with being underweight among women of reproductive age (15-49 years) in Sierra Leone.

METHODS

We used Sierra Leone Demographic and Health Survey (2019-SLDHS) data of 7,514 women aged 15 to 49 years, excluding pregnant, post-natal, lactating, and post-menopausal women. A multistage stratified sampling approach was used to select study participants, and data was collected using validated questionnaires. A multivariable logistic regression analysis was used to determine factors associated with underweight among 15-49-year-old women in Sierra Leone. Ethical approval for the study was obtained.

RESULTS

The prevalence of underweight was 6.7% (502/7,514). Underweight was likely among age-group of 15-24 years, AOR = 2.50,95%CI:2.39-2.60;p < 0.001 compared to 25-34 year age-group and likely among women with parity of one to four, AOR = 1.48,95%CI:1.08-2.03;p = 0.015 compared to women who never gave birth. Underweight was unlikely among women who did not listen to radios AOR = 0.67,95%CI:0.55-0.83;p < 0.001 compared to those who did; women from the north AOR = 0.73,95%CI:0.56-0.96;p = 0.026 compared to the east, and not married women AOR = 0.59,95%CI:0.47-0.76;p < 0.001 compared to married. All household wealth indices were not significantly associated with underweight.

CONCLUSION

The prevalence of underweight among women in the reproductive age (15-49 years) in Sierra Leone was 6.7% and it is lower compared to global and most sub-Saharan African data. Factors associated with underweight were 15-24-year age-group, and parity of one to four. Being underweight was unlikely among women who did not listen to radios, women from the north and not married. All household wealth indices were not significantly associated with underweight. Even though household wealth indices were not significantly associated with being underweight, most underweight women 68.7% (345/502) were in the poorest, poorer, and middle household wealth indices. The need to address socio-economic determinants of underweight among women (aged 15-49 years) due to household poverty is a priority in Sierra Leone.

Prevalence of overweight and obesity and associated factors among people living with HIV attending a tertiary care clinic in Uganda

Background:

Overweight and obesity are significantly increasing among people living with HIV (PLWH), contributing to the risk of major adverse cardio-metabolic events. However, little is known on its prevalence among PLWH in sub-Saharan Africa. In this study, we report the prevalence and factors associated with overweight and obesity among PLWH in a large tertiary HIV clinic in Kampala, Uganda.

Methods:

A cross-sectional, retrospective review of electronic database of all PLWH that attended the Adult Infectious Diseases Institute clinic between November 2018 and April 2019 was conducted. Demographic, body mass index (BMI) [kg/m²] and clinical variables were extracted. Based on BMI, nutritional status was classified as undernutrition (< 18.5kg/m²), normal (≥ 18.5 < 25kg/m²), overweight (≥ 25 < 30kg/m²) and obesity (≥ 30kg/m²). Poisson regression analysis was performed to determine factors associated with overweight and obesity.

Results:

Overall, 7,818 participants were included in the analysis, 64% (n = 4,976) were female, with a median age of 44 years (interquartile range (IQR): 36–51) and a median BMI of 24.2 (IQR: 21.2–28.1). The prevalence of overweight and obesity combined was 46% (55% female versus 30% male), obesity 18.2% (24.6% female versus 7.1% male) and overweight 27.8% (30.4% female versus 22.9% male). Factors associated with overweight and obesity were: Females (adjusted prevalence ratio [aPR]: 1. 8, 95%CI:1.69–1.87), age category 25—59 years (aPR: 1.9, 95%CI: 1.63–2.24) and ≥ 60 years (aPR: 1.8, 95%CI:1.49–2.12); duration on antiretroviral therapy (ART) for 6—10 years (aPR: 1.1, 95%CI:1.08–1.18), CD4 count 200–500 (aPR:0.08, 95%CI:0.01–0.15) and > 500 (aPR:0.46, 95%CI:0.39–0.54) and having at least one noncommunicable disease (NCD) (aPR: 1.1, 95%CI:1.07–1.18).

Conclusion

There is a high burden of overweight and obesity among PLWH in Uganda. Nutrition and weight management programs particularly targeting high risk groups such as females and persons with underlying NCDs should be integrated into HIV care.

Country-Level Variations in Overweight and Obesity among Reproductive-Aged Women in Sub-Saharan Countries

Background: Overweight and obesity in adults are on the rise around the world, contributing significantly to noncommunicable disease deaths and disability. Women bear a disproportionate burden of obesity when compared with men, which has a negative impact on their health and the health of their children. The objective of this study was to examine the country-level prevalence of overweight and obesity among women of reproductive age in sub-Saharan countries. Methods: A total of 504,264 women from 2006 to 2021 were examined using cross-sectional Demographic and Health Surveys data. The outcome variables for this study include: (a) women who are overweight according to body mass index (BMI) (25.0–29.9kg/m2); (b) women who are obese according to BMI (≥30.0 kg/m2). Results: Eswatini (28%), Mauritania (27%), South Africa (26%), Gabon, Lesotho and Ghana (25% each) had the highest prevalences of overweight. In addition, obesity prevalence was highest in South Africa (36%), Mauritania (27%), Eswatini (23%), Lesotho (20%), Gabon (19%) and Ghana (15%), respectively. Overweight and obesity were more prevalent among older women, those living in urban areas, women with secondary/higher education and those in the richest household wealth quintiles. Conclusion: The risk factors for overweight and obesity, as well as the role that lifestyle changes play in preventing obesity and the associated health risks, must be made more widely known. In order to identify those who are at risk of obesity, we also recommend that African countries regularly measure their citizens’ biometric characteristics.

Basic determinants of child linear growth outcomes in sub-Saharan Africa: a cross-sectional survey analysis of positive deviants in poor households

Childhood malnutrition is a significant public health problem confronting countries across the globe. Although there is evidence of a downward trend in undernutrition globally, sub-Saharan Africa did not experience significant improvement in the past decades. This study investigated the basic determinants of linear growth among children living in poor households. We analysed a nationally representative sample of children aged 0–59 months (N = 24,264). The study countries were Ghana, Kenya, the Democratic Republic of Congo (DRC), Nigeria, and Mozambique. The child’s height-for-age Z-scores (HAZ), categorised into HAZ > − 2 standard deviations (SD) (not stunted) and HAZ < − 2 SD (stunted) was the outcome variable of interest. We used logistic regression as our analytical strategy. In DRC, Ghana, Kenya and Nigeria, maternal years of schooling was associated with positive linear growth among children living in poor households. In Ghana and DRC, four antenatal visits had a positive effect on better linear growth, while in Nigeria, healthy maternal body mass index (kg/m²) had a positive effect on child's linear growth. The putative socio-demographic determinants investigated in our study can promote the linear growth of children living in poor households. Interventions aimed at fostering linear growth among children living in poverty should focus on enhancing these factors.

Profiling household double and triple burden of malnutrition in sub-Saharan Africa: prevalence and influencing household factors

OBJECTIVE

Undernutrition and anaemia (the commonest micronutrient deficiency), continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. The current study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA.

SETTING

The study involved twenty-three countries across SSA who conducted Demographic and Health Surveys between 2008 and 2017.

PARTICIPANTS

The analytical sample includes 145 020 households with valid data on the nutritional status of women and children pairs (i.e. women of reproductive age; 15-49 years and children under 5 years).

DESIGN

Logistic regression analyses were used to determine household correlates of household burden of malnutrition.

RESULTS

Anaemia was the most common form of household burden of malnutrition, affecting about seven out of ten households. Double and triple burden of malnutrition, though less common, was also found to be present in 8 and 5 % of the households, respectively. The age of the household head, location of the household, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition.

CONCLUSIONS

The findings of the current study reveal that both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only but also address overweight/obesity and anaemia.

Consumers’ Knowledge and Use of Nutritional Labelling Information in Lagos, Nigeria

Nutrition labelling is a topical issue, being a vital aid that shapes consumers’ food choices and could be an efficient tool for the prevention of consumer vulnerability to diet-related diseases such as cancer, high blood pressure, hypertension, and obesity. However, data on the public use of nutritional labels as an information source on nutritional properties of foods and health claims, especially as it relates to Nigeria, are not popular in the literature. This study seeks to examine consumers’ use of labelling information: knowledge; attitude, and practice. A cross-sectional study with the aid of a survey elicited information from 374 randomly selected shoppers in five shopping malls in Lagos State. Data were analysed using the T-test method. Findings show that while the majority of the respondents (70.6%) read the nutritional information, only 64.9% understand the information presented on food labels. The study also reveals that the majority of the respondents (57.5%) do not know that information on food labels should be presented in the English language before any other language as recommended by the National Agency Food and Drug Administration and Control (NAFDAC). While 57.9% of consumers have a positive attitude towards using food labels, 58% of the respondents’ buying decisions are influenced by food labels. The study concludes that consequent upon the importance of nutritional knowledge and wellbeing, consumers of Fast Moving Goods in Nigeria are beginning to consciously pay attention to nutritional labels. The study recommends that producers of Fast Moving Consumer Goods (FMCG) products in Nigeria should adopt the total disclosure of ingredients and nutritional content of their products. Also, regulatory bodies in charge of pre-packaged food products in Nigeria (NAFDAC) should go the whole way and make nutritional labelling mandatory.

Multilevel Analysis of Urban-Rural Variations of Body Weights and Individual-Level Factors among Women of Childbearing Age in Nigeria and South Africa: A Cross-Sectional Survey

Background: An unhealthy body weight is an adverse effect of malnutrition associated with morbidity among women of childbearing age. While there is increasing attention being paid to the body weights of children and adolescents in Nigeria and South Africa, a major surge of unhealthy body weight in women has received less attention in both countries despite its predominance. The purpose of this study was to explore the prevalence of body weights (underweight, normal, overweight, and obese) and individual-level factors among women of childbearing age by urban-rural variations in Nigeria and South Africa. Methods: This study used the 2018 Nigeria Demographic Health Survey data (n = 41,821) and 2016 South Africa Demographic Health Survey (n = 8514). Bivariate, multilevel, and intracluster correlation coefficient analyses were used to determine individual-level factors associated with body weights across urban-rural variations. Results: The prevalence of being overweight or obese among women was 28.2% and 44.9%, respectively, in South Africa and 20.2% and 11.4% in Nigeria. A majority, 6.8%, of underweight women were rural residents in Nigeria compared to 0.8% in South Africa. The odds of being underweight were higher among women in Nigeria who were unemployed, with regional differences and according to breastfeeding status, while higher odds of being underweight were found among women from poorer households, with differences between provinces and according to cigarette smoking status in South Africa. On the other hand, significant odds of being overweight or obese among women in both Nigeria and South Africa were associated with increasing age, higher education, higher wealth index, weight above average, and traditional/modern contraceptive use. Unhealthy body weights were higher among women in clustering areas in Nigeria who were underweight (intracluster correlation coefficient (ICC = 0.0127), overweight (ICC = 0.0289), and obese (ICC = 0.1040). Similarly, women of childbearing age in clustering areas in South Africa had a lower risk of experiencing underweight (ICC = 0.0102), overweight (ICC = 0.0127), and obesity (ICC = 0.0819). Conclusions: These findings offer a deeper understanding of the close connection between body weights variations and individual factors. Addressing unhealthy body weights among women of childbearing age in Nigeria and South Africa is important in preventing disease burdens associated with body weights in promoting Sustainable Development Goal 3. Strategies for developing preventive sensitization interventions are imperative to extend the perspectives of the clustering effect of body weights on a country level when establishing social and behavioral modifications for body weight concerns in both countries.

Spatial location, temperature and rainfall diversity affect the double burden of malnutrition among women in Kenya

Studies have looked into how environmental and climate covariates affect under-and over-nutrition, but little is known about the spatial distribution of different forms of malnutrition in Kenya and whether there are locations that suffer from double-burden of malnutrition. This research quantifies spatial variations and estimates how climatic and environmental factors affect under-and over-nutrition among women in Kenya. This enables us to determine if the patterns in which these factors affect the malnutrition indicators are similar and whether there are overlaps in the spatial distributions. The study used data from the Demographic and Health Survey, which included cross-sectional data on malnutrition indicators as well as some climate and environmental variables. A multicategorical response variable that classified the women into one of four nutritional classes was generated from the body mass index (BMI) of the women, and a Bayesian geoadditive regression model with an estimate based on the Markov chain Monte Carlo simulation technique was adopted. Findings show that women in Turkana, Samburu, Isiolo, Baringo, Garissa, and West Pokot counties are more likely to be underweight than women in other counties while being overweight is prevalent in Kirinyag'a and Kitui counties. Obesity is prevalent in Kirinyag'a, Lamu, Kiambu, Murang'a, and Taita Taveta counties. The study further shows that as mean temperature and precipitation increase, the likelihood of being underweight reduces. The chances of being underweight are lower among literate women [OR: 0.614; 95% CrI: 0.513,0.739], married women [OR: 0.702; 95% CrI: 0.608,0.819] and those from rich households [OR: 0.617; 95% CrI: 0.489,0.772], which is not the case for overweight and obesity. The generated spatial maps identify hot spots of the double burden of malnutrition that can assist the government and donor agencies in channeling resources efficiently.

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Low- and middle-income countries have been experiencing double burden of malnutrition.

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The generated spatial maps identify hot spots of the double burden of malnutrition.

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Carefully thought-out policy plans are required to curb the challenges of the double burden of malnutrition.

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Burden of undernutrition has decreased but the cost of being overweight or obese is increasing among women.

Trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa since 2000: a cross-sectional series study

Introduction

Evidence on the rate at which the double burden of malnutrition unfolds is limited. We quantified trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa.

Methods

We analysed 102 Demographic and Health Surveys between 1993 and 2017 from 35 countries. We assessed regional trends through cross-sectional series analyses and ran multilevel linear regression models to estimate the average annual rate of change (AARC) in the prevalence of underweight, anaemia, anaemia during pregnancy, overweight and obesity among women by their age, residence, wealth and education levels. We quantified current absolute inequalities in these indicators and wealth-inequality trends.

Results

There was a modest decline in underweight prevalence (AARC=−0.14 percentage points (pp), 95% CI −0.17 to -0.11). Anaemia declined fastest among adult women and the richest pregnant women with an AARC of −0.67 pp (95% CI −1.06 to -0.28) and −0.97 pp (95% CI −1.60 to -0.34), respectively, although it affects all women with no marked disparities. Overweight is increasing rapidly among adult women and women with no education. Capital city residents had a threefold more rapid rise in obesity (AARC=0.47 pp, 95% CI 0.39, 0.55), compared with their rural counterparts. Absolute inequalities suggest that Ethiopia and South Africa have the largest gap in underweight (15.4 pp) and obesity (28.5 pp) respectively, between adult and adolescent women. Regional wealth inequalities in obesity are widening by 0.34 pp annually.

Conclusion

Underweight persists, while overweight and obesity are rising among adult women, the rich and capital city residents. Adolescent girls do not present adverse nutritional outcomes except anaemia, remaining high among all women. Multifaceted responses with an equity lens are needed to ensure no woman is left behind.

Prevalence and Factors Associated with the Triple Burden of Malnutrition among Mother-Child Pairs in Sub-Saharan Africa

Despite concerns about the coexistence of overnutrition, undernutrition and micronutrient deficiencies, which is compositely referred to as the triple burden of malnutrition (TBM), little is known about the phenomenon in sub-Saharan Africa (SSA). We, therefore, aimed to examine the prevalence and investigate the factors associated with TBM in SSA. This study uses cross-sectional survey data collected through the Demographic and Health Surveys (DHS) Program from 2010 to 2019. Data from 32 countries in SSA were used for the analysis. The prevalence of TBM were presented in tables and maps using percentages. The predictors of TBM were examined by fitting a negative log-log regression to the data. The results were then presented using adjusted odds ratios (aORs) at 95% Confidence Intervals (CIs). Out of the 169,394 children, 734 (1%) suffered from TBM. The highest proportion of children with TBM in the four geographic regions in SSA was found in western Africa (0.75%) and the lowest in central Africa (0.21%). Children aged 1 [aOR = 1.283; 95% CI = 1.215–1.355] and those aged 2 [aOR = 1.133; 95% CI = 1.067–1.204] were more likely to experience TBM compared to those aged 0. TBM was less likely to occur among female children compared to males [aOR = 0.859; 95% CI = 0.824–0.896]. Children whose perceived size at birth was average [aOR = 1.133; 95% CI = 1.076–1.193] and smaller than average [aOR = 1.278; 95% CI = 1.204–1.356] were more likely to suffer from TBM compared to those who were larger than average at birth. Children born to mothers with primary [aOR = 0.922; 95% CI = 0.865–0.984] and secondary [aOR = 0.829; 95% CI = 0.777–0.885] education were less likely to suffer from TBM compared to those born to mothers with no formal education. Children born to mothers who attended antenatal care (ANC) had lower odds of experiencing TBM compared to those born to mothers who did not attend ANC [aOR = 0.969; 95% CI = 0.887–0.998]. Children born to mothers who use clean household cooking fuel were less likely to experience TBM compared to children born to mothers who use unclean household cooking fuel [aOR = 0.724; 95% CI = 0.612–0.857]. Essentially, higher maternal education, ANC attendance and use of clean cooking fuel were protective factors against TBM, whereas higher child age, low size at birth and being a male child increased the risk of TBM. Given the regional variations in the prevalence and risk of TBM, region-specific interventions must be initiated to ensure the likelihood of those interventions being successful at reducing the risk of TBM. Countries in Western Africa in particular would have to strengthen their current policies and programmes on malnutrition to enhance their attainment of the SDGs.

Multilevel analysis of unhealthy bodyweight among women in Malawi: Does urbanisation matter?

BACKGROUND

Underweight and overweight constitute unhealthy bodyweight and their coexistence is symptomatic of the dual burden of malnutrition (DBM) of high public health concern in many sub-Saharan Africa countries. Little is known about DBM and its correlates in Malawi, a country undergoing urbanisation. The study examined net effects of urban residence on unhealthy weights amidst individual- and community-level factors among women in Malawi.

METHODS

Data on 7231 women aged 15-49 years nested within 850 communities extracted from 2015-16 Malawi Demographic and Health Survey were analysed. Women's weight status measured by body mass index, operationally categorised as underweight, normal and overweight, was the outcome variable while urban-rural residence was the main explanatory variable. Multilevel multinomial logistic regression analysis was employed at 5% significant level; the relative-risk ratio (RR) and its 95% confidence interval (CI) were presented.

RESULTS

Urban residents had a significantly higher prevalence of overweight than rural (36.4% vs. 17.2%; p< 0.001) but a -non-significant lower prevalence of underweight (6.2% vs. 7.4%; p = 0.423). Having adjusted for both individual- and community-level covariates, compared to rural, living in urban (aRR = 1.25; CI: 1.02-1.53) accounted for about 25% higher risk of being overweight relative to normal weight. Higher education attainment, being married and belonging to Chewa, Lomwe or Mang'anja ethnic group significantly reduced the risk of being underweight but heightened the risk of being overweight. Being older and living in wealthier households respectively accounted for about 3- and 2-times higher likelihood of being overweight, while breastfeeding (aRR = 0.65; CI: 0.55-0.76) was protective against overweight. Living in communities with higher poverty and higher education levels reduced and increased the risk of being overweight, respectively. Evidence of community's variability in unhealthy weights was observed in that 11.1% and 3.0% respectively of the variance in the likelihood of being overweight and underweight occurred across communities.

CONCLUSIONS

The study demonstrated association between urban residence and women overweight. Other important associated factors of overweight included breastfeeding, community education- and poverty-level, while education attainment, marital status and ethnicity were associated with the dual unhealthy weight. Thus, both individual- and community-level characteristics are important considerations for policy makers in designing interventions to address DBM in Malawi.

Differential effects of socio-demographic factors on maternal haemoglobin concentration in three sub-Saharan African Countries

Low Haemoglobin concentration (Hb) among women of reproductive age is a severe public health problem in sub-Saharan Africa. This study investigated the effects of putative socio-demographic factors on maternal Hb at different points of the conditional distribution of Hb concentration. We utilised quantile regression to analyse the Demographic and Health Surveys data from Ghana, Democratic Republic of the Congo (DRC) and Mozambique. In Ghana, maternal schooling had a positive effect on Hb of mothers in the 5th and 10th quantiles. A one-year increase in education was associated with an increase in Hb across all quantiles in Mozambique. Conversely, a year increase in schooling was associated with a decrease in Hb of mothers in the three upper quantiles in DRC. A unit change in body mass index had a positive effect on Hb of mothers in the 5th, 10th, 50th and 90th, and 5th to 50th quantiles in Ghana and Mozambique, respectively. We observed differential effects of breastfeeding on maternal Hb across all quantiles in the three countries. The effects of socio-demographic factors on maternal Hb vary at the various points of its distribution. Interventions to address maternal anaemia should take these variations into account to identify the most vulnerable groups.

Fertility is a key predictor of the double burden of malnutrition among women of child-bearing age in sub-Saharan Africa

BACKGROUND

The ongoing nutrition transition in sub-Saharan Africa (SSA) is exhibiting spatial heterogeneity and temporal variability leading to different forms of malnutrition burden across SSA, with some regions exhibiting the double burden of malnutrition. This study aimed to develop a predictive understanding of the malnutrition burden among women of child-bearing age.

METHODS

Data from 34 SSA countries were acquired from the Demographic and Health Survey, World Bank, and Swiss Federal Institute of Technology. The SSA countries were classified into malnutrition classes based on their national prevalence of underweight, overweight, and obesity using a 10% threshold. Next, random forest analysis was used to examine the association between country-level demographic variables and the national prevalence of underweight, overweight and obesity. Finally, random forest analysis and multinomial logistic regression models were utilized to investigate the association between individual-level social and demographic variables and Body Mass Index (BMI) categories of underweight, normal weight, and combined overweight and obesity.

RESULTS

Four malnutrition classes were identified: Class A had 5 countries with ≥10% of the women underweight; Class B had 11 countries with ≥10% each of underweight and overweight; Class C1 had 7 countries with ≥10% overweight; and Class C2 had 11 countries with ≥10% obesity. At the country-level, fertility rate predicted underweight, overweight and obesity prevalence, but economic indicators were also important, including the gross domestic product per capita - a measure of economic opportunity that predicted both overweight and obesity prevalence, and the GINI coefficient - a measure of economic inequality that predicted both underweight and overweight prevalence. At the individual-level, parity was a risk factor for underweight in underweight burdened countries and a risk factor for overweight/obesity in overweight/obesity burdened countries, whereas age and wealth were protective factors for underweight but risk factors for overweight/obesity.

CONCLUSIONS

Beyond the effect of economic indicators, this study revealed the important role of fertility rate and parity, which may represent risk factors for both underweight and combined overweight and obesity among women of child-bearing age. Health professionals should consider combining reproductive health services with nutritional programs when addressing the challenge of malnutrition in SSA.

Prevalence of Underweight and Its Associated Factors among Reproductive Age Group Women in Ethiopia: Analysis of the 2016 Ethiopian Demographic and Health Survey Data

Background

Underweight is defined as being below the healthy weight range. Underweight in reproductive age group women not only affects women but also increases the risk of an intergenerational cycle of malnutrition and child mortality. Various factors are linked with underweight among women. However, studies on the prevalence of underweight and its associated factors among women are limited in Ethiopia. Hence, this study aimed to assess the prevalence of underweight and its associated factors among reproductive age group women in Ethiopia.

Methods

For this study, data were drawn from the 2016 Ethiopian demographic and health survey (EDHS). From the total, 15,683 women participants of the 2016 EDHS; a subsample of 2,848 participants aged 15-49 years who had a complete response to all variables of interest were selected and utilized for analysis. Data were analyzed using SPSS version 20 software program. Pearson's chi-squared test was used to assess the frequency distribution of underweight and is presented with different sociodemographic characteristics. Logistic regression models were applied for analysis. A two-sided p value of less than 0.05 was used to declare a statistically significant association between the independent variables and underweight among women.

Results

The prevalence of underweight among reproductive age group women in Ethiopia was 17.6%. The majority, 78.3% of underweight women, were rural dwellers. The odds of being underweight was higher among the young aged women, among those residing in rural areas, in those with higher educational status, and in those who have one or more children. On the other hand, the odds of underweight among respondents living in Benishangul, SNNPR, and Addis Ababa were less compared to those living in Dire Dawa. Similarly, the odds of underweight among participants with a higher level of husband or partner educational status and among those who chew Khat were less compared to their counterparts.

Conclusion

Underweight among reproductive age group women in Ethiopia is still a major public health problem, particularly among rural dwellers. Underweight was significantly associated with different sociodemographic variables. Hence, context-based awareness creation programs need to be designed on the prevention methods of underweight in Ethiopia, giving especial emphasis to those residing in rural areas.

Socio-demographic factors associated with normal linear growth among pre-school children living in better-off households: A multi-country analysis of nationally representative data

This study examined the socio-demographic factors associated with normal linear growth among pre-school children living in better-off households, using survey data from Ghana, Kenya, Nigeria, Mozambique and Democratic Republic of Congo (DRC). The primary outcome variable was child height-for-age z-scores (HAZ), categorised into HAZ≥-2SD (normal growth/not stunted) and HAZ<-2 (stunted). Using logistic regression, we estimated adjusted odds ratios (aORs) of the factors associated with normal growth. Higher maternal weight (measured by body mass index) was associated with increased odds of normal growth in Mozambique, DRC, Kenya and Nigeria. A unit increase in maternal years of education was associated with increased odds in normal growth in DRC (aOR = 1.06, 95% CI = 1.03, 1.09), Ghana (aOR = 1.08, 95% CI = 1.04, 1.12), Mozambique (aOR = 1.08, 95% CI = 1.05, 1.11) and Nigeria (aOR = 1.07, 95% CI = 1.06, 1.08). A year increase in maternal age was positively associated with normal growth in all the five countries. Breastfeeding was associated with increased odds of normal growth in Nigeria (aOR = 1.30, 95% CI = 1.16, 1.46) and Kenya (aOR = 1.37, 95% CI = 1.05, 1.79). Children of working mothers had 25% (aOR = 0.75, 95% CI = 0.60, 0.93) reduced odds of normal growth in DRC. A unit change in maternal parity was associated with 10% (aOR = 0.90, 95% CI = 0.84, 0.97), 23% (aOR = 0.77, 95% CI = 0.63, 0.93), 25% (aOR = 0.75, 95% CI = 0.69, 0.82), 6% (aOR = 0.94, 95% CI = 0.89, 0.99) and 5% (aOR = 0.95, 95% CI = 0.92, 0.99) reduced odds of normal growth in DRC, Ghana, Kenya, Mozambique and Nigeria, respectively. A child being a male was associated with 18% (aOR = 0.82, 95% CI = 0.68, 0.98), 40% (aOR = 0.60, 95% CI = 0.40, 0.89), 37% (aOR = 0.63, 95% CI = 0.51, 0.77) and 21% (aOR = 0.79, 95% CI = 0.71, 0.87) reduced odds of normal child growth in DRC, Ghana, Kenya and Nigeria, respectively. In conclusion, maternal education, weight, age, breastfeeding and antenatal care are positively associated with normal child growth. In contrast, maternal parity, employment, and child sex and age are associated negatively with normal growth. Interventions to improve child growth should take into account these differential effects.

Commercial Snack Food and Beverage Consumption Prevalence among Children 6-59 Months in West Africa

Consumption of commercial snack food and beverage products among infants, young, and school-aged children may have negative effects on child nutritional outcomes, as these foods are typically dense in energy but not in micronutrients. However, there is limited information available about the consumption of such snacks in low-income settings, particularly in Africa. We contribute to filling this gap using data from 11,537 children aged 6-59.9 months from four West African countries (i.e., Burkina Faso, Cote d'Ivoire, Mali, and Niger). We estimated the prevalence of commercial snack food and drink consumption and explored variations within the sample by age group, urban or rural residence, household wealth status, and caregiver educational attainment. The results show that 25.7% of children in Niger, 31.5% in Burkina Faso, 42.9% in Mali, and 45.4% in Cote d'Ivoire ate at least one commercial snack food or beverage in the prior 24 h. Consumption prevalence was significantly higher in urban areas than rural areas, among older children (ages 2-5 y) than those in the complementary feeding period (6-23.9 months), and among children in wealthier households. These relationships were confirmed via logistic regression. Our results confirm the widespread consumption of commercial snack foods and drinks by young children in West Africa, a finding with relevance for nutrition policy and programming.