The prevalence of malnutrition and its associated risk factors among women of reproductive age in Ziway Dugda district, Arsi Zone, Oromia Regional State, Ethiopia

OBJECTIVES

Adequate nutrition is an important factor to determine the health and well-being of women, children and society as a whole. Although various nutritional policies were formulated and aimed at reducing malnutrition at the global level, the magnitude of malnutrition (body mass index [BMI] <18.5 kg/m²) among women remained between 10% and 40% in most low- and middle-income countries. We aimed to determine the prevalence of malnutrition and to identify the associated risk factors among women of reproductive age.

STUDY DESIGN

A cross-sectional study was conducted in Ziway Dugda district in Ethiopia among 430 women of reproductive age between September 20 and November 21, 2015.

METHODS

A systematic sampling method was used to select the study participants. Descriptive statistics and logistic regression were used to determine the prevalence of malnutrition and to identify associated independent risk factors such as women's age, housing conditions, drinking water sources, habits of hand washing, dietary intake and food insecurity.

RESULTS

The mean values of weight, height and BMI of the study participants were 51 kg, 157 cm and 18.1 kg/m², respectively. Prevalence of malnutrition (BMI <18.5 kg/m²) among women of reproductive age was found to be 48.6%. Being in the age group of 26-35 years (adjusted odds ratio [AOR] = 0.50, 95% confidence interval [CI] = 0.26-0.84), thatched housing conditions (AOR = 1.83, 95% CI = 1.16-2.89), unprotected sources of drinking water (AOR = 1.65, 95% CI = 1.06-2.57), lack of habit of hand wash after using the toilet (AOR = 1.62, 95% CI = 1.06-2.47), consumption of fish (AOR = 2.12, 95% CI = 1.12-3.99), consumption of dairy products (AOR = 2.40, 95% CI = 1.42-4.03) and food insecurity (AOR = 2.44, 95% CI = 1.50-3.95) were considered as independent predictors of risk for having malnutrition among women of the same age group compared to women from food secured households.

CONCLUSIONS

A high prevalence of malnutrition (48.6%) was observed among women of reproductive age. Although nutrient-rich foods were available, their consumption appears insufficient. Hence, it is strongly recommended to have behavioural change communication for enhancing adequate intake of a diversified diet and to promote environmental and hygienic conditions of women through improving their socio-economic status.

Recreation, transportation or labour saving? Examining the association between household asset ownership and body mass index among Ghanaian women

Background

In most of the developing world, ownership of modern household assets such as television sets, refrigerators, microwave ovens and washing machines is becoming common. Ownership of these household assets, however, promotes sedentary behaviour which has implications for obesity and non-communicable disease conditions such as hypertension, diabetes, stroke and other cardiovascular conditions. Additionally, increased household asset ownership is an indicator of socio-economic status and is also associated with obesity promoting dietary behaviours especially in urban areas. Very few studies have examined the relationship between household asset ownership and obesity in sub-Saharan Africa where asset ownership is becoming a norm. This paper examined the relationship between ownership of different types of household assets and Body Mass Index (BMI) among a nationally representative sample of Ghanaian women.

Methods

The study analysed secondary data from the 2008 Ghana Demographic and Health Survey (GDHS) involving a total of 4916 women aged 15–49 years. The analytical sample consist of 4010 (weighted sample) non-pregnant females who had valid data on all the variables used in the analyses. The BMI of the women was used as the dependent variable with three categories of normal weight, overweight and obese based on the standard World Health Organization (WHO) classifications. Multinomial logistic regression models were specified to examine the relationship between ownership of household assets and BMI.

Results

Obesity was more common among women whose household owned a television-15.60 %, DVD/VCD-18.58 %, computer-20.70 %, refrigerator-17.16 % and washing machine-27.43 %, but less common among women whose household owned a motorcycle/scooter-7.74 % and a bicycle-7.92 %. Household ownership of DVD was significantly associated with increased odds of obesity (OR = 1.59, P < 0.01) while ownership of a motor cycle/scooter (OR = 2.05, P <0.001), a refrigerator (OR = 1.33, P < 0.05), and a television set (OR = 1.27, P < 0.10) were associated with higher odds of overweight. Ownership of each additional household asset was also associated with 15 % and 25 % higher odds of overweight and obesity respectively.

Conclusion

The findings indicate that at least one asset among the various domains of household assets examined is associated with either overweight or obesity among Ghanaian women. Also, increased household asset ownership is associated with increased odds of overweight and obesity. Interventions that aim at reducing sedentary and unhealthy dietary behaviours in the phase of increasing asset ownership maybe helpful in addressing the rising prevalence of obesity among Ghanaian women.

Gender and adult undernutrition in developing countries

BACKGROUND

Information on the prevalence of undernutrition in adults in developing countries is mainly restricted to data on women. Literature reporting on the occurrence of female deprivation in developing countries, in particular in South Asia, suggests that differences between undernutrition prevalence in adult men and adult women might occur, but systematic information on the subject is lacking.

AIM

The study compares undernutrition prevalence rates, based on prevalence of low body mass index (BMI < 18.5), in adult men and adult women in developing countries. Regional comparison is made between the main developing regions: Sub-Saharan Africa, South/Southeast Asia and Latin America.

SUBJECTS AND METHODS

The study uses data as reported in 75 samples from 31 countries(divided over the three developing regions), in which anthropometric information has been collected in adult men and women within one and the same community.

RESULTS

Results indicate that, in general, prevalence rates of undernutrition are rather similar in adult men and women. However, there are regional differences. In communities in Sub-Saharan Africa, prevalence of low BMI is, on average, a few percent higher in men than in women; in South/Southeast Asia the reverse is the case. In some communities differences in undernutrition prevalence between men and women are exceptionally large.

CONCLUSIONS

It can be concluded that, in general, information on undernutrition prevalence in women can be considered a proxy for undernutrition prevalence in all adults, men and women together. However, the finding that in South/Southeast Asia women's nutritional status relative to men's nutritional status compares unfavourably with results from other developing regions, in particular Sub-Saharan Africa, provides some support for the concept of female deprivation in South/Southeast Asia. Where large differences between prevalence of low BMI in men and women occur, gender-specific policies aimed at reducing under-nutrition should be considered.

Nutrient intake and iron status of urban poor and rural poor without access to rice fields are affected by the emerging economic crisis: the case of pregnant Indonesian women

OBJECTIVE

We evaluated the adequacy of nutrient intake in comparison with the Indonesian Estimated Average Requirement (EARs) among pregnant Indonesian women and explain the short-term effect of economic crisis on nutrient intake and iron status.

DESIGN

Cross-sectional study.

SETTING

Purworejo District, Central Java, located 60 km west of Yogyakarta Province, Indonesia.

SUBJECTS

During the period from 1996 to 1998, up to six 24 h recalls were performed during the second trimester of pregnancy among 450 women. Nutrient intake and iron status was evaluated in relation to date of data collection relative to the economic crisis that emerged in August 1997. A computer program (Inafood) was developed to calculate nutrient intake.

RESULTS

: Forty percent of the pregnant women were at risk of inadequate intake of energy and protein, and 70% were at risk of inadequate intake of vitamin A, calcium and iron even before the crisis. Our results also demonstrate an effect of short-term economic crisis on nutrient intake and iron status. When the crisis emerged, urban poor experienced a decrease in intake of most nutrients. During the crisis, rich women experienced a significant decrease in fat (P<0.05). Negative changes in fat density during crisis were experienced by the rich and the rural, poor, and access to rice field subgroups (P<0.01). A significant increase in carbohydrate densities was seen for the rich and rural, poor, and access to rice fields groups (P<0.05). Urban poor experienced decreased serum ferritin concentration (P<0.05), whereas rich women experienced a significant increase (P<0.05).

CONCLUSIONS

Urban poor and rural poor landless women were most directly affected by the emerging economic crisis.

Underreporting of energy intake is less common among pregnant women in Indonesia

OBJECTIVES

To evaluate the ratio of reported energy intake to basal metabolic rate (EI/BMR) among pregnant Indonesian women, as well as identifying risk factors for being an underreporter.

DESIGN

Longitudinal study of dietary intake, using six repeated 24-hour diet recalls each trimester. Basal metabolic rate was estimated from body weight and physical activity from occupation. The lower 95% confidence interval for plausible EI/BMR was calculated and the proportion of underreporters estimated. Risk factors for being an underreporter were assessed in multivariate logistic regression analyses.

SETTING

Purworejo District, central Java, Indonesia.

SUBJECTS

Pregnant women

RESULTS

For the three trimesters, EI/BMR ratio was and (mean+/-standard deviation), respectively. The proportion of underreporters was 29.7%, 16.2% and 17.6%. Characteristics significantly associated with underreporting in at least one trimester included high body mass index and low education.

CONCLUSIONS

Levels of underreporting were low among the pregnant Indonesian women during the second and third trimesters. The low EI/BMR ratio during the first trimester likely reflects a true low intake due to nausea, rather than underreporting. Risk factors for being an underreporter included those known from developed countries, i.e. obesity and low education.

Weight-gain patterns from prepregnancy until delivery among women in Central Java, Indonesia

BACKGROUND

Representative data on pregnancy weight-gain patterns from developing countries are scarce. The reasons include difficulties in obtaining population-based samples and in collecting data before and throughout pregnancy.

OBJECTIVE

The objective was to measure weight-gain patterns from prepregnancy until after delivery in a population-based sample of rural Indonesian women.

DESIGN

Two cross-sectional surveys of nutritional status among nonpregnant women of reproductive age were carried out through a surveillance system in Purworejo District, Central Java, Indonesia, in 1996 and 1997. Between 1996 and 1998, 846 newly pregnant women were enrolled in a cohort study in which weight was monitored monthly throughout pregnancy. Prepregnancy weights and other anthropometric measures were available for 251 of the women who had live births.

RESULTS

Before pregnancy, 16.7% of the women had chronic energy deficiency and 10.0% were obese. The mean total pregnancy weight gain for all the women was 8.3 +/- 3.6 kg, and 79% did not meet the international recommendation regarding weight gain for their prepregnant body mass index. The rate of weight gain was highest during the second trimester (0.34 kg/wk). In the first and third trimesters, it was 0.08 and 0.26 kg/wk, respectively. Total weight gain was associated with prepregnant body mass index, education, and socioeconomic status.

CONCLUSIONS

Many women in rural Central Java, Indonesia, enter pregnancy with suboptimal nutritional status. For most of these women, total weight gain during pregnancy is insufficient. It is likely that this contributes to adverse health outcomes for both the mothers and their newborns.

Variability in nutrient intakes among pregnant women in Indonesia: implications for the design of epidemiological studies using the 24-h recall method

Few studies have assessed the reliability of dietary intake methods during pregnancy. Between 1996 and 1998, a longitudinal study of dietary intake during pregnancy was carried out among 451 women in Central Java, Indonesia. Six 24-h recalls were performed each trimester. We report here on intraindividual and interindividual variability in energy and nutrient intakes, as well as the reliability of the 24-h diet recall method. Implications of the use of different numbers of replicate days for estimating dietary intake and the relationships between dietary intake and health outcomes are also discussed. Intravariance-to-intervariance ratios were <1 for energy and carbohydrates and >1 for all other nutrients throughout pregnancy. Reliability analyses found good agreement (reliability coefficient >0.7) with three replicates for the macronutrients, but at least six replicates were needed for an agreement of > or =0.6 for the micronutrients. To estimate true individual average intake with a precision of +/-20%, six replicate recalls were sufficient for energy, carbohydrates, vitamin A, iron and vitamin C. In conclusion, mean intake of several nutrients can be reliably measured with the 24-h recall method, using a limited number of days. The nutrient of interest, the primary objectives and method of analyses should all be taken into account when planning sample size and number of replicates.

Predicting under- and overnutrition among women of reproductive age: a population-based study in central Java, Indonesia

OBJECTIVES

To evaluate changes over 1 year in weight and body mass index (BMI) among a population-based sample of non-pregnant women in Indonesia and to identify risk factors for developing under- and overnutrition.

DESIGN

Cross-sectional studies in 1996 and 1997 in the same population.

SETTING

Purworejo District, central Java, Indonesia.

SUBJECTS

Non-pregnant women (n = 4132) aged 15-49 years of age who participated in both 1996 and 1997. Based on BMI, women were classified as having chronic energy deficiency (CED), and as being either of normal weight or obese.

RESULTS

The mean height of the women was below the fifth percentile of international standards. In 1996, 16.2% had CED, 72.2% were normal and 11.6% were obese. In 1997, the corresponding figures were 14.4%, 71.2% and 14.3%, respectively, revealing a significant mean increase in weight and BMI. Among women classified as normal in 1996, 3.0% developed CED in 1997. Significant risk factors for developing CED were experiences of child deaths and non-use of contraceptives. Among women classified as normal in 1996, 5.3% developed obesity in 1997. Here, significant risk factors included most indicators of wealth as well as occupation.

CONCLUSIONS

The results should be important for future efforts to prevent CED and obesity in the general population; conditions which are both associated with health risks.