Population-based survey of overweight and obesity and the associated factors in peri-urban and rural Eastern Uganda

Prevalence of metabolically healthy obesity and healthy overweight and the associated factors in southern Iran: A population-based cross-sectional study

Background and Aims

Obesity is considered a major growing threat to public health which could negatively affect the quality of life. The current cross-sectional study was conducted to investigate the population-based prevalence of metabolically healthy obesity (MHO) and healthy overweight (MHOW) and associated factors in southern Iran.

Methods

Baseline data from the Pars Cohort Study was analyzed. Metabolically healthy participants were identified based on the definition of the American Heart Association for the metabolic syndrome. The prevalence of MHOW and MHO and their 95% confidence intervals were estimated. Poisson regression was applied for the calculation of prevalence ratios (PRs).

Results

Gender- and age-standardized prevalences of MHOW and MHO were 6.3% (6.0%-6.6%) and 2.3% (2.1%-2.5%), respectively. The following factors were associated with being MHOW compared with those with normal weight: Being younger, female gender (1.31, 1.20-1.43), higher socioeconomic status, being noncurrent cigarette smoker (1.27, 1.11-1.45), low level of physical activity (1.14, 1.03-1.25), having normal overweight during adolescence, and overweight (1.35, 1.24-1.48) or obesity (1.68, 1.53-1.86) during young adulthood. We also found strong associations between MHO and younger age groups, female gender (2.87, 2.40-3.42), being married (1.57, 1.08-2.27), Fars ethnicity (1.25, 1.10-1.43), higher socioeconomic status, ever use of tobacco (1.14, 1.00-1.30), never use of opium (1.85, 1.19-2.86), lower physical activity (1.45, 1.20-1.72), being normal weight in 15-year body pictogram and being overweight (1.87, 1.59-2.20) or obese (3.20, 2.74-3.72) in 30-year body pictogram when considering those with normal weight or MHO.

Conclusion

Potentially modifiable factors including physical activity should be more emphasized. Furthermore, our study issued that it would be more reasonable that the prevention of unhealthy obesity be initiated before the development of MHO, where there are more protective factors and they could be more effective.

Socio-demographic predictors of obesity among women in Mukono Central Division in Central Uganda: a cross-sectional study

BACKGROUND

There is a steadily increasing trend in obesity globally and in Sub-Saharan Africa that disproportionately affects women in most places. This is not different in Uganda, where the Uganda Demographic and Health Survey indicated an increase in obesity among women of reproductive age as measured by the body mass index (BMI). However, studies on the predictors of obesity in women are still limited. Particularly, studies using specific indicators of body fat are scant. This study explored the socio-demographic predictors of obesity as indicated by total body fat percentage among women in the age range of 18 to 69 years old living in Mukono Central Division in Central Uganda.

METHODS

A cross sectional study design using quantitative methods was employed. A total of 384 women between 18 and 69 years old from Mukono Central Division in Central Uganda were randomly recruited. A structured questionnaire was used to collect socio-demographic data including age, level of education, marital status, childbearing status, household expenditure, household size and employment status. Total body fat percentage, the indicator for obesity was measured using the body composition meter from TANITA. The data was analyzed using multinomial logistic regression analysis using SPSS version 20.

RESULTS

155 women, nearly two fifths (40.4% CI 95% 38.4-42.4) were classified as obese. Age, marital status, childbearing status, and employment status were the factors that were associated with obesity among these women. Employment status was the only variable that remained significantly associated with obesity among the women after adjusting for other factors. Unemployed women were nearly two times more likely to be obese than the employed women (AOR 1.9; 95% CI 1.1-3.1). The prevalence of obesity among the unemployed and employed women was 48.2% and 34.4% respectively.

CONCLUSIONS

Obesity in women was predicted by employment status. An in-depth study on factors that predispose unemployed women to obesity, will be instrumental in guiding interventions to curb the emerging obesity epidemic in Uganda. In the same vein, strategies to reduce levels of unemployment among women living in urban Uganda are essential for protecting public health from the dimension of reducing obesity levels.

Prevalence, trends and distribution of lifestyle cancer risk factors in Uganda: a 20-year systematic review

BACKGROUND

Cancer is becoming an important public health problem in Uganda. Cancer control requires surveillance of lifestyle risk factors to inform targeted interventions. However, only one national Non-Communicable Disease (NCD) risk factor survey has been conducted in Uganda. This review assessed the prevalence, trends and distribution of lifestyle risk factors in Uganda.

METHODS

The review identified studies up to January 2019 by searching Medline, Embase, CINAL and Cochrane databases. Further literature was identified from relevant websites and journals; scanning reference lists of relevant articles; and citation searching using Google Scholar. To be eligible, studies had to have been conducted in Uganda, and report prevalence estimates for at least one lifestyle cancer risk factor. Narrative and systematic synthesis was used to analyse the data.

RESULTS

Twenty-four studies were included in the review. Overall, unhealthy diet (88%) was the most prevalent lifestyle risk factor for both males and females. This was followed by harmful use of alcohol (range of 14.3% to 26%) for men, and being overweight (range of 9% to 24%) for women. Tobacco use (range of 0.8% to 10.1%) and physical inactivity (range of 3.7% to 4.9%) were shown to be relatively less prevalent in Uganda. Tobacco use and harmful use of alcohol were more common in males and more prevalent in Northern region, while being overweight (BMI > 25 kg/m2) and physical inactivity were more common in females and more prevalent in Central region. Tobacco use was more prevalent among the rural populations compared to urban, while physical inactivity and being overweight were more common in urban than in rural settings. Tobacco use has decreased overtime, while being overweight increased in all regions and for both sexes.

CONCLUSION

There is limited data about lifestyle risk factors in Uganda. Apart from tobacco use, other lifestyle risk factors seem to be increasing and there is variation in the prevalence of lifestyle risk factors among the different populations in Uganda. Prevention of lifestyle cancer risk factors requires targeted interventions and a multi-sectoral approach. Most importantly, improving the availability, measurement and comparability of cancer risk factor data should be a top priority for future research in Uganda and other low-resource settings.

Physical and psychiatric comorbidities among patients with severe mental illness as seen in Uganda

While psychiatric and physical comorbidities in severe mental illness (SMI) have been associated with increased mortality and poor clinical outcomes, problem has received little attention in low- and middle-income countries (LMICs). This study established the prevalence of psychiatric (schizophrenia, bipolar affective disorder, and recurrent major depressive disorder) and physical (HIV/AIDS, syphilis, hypertension and obesity) comorbidities and associated factors among 1201 out-patients with SMI (schizophrenia, depression and bipolar affective disorder) attending care at two hospitals in Uganda. Participants completed an assessment battery including structured, standardised and locally translated instruments. SMIs were established using the MINI International Neuropsychiatric Interview version 7.2. We used logistic regression to determine the association between physical and psychiatric comorbidities and potential risk factors. Bipolar affective disorder was the most prevalent (66.4%) psychiatric diagnoses followed by schizophrenia (26.6%) and recurrent major depressive disorder (7.0%). Prevalence of psychiatric comorbidity was 9.1%, while physical disorder comorbidity was 42.6%. Specific comorbid physical disorders were hypertension (27.1%), obesity (13.8%), HIV/AIDS (8.2%) and syphilis (4.8%). Potentially modifiable factors independently significantly associated with psychiatric and physical comorbidities were: use of alcohol for both syphilis and hypertension comorbidities; and use of a mood stabilisers and khat in comorbidity with obesity. Only psychiatric comorbidity was positively associated with the negative outcomes of suicidality and risky sexual behaviour. The healthcare models for psychiatric care in LMICs such as Uganda should be optimised to address the high burden of psychiatric and physical comorbidities.

Overweight and obesity in south central Uganda: A population-based study

Obesity is a rapidly growing global health challenge, but there are few population-level studies from non-urban settings in sub-Saharan Africa. We evaluated the prevalence of overweight (body mass index (BMI)>25 kg/m2), obesity (BMI>30 kg/m2), and associated factors using data from May 2018 to November 2020 from the Rakai Community Cohort Study, a population-based cohort of residents aged 15 to 49 living in forty-one fishing, trading, and agrarian communities in South Central Uganda. Modified Poisson regression was used to estimate adjusted prevalence risk ratios (PRR) and 95% confidence intervals (CI) in 18,079 participants. The overall mean BMI was 22.9 kg/m2. Mean BMI was 21.5 kg/m2 and 24.1 kg/m2 for males and females, respectively. The prevalence of overweight and obesity were 22.8% and 6.2%, respectively. Females had a higher probability of overweight/obesity (PRR: 4.11, CI: 2.98-5.68) than males. For female participants, increasing age, higher socioeconomic status, residing in a trading or fishing community (PRR: 1.25, CI 1.16-1.35 and PRR: 1.17, CI 1.10-1.25, respectively), being currently or previously married (PRR: 1.22, CI 1.07-1.40 and PRR: 1.16, CI 1.01-1.34, respectively), working in a bar/restaurant (PRR: 1.29, CI 1.17-1.45), trading/shopkeeping (PRR: 1.38, CI 1.29-1.48), and reporting alcohol use in the last year (PRR: 1.21, CI 1.10-1.33) were risk factors for overweight/obese. For male participants, increasing age, higher socioeconomic status, being currently married (PRR: 1.94, CI 1.50-2.50), residing in a fishing community (PRR: 1.68, CI 1.40-2.02), working in a bar/restaurant (PRR: 2.20, CI 1.10-4.40), trading/shopkeeping (PRR: 1.75, CI 1.45-2.11), or fishing (PRR: 1.32, CI 1.03-1.69) increased the probability of overweight/obesity. Non-Muslim participants, male smokers, and HIV-positive females had a lower probability of overweight/obese. The prevalence of overweight/obesity in non-urban Ugandans is substantial. Targeted interventions to high-risk subgroups in this population are needed.

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.

Prevalence and determinants of obesity and abdominal obesity among rural workers in Southeastern Brazil

The objectives of this study were to assess the nutritional status of rural workers from a municipality in Southeastern Brazil and estimate the association of sociodemographic, labor, lifestyle, and dietary pattern factors with obesity and abdominal obesity of men and women of this rural area. This is a cross-sectional, epidemiological study of 740 farmers (51.5%, n = 381 males; 48.5%, n = 359 females). The sociodemographic, labor, lifestyle and dietary patterns determinants were assessed. Food intake data were obtained by applying three 24-hour recalls and dietary patterns were determined by Principal Component Analysis with Varimax orthogonal rotation. Poisson regression with robust variance stratified by sex was applied. The general prevalence of overweight status was 31.5% (95% CI 28.2-34.8%), 19.7% of obesity (95% CI 16.8-22.6%) and 31.5% of abdominal obesity (95% CI 28.2-34.8%), with higher rates in women (P < 0.001). Men of higher socioeconomic class had a 2.3 times higher prevalence of obesity (95% CI 1.08-4.90). In addition, the shorter travel time to purchase food increased the prevalence of abdominal obesity in males. For women, the older the age group, the greater the general and central obesity. A lower adherence to traditional dietary patterns (approximately PR [prevalence ratio] 1.6 for general obesity and PR 1.3 for abdominal obesity) and a greater number of places to buy food were associated with higher rates of obesity in women. Finally, women farmers with a higher workload had a 20% lower prevalence of central obesity (PR 0.80; 95% CI 0.65-0.97). Such findings demonstrate that obesity must be an issue in the health care of remote and rural populations. There is a need to promote healthier environments that respect traditional food culture through multiple approaches that consider the heterogeneity of rural areas and the differences between sexes.

The Magnitude of NCD Risk Factors in Ethiopia: Meta-Analysis and Systematic Review of Evidence

Background: Non-communicable Diseases (NCDs) and their risk factors are the leading contributors to morbidity and mortality globally, particularly in low- and middle-income countries including Ethiopia. To date, there has been no synthesis of the literature on the relative prevalence of NCD risk factors in Ethiopia. Methodology: We conducted a systematic review and meta-analysis of primary studies reporting on the prevalence of NCD risk factors in Ethiopia published in English from 2012 to July 2020. Pre-tested NCD search terms were applied to Medline, Embase, Scopus, CINAHL, and Global Health. Three reviewers screened and appraised the quality of the identified papers. Data extraction was conducted using a pilot tested proforma. Meta-analysis was conducted using Stata 16 and pooled prevalence estimated with associated 95% confidence intervals. Clinically heterogeneous studies that did not fulfil the eligibility criteria for meta-analysis were narratively synthesised. I² was used to assess statistical heterogeneity. Results: 47 studies fulfilled the inclusion criteria and contributed 68 NCD risk factor prevalence estimates. Hypertension was the most frequently examined NCD risk factor, with a pooled prevalence of 21% (n = 27 studies). The pooled prevalence percentages for overweight and obesity were 19.2% and 10.3%, respectively (n = 7 studies each), with a combined prevalence of 26.8% (n = 1 study). It was not possible to pool the prevalence of alcohol consumption, smoking, metabolic disorders, or fruit consumption because of heterogeneity across studies. The prevalence of alcohol use, as reported from the included individual studies, ranged from 12.4% to 13.5% (n = 7 studies). More than 90% of participants met the WHO-recommended level of physical activity (n = 5 studies). The prevalence of smoking was highly variable, ranging between 0.8% and 38.6%, as was the prevalence of heavy alcohol drinking (12.4% to 21.1%, n = 6 studies) and metabolic syndrome (4.8% to 9.6%, n = 5 studies). Fruit consumption ranged from 1.5% up to the recommended level, but varied across geographic areas (n = 3 studies). Conclusion and recommendations: The prevalence of NCD risk factors in Ethiopia is relatively high. National NCD risk factor surveillance is required to inform the prioritisation of policies and interventions to reduce the NCD burden in Ethiopia.

Metabolic syndrome in childhood cancer survivors: delta BMI a risk factor in lower-middle-income countries

PURPOSE

Metabolic syndrome (MetSyn) is an important late effect of childhood cancer. The combination of rising obesity and high prevalence of under-nutrition at diagnosis makes this a unique population to study in LMIC (lower middle-income countries).

METHODS

Children ≤ 18 years of age at cancer diagnosis, in a single center in a LMIC, who were disease free and had completed treatment at least 2 years prior to study were included. MetSyn was defined using International Federation for Diabetes criteria for Asian Indians. Logistic regression analyses were carried out to evaluate the influence of various risk factors, including delta BMI (increase in body mass index from diagnosis to evaluation), on MetSyn.

RESULTS

A high prevalence of MetSyn (12.2%), central obesity (33%), and dyslipidemia (61.8%) were found in a cohort of 500 Asian Indian childhood cancer survivors (CCS) at a median follow-up age of 17 years. Multivariable analysis revealed older age at diagnosis ≥ 10 years, OR 2.9 (1.6-5); longer survival duration ≥ 10 years, OR 2.2 (1.3-3.8); high BMI at diagnosis, OR 3.2 (1.5-6.9); and large delta BMI ≥ 50, OR 3.15(1.7-5.9) to be independent predictors of MetSyn. Patients who were underweight or normal at diagnosis with large delta BMI ≥ 50 had very high odds (OR, 12.5, 1.7-92) of developing MetSyn compared to those with lower delta BMI.

CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS

A high prevalence of MetSyn was observed in CCS with early age at onset. Timely screening and early intervention are proven to be beneficial and delta BMI could be a useful screening tool for LMIC.

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.

High Prevalence of Overweight and Its Association with Mid-Upper Arm Circumference among Female and Male Farmers in Tanzania and Mozambique

The increasing prevalence of overweight/obesity may already have reached the farmers in Tanzania and Mozambique. Here, the measurement of the mid-upper-arm-circumference (MUAC) could become a simple and sensitive tool for early detection of at-risk groups of overweight as well as underweight. Body Mass Index (BMI) and MUAC of female and male farmers (n = 2106) from different regions of Tanzania and the Zambézia province, Mozambique, were analyzed by region, sex, age, and correlates. MUAC cut-offs, calculated via BMI cut-offs (<18.5, ≥25, and ≥30 kg/m²), and multiple linear regression (MLR), compared to those selected by highest Youden’s index (YI) value, were assessed. The study showed an overall higher prevalence of overweight (19%) than underweight (10%) due to the high number of overweight female farmers (up to 35%) in southern Tanzania. BMI, which was mainly and positively predicted by MUAC, was higher in Tanzania and among female farmers, and decreased significantly from the age of ≥65 years. MUAC cut-offs of <24 cm and ≥30.5 cm, calculated by MLR, detected 55% of farmers being underweight and 74% being overweight, with a specificity of 96%; the higher cut-off <25 cm and lower cut-off ≥29 cm, each selected according to YI, consequently detected more underweight (80%) and overweight farmers (91%), but on the basis of a lower specificity (87–88%). Overweight was evident among female farmers in East Africa. MUAC cut-offs, whether defined via linear regression or Youden’s Index, could prove to be easy-to-use tools for large-scale screenings of both underweight and overweight.

Factors associated with childhood overweight and obesity in Uganda: a national survey

Background

Childhood obesity is an emerging public health problem globally. Although previously a problem of high-income countries, overweight and obesity is on the rise in low- and middle-income countries. This paper explores the factors associated with childhood obesity and overweight in Uganda using data from the Uganda Demographic and Health Survey (UDHS) of 2016.

Methods

We used Uganda Demographic and Health Survey (UDHS) 2016 data of 4338 children less than 5 years. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. Overweight and obesity were combined as the primary outcome. Children whose BMI z score was over two were considered as overweight while those with a BMI z score greater than three were considered as obese. We used multivariable logistic regression to determine factors associated with obesity and overweight among children under 5 years of age in Uganda.

Results

The prevalence of overweight and obesity was 5.0% (217/4338) (95% CI: 4.3–5.6), with overweight at 3.9% (168/4338: 95% CI: 3.2–4.3) and obesity at 1.1% (49/4338: 95% CI: 0.8–1.5). Mother’s nutritional status, sex of the child, and child’s age were associated with childhood obesity and overweight. Boys were more likely to be overweight or obese (aOR = 1.81; 95% CI 1.24 to 2.64) compared to girls. Children who were younger (36 months and below) and those with mothers who were overweight or obese were more likely to have obesity or overweight compared to those aged 49–59 months and those with underweight mothers respectively. Children from the western region were more likely to be overweight or obese compared to those that were from the North.

Conclusion

The present study showed male sex, older age of the children, nutritional status of the mothers and region of residence were associated with obesity and overweight among children under 5 years of age.

Factors Associated with Over-Nutrition Among Men 15-54 years in Uganda: A National Survey

Background

Globally and in Sub-Saharan Africa (SSA), the prevalence of overweight and obesity are on the rise. Data on overweight and obesity among men are scarce.

Objective

We aimed to determine the prevalence and factors associated with over-nutrition among men in Uganda.

Methods

We used Uganda Demographic and Health Survey (UDHS) 2016 data of 5,408 men aged 15 to 45 years. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. Multivariable logistic regression was used to determine factors associated with over-nutrition among 15 to 54-year-old men in Uganda.

Results

The prevalence of over nutrition was 9.1%, where that of overweight was 7.9% (95% CI 7.2-8.7 and obesity was1.2% (95% CI 0.9-1.5). Men who were aged 25 to 34 (AOR = 3.28; 95% CI: 1.92-5.59), 35-44 (AOR = 4.51; 95% CI: 2.61-7.82) and 45 to 54 (AOR = 4.28; 95% CI: 2.37-7.74) were more likely to have over-nutrition compared to those aged 15 to 24 years. Married men (AOR=2.44; 95% CI: 1.49-3.99) were 2 times more likely to have over-nutrition than men who were not married. Men in the central region (AOR = 1.78; 95% CI: 1.22-2.60) were 1.78 times more likely to have over-nutrition than men in the northern region. Men who were in the richest wealth index quintiles were 10 times more likely to have over-nutrition compared to those in the poorest wealth index quintile (AOR = 9.38: 95 % CI 5.14-17.10).

Conclusion

The factors associated with over-nutrition among Ugandan men in our study were increasing age, marital status, increasing wealth and region of origin. This shows the need for measures to abate the regional development inequalities, need to promote physical activity among older men and need to improve on the knowledge of nutrition and dietetic practices for married couples and men of different social classes.

Social determinants and behaviors associated with overweight and obesity among youth and adults in a peri-urban area of Maputo City, Mozambique

BACKGROUND

Overweight and obesity are important risk factors for non-communicable diseases (NCDs) such as cardiovascular diseases (CVD), type 2 diabetes and certain cancers. NCDs are responsible for an increased number of deaths worldwide, including in developing countries. We aimed to determine the prevalence of overweight and obesity among youth and adults in a peri-urban area of Maputo city, Mozambique, and to assess their social and behavioral determinants.

METHODS

A cross-sectional study was conducted in a Health and Demographic Surveillance System (HDSS) area in Maputo city. We measured BMI and interviewed 15-64-year-old inhabitants to assess sociodemographic and behavioral characteristics using the STEPwise Approach methodology. A household wealth index was derived through Principal Component Analysis of various household assets and physical activity (PA) was measured using pedometers and accelerometers. Univariable and multivariable analyses were conducted to determine associations between overweight/obesity and social and behavioral determinants.

RESULTS

Among a total of 931 participants, the prevalence of overweight (BMI≥25 kg/m2) and obesity (BMI≥30 kg/m2) was 30.9% (95% confidence interval (CI) = 28.0, 33.9) and 12.6% (95% CI = 10.4, 14.7), respectively; one in every 10 youths and adults were underweight. Being female, older and living in a wealthier household were found to be significantly associated with overweight and obesity. Those with higher levels of education were found to have a reduced risk of being obese compared to those with no or lower levels of education. Behavioral risk factors (diet, alcohol and tobacco consumption and physical activity) did not significantly increase the risk of overweight and obesity.

CONCLUSIONS

Overweight and obesity are highly prevalent in this peri-urban part of the Mozambican capital, where underweight is still present in youth and adults, confirming that the country is facing a double burden of malnutrition. Social determinants of health should be taken into consideration in the design and implementation of NCD prevention programs.

An assessment of non-communicable disease mortality among adults in Eastern Uganda, 2010-2016

BACKGROUND

There is a dearth of studies assessing non-communicable disease (NCD) mortality within population-based settings in Uganda. We assessed mortality due to major NCDs among persons ≥ 30 years in Eastern Uganda from 2010 to 2016.

METHODS

The study was carried out at the Iganga-Mayuge health and demographic surveillance site in the Iganga and Mayuge districts of Eastern Uganda. Information on cause of death was obtained through verbal autopsies using a structured questionnaire to conduct face-face interviews with carers or close relatives of the deceased. Physicians assigned likely cause of death using ICD-10 codes. Age-adjusted mortality rates were calculated using direct method, with the average population across the seven years of the study (2010 to 2016) as the standard. Age categories of 30-40, 41-50, 51-60, 61-70, and ≥ 71 years were used for standardization.

RESULTS

A total of 1,210 deaths among persons ≥ 30 years old were reported from 2010 to 2016 (50.7% among women). Approximately 53% of all deaths were due to non-communicable diseases, 31.8% due to communicable diseases, 8.2% due to injuries, and 7% due to maternal-related deaths or undetermined causes. Cardiovascular diseases accounted for the largest proportion of NCD deaths in each year, and women had substantially higher cardiovascular disease mortality rates compared to men. Conversely, women had lower diabetes mortality rates than men for five of the seven years examined.

CONCLUSIONS

Non-communicable diseases are major causes of death among adults in Iganga and Mayuge; and cardiovascular diseases and diabetes are leading causes of NCD deaths. Efforts are needed to tackle NCD risk factors and provide NCD care to reduce associated burden and premature mortality.

Food intake and cardiometabolic risk factors in rural Uganda

BACKGROUND

Along with a nutritional transition in Sub-Saharan Africa, the prevalence of non-communicable diseases is increasing rapidly. We assess the association between food intake and cardiometabolic risk factors in a rural population in Uganda.

METHODS

The present study was based on data from a household-based case-control study of diabetic and non-diabetic households in Southwestern Uganda, 2012-2013. We analysed food intake in 359 individuals age ≥ 13 years from 87 households, using a household food frequency questionnaire, and measures of glycated haemoglobin (HbA1c), height and weight. We used multinomial logistic regression to model abnormal HbA1c (≥5.7%) and weight status (underweight, normal weight and overweight) as an outcome of total food intake and by nine food groups. Results were reported as odds ratios (OR) with 95% confidence intervals (CI). Models were adjusted for three nested sets of covariates.

RESULTS

The diet primarily consisted of staple food (cassava and plantain). High-Glycaemic Index staple food was the most consumed food group (median = 14 servings/week, p25-p75: 11-17). Milk, meat, fish and vegetables were the least consumed food groups (medians: 0-3 servings/week). Median intake of sugary food was 6 servings/week (p25-p75: 2-9). The OR of having abnormal HbA1c or being overweight increased with every weekly serving of food (1.02, 95% CI: 1.00-1.04 and 1.01 95% CI: 1.00-1.03, respectively). Of specific food groups, each weekly serving of meat increased the OR of being overweight with 33% (95% CI: 1.08-1.64), and fruit intake decreased the OR of abnormal HbA1c (0.94, 95% CI: 0.88-1.00), though this latter association was attenuated after adjustment for weight status, aerobic capacity, and socioeconomic status.

CONCLUSION

Diet was monotonous, mainly consisting of cassava and plantain, and increasing food intake was associated with abnormal HbA1c and overweight. To prevent non-communicable diseases a diet with higher intake of fish and vegetables, and less sugary food is recommended.

Comparative assessment of overweight/obesity among rural and urban reproductive-age women in Ethiopia: Evidence from a cross-sectional 2016 national survey

BACKGROUND

Overweight/obesity has become a global health problem for both developed and developing regions. Nowadays, overweight/obesity among childrearing-age women has become rapidly increasing in both urban and rural areas.

AIM

This study aimed to assess the variation of overweight/obesity among urban and rural reproductive-age women in Ethiopia.

METHODS

For this study, the 2016 Ethiopia Demographic and Health Survey data were used. The survey was a community-based cross-sectional study, which used a two-stage stratified cluster sampling technique to select the participants. A total of 13,451 reproductive-age women were included in the analysis. Both descriptive and analytical analysis was performed. A p-value of less than 0.05 was used as the measure of statistical significance.

RESULTS

The prevalence of overweight/obesity among urban reproductive-age women was statistically higher (p = 21.5%; 95% confidence interval (CI): 18.2-25.1) than the rural women (p = 3.5%; 95% CI: 2.9%-4.2%). Women who attend secondary or above education, women in the age groups 25-34 and ≥ 35 years, and high wealth index (rich) had higher odds of overweight/obesity in both urban and rural women. Moreover, women who were married, who had a large family size, and who have a history of alcohol intake had higher odds of overweight/obesity among urban women.

CONCLUSIONS

Overweight/obesity among reproductive-age women is a public health problem in Ethiopia, especially for women who are living in urban settings. Therefore, it is important to establish targeted overweight reduction programs with particular emphasis on urban, older aged, educated, and married women. Additionally, encouraging the limitation of the number of family size and alcohol intake can reduce women's overweight/obesity.

Prevalence and risk factors for overweight and obesity: a cross-sectional countrywide study in Burkina Faso

OBJECTIVE

The objective of this study was to determine the prevalence and predictors of overweight and obesity in Burkina Faso using a population-based countrywide sample. We hypothesise that there is a significant burden related to overweight/obesity in Burkina Faso.

DESIGN

Secondary analysis of a population-based countrywide cross-sectional study.

SETTING

Burkina Faso, all the 13 regions including both rural and urban residential areas.

PARTICIPANTS

4800 participants of both sexes, aged between 25 and 64 years.

MAIN OUTCOMES

Overweight and obesity using body mass index cut-off levels of the WHO.

RESULTS

The prevalence of overweight and obesity in Burkina Faso were 13.82% (95% CI: 12.25 to 15.55) and 4.84% (95% CI: 3.99 to 5.86), respectively. Among men, the proportional odds of overweight/obesity increase with urban residency (p<0.001), greater age (p<0.002), marital status different from single (p≤0.007) and decrease with current smoking (p=0.009). Among women, the proportional odds of overweight/obesity increase with urban residency (p<0.001), primary educational level (p=0.01), high total blood cholesterol level (p<0.001) and high fasting blood glucose level (p=0.02), and decrease with current smoking (p<0.001).

CONCLUSION

Our study showed that nearly one person out of five in the adult population of Burkina has an abnormal weight status with women being more affected than men. Urban residency is a consistent risk factor in both men and women. Alcohol consumption and education were associated with an increased odds in only women. Overnutrition needs to be recognised as an important public health issue in Burkina Faso and nutrition interventions need to be reshaped to account for it.

Prevalence and factors associated with overweight and obesity among patients with type 2 diabetes mellitus in Uganda-a descriptive retrospective study

OBJECTIVES

To assess the prevalence and risk factors of overweight and obesity among type 2 diabetes mellitus (T2DM) patients in Uganda.

DESIGN

Retrospective chart review.

SETTING

This study was conducted in the outpatient's T2DM clinic in St. Francis Hospital-Nsambya, Uganda between March and May 2017.

PARTICIPANTS

Type 2 diabetes patients registered in the diabetes clinic between July 2003 and September 2016.

OUTCOME MEASURES

Overweight and obesity defined as body mass index (kg/m2) of 25.0-29.9 and obesity as 30.0 or higher.

RESULTS

Of 1275 T2DM patients, the median age was 54 (IQR: 44-65) years, 770 (60.40%) were females, 887 (69.6%) had hypertension, 385 (28%) had controlled glycaemia, 349 (27%) were obese, while 455 (36%) were overweight. Overweight/obesity were lower among men (OR: 0.45, 95% CI: 0.340 to 0.593, p≤0.001) and among patients aged ≥65 years (OR: 0.52, 95% CI: 0.350 to 0.770, p=0.001); patients who rarely ate fruits and vegetables (OR: 0.66, 95% CI: 0.475 to 0.921, p=0.014) but higher among patients of middle (OR: 1.83, 95% CI: 1.320 to 2.550, p≤0.001) and upper (OR: 2.10, 95% CI: 1.450 to 2.990, p≤0.001) socioeconomic status; on dual therapy (OR: 2.17, 95% CI: 1.024 to 4.604, p=0.043); with peripheral neuropathy (OR: 1.40, 95% CI: 1.039 to 1.834, p=0.026) and hypertension (OR: 1.70, 95% CI: 1.264 to 2.293, p≤0.001).

CONCLUSIONS

Overweight and obesity are high among T2DM patients in this population and may contribute significantly to poor outcomes of T2DM. Therefore, strategies to address this problem are urgently needed.

Cardio-metabolic abnormalities among patients with severe mental illness at a Regional Referral Hospital in southwestern Uganda

Patients with severe mental illness (SMI) have a higher burden of premature cardio-metabolic abnormalities, including diabetes mellitus, hypertension, hyperlipidemia, and obesity resulting into a 3-fold increase in mortality, and up to 20% reduction in life expectancy compared to the general population. Although over 30% of Ugandans have some form of mental illness, there are no national or hospital-based screening guidelines for cardio-metabolic abnormalities among these patients a general trend in most low-income countries. The screening rates for cardio-metabolic abnormalities in most low-income countries are at only 0.6%. The objective of this study was to describe the cardio-metabolic abnormalities among patients with SMI at Mbarara Regional Referral Hospital. Through a cross-sectional study, we recruited 304 patients with SMI and evaluated them for cardio-metabolic abnormalities using the National Cholesterol Education Programme Adult Treatment Panel III criteria for dyslipidemias, World Health Organisation criteria for diabetes mellitus, obesity, and the Joint national committee criteria for hypertension. We then determined the proportion of participants who met the criteria for each of the individual cardio-metabolic abnormalities. Of the 304 participants, 44.41% were male and 55.59% female with a mean age of 38.56±13.66 years. Almost half (46.38%) of the participants were either overweight or obese, 33.22% had abdominal obesity, 40.46% were hypertensive, 34.11% had low high-density lipoproteins, 37.42% had hypertriglyceridemia and 34.77% had hypercholesterolemia. Based on fasting blood sugar, 11.18% and 9.87% had pre-diabetes and diabetes respectively. There is a high level of cardio-metabolic abnormalities among patients with psychiatric disorders and thus metabolic screening for these abnormalities should be done routinely during psychiatric reviews. There is a need for national guidelines for screening of metabolic abnormalities among patients with SMI so that these abnormalities can be detected early enough at stages where they can be either reversed or delayed to progress to cardiovascular disease.

Prevalence and factors associated with overweight and central obesity among adults in the Eastern Sudan

Background

A global epidemic of obesity has been documented, particularly among African countries. While central obesity and overweight have been reported for many countries, very limited information exists about the prevalence of these health problems in Sudan, and these data are nonexistent for Eastern Sudan. The present study aimed to determine the prevalence of obesity and central obesity, as well as the factors associated with both, among adults in Gadarif, Eastern Sudan.

Methods

A cross-sectional study was conducted in Gadarif, Eastern Sudan, during the period of January through May 2018. Sociodemographic and health characteristics data were collected through a questionnaire. Body mass index (BMI) and waist circumference (WC) were measured using the standard methods. Both descriptive and inferential statics were applied to analyze the data.

Results

A total of 594 adults participated in the study; 70.4% of them were female. The mean (standard deviation) age was 44.98 (16.64) years. Of the 594 enrolled participants, 33.7%, 7.4%, 26.8%, and 32.2% were normal weight, underweight, overweight, and obese, respectively. The prevalence of central obesity was (67.8%). Approximately, one-third of the participants (29.29%) were obese and had central obesity. In the multinomial regression, being married was the main risk factor associated with overweight, and older age, female sex, being married and hypertension were significantly associated with obesity. In the binary regression, the main risk factors associated with central obesity were female sex and being married.

Conclusion

The prevalence rates of both obesity and central obesity among the study participants were high. Older age and hypertension were only associated with obesity. Obesity and central obesity were significantly associated with female sex and being married. This study provided valuable baseline information to develop appropriate strategies for the prevention and control of obesity in Eastern Sudan.

Predictive formulas for estimation of height in sub-Saharan African older people: A new formula (EPIDEMCA study)

OBJECTIVES

Chumlea's formulas are a way of predicting height from knee height (KHt), including among individuals >60 y of age who cannot stand upright. However, the formulas were developed with white and African American people and have not yet been validated in native Africans >60 y of age. The aims of the study were to assess Chumlea's formulas in older people in central Africa and to propose a new validated formula for the same population.

METHODS

Height (MHt) and KHt were measured in a population of individuals >65 y of age from the Republic of Congo and the central African Republic. Predicted height (PHt) was calculated using Chumlea's formulas for the American black population (CBP) and for whites (CC). The percentages of accurate predictions (±5 cm) were compared between MHt and PHt. A new formula was estimated after randomization in a derivation sample (n = 877) and assessed for accuracy in a validation sample (n = 877).

RESULTS

The study included 1754 individuals. Prediction was accurate (±5 cm) in 66.8% and 63.2% of CBP and CC, respectively. Overestimation was as high as 24.1% and 29%, respectively. Because an overestimation is unacceptable in clinical practice and population surveys, a new formula was proposed: height (cm) = 72.75 + (1.86 × KHt [cm]) - (0.13 × age [y]) + 3.41 × sex (0: women; 1: men). This new formula significantly increases accuracy (71.3%) and decreases overestimation (14.7%). The nutritional status based on body mass index did not differ with the MHt and the PHt by the new formula.

CONCLUSION

Chumlea's formulas provided a poor estimate of height in this population sample. The proposed formula more accurately estimates height in older native Africans. This formula should be tested in other sub-Saharan African countries to extend its use in clinical practice and in future studies.

Prevalence and factors associated with overweight and obesity among rural and urban women in Burkina Faso

Introduction

Low- and middle-income countries, including Burkina Faso, are facing increasing urbanization with health challenges related to nutrition transition that impact body weight change. This study reported the prevalence and factors associated with overweight/obesity among women living in rural and urban Burkina Faso.

Methods

We conducted a secondary analysis using data from the Burkina Faso 2013 WHO STEPwise survey. Data included socio-demographic, clinical (anthropometric, systolic/diastolic blood pressure (SBP/DBP), oral/dental symptoms), biological (total and high-density lipoprotein cholesterol and fasting blood sugar), and alcohol and tobacco consumption data. A total of 2191 participants with complete data were considered in the analysis. We categorized the 13 Burkinabe regions by urbanization rate quartiles. We then performed Student's t, chi-squared, and Fisher's exact tests and backward stepwise regressions.

Results

The overall prevalence of overweight/obesity was 19.6% (13.1% and 44% in rural and urban women respectively, p=0.0001). Common factors positively associated with overweight/obesity in both rural and urban women were being a resident of a region in the highest urbanization rate quartile, having a high level of total cholesterol (alone or via an interaction with age) and having a high DBP. In urban women only, overweight/obesity was also associated with a high SBP.

Conclusion

The prevalence of overweight/obesity in urban women in Burkina was among the highest levels in urban sub-Saharan Africa and roughly mimicked the urbanization profile of the country. In overweight/obesity conditions, cardiovascular concerns, such as increase in total cholesterol and blood pressure, were objective, and the blood pressure increase was more severe in urban women than in rural women.

Prevalence and Sex-Specific Distribution of Cardiovascular Risk Factors in University Students in an Urban-Rural Environment of the Democratic Republic of the Congo

A recent qualitative study on health promotion in non-communicable diseases in Sub-Saharan University students suggested sex differences in knowledge and beliefs concerning a healthy lifestyle. However, the extent to which this is reflected in sex-specific distribution of cardiovascular risk factors among Sub-Saharan African students have not been fully evaluated. The objective of this study was to assess the prevalence and the sex-specific distribution of some modifiable cardiovascular risk factors among students at University of Kikwit in the Democratic Republic of the Congo. This cross-sectional descriptive study included 780 students (62.2% men) at the University of Kikwit between January and March of 2016. Data on physical measurements, lifestyle factors, and medical history were collected. The median age (interquartile range) of the students was 23 years (21-25 years). The modifiable cardiovascular risk factors identified were: alcohol consumption (53.1%), overweight (16.4%), general obesity (1.9%), abdominal obesity (10.4%), tobacco consumption (8.1%), hypertension (7.6%) and high pulse pressure (6.4%). Compared to women, men had a higher prevalence of hypertension (9.9 vs. 3.7%; p = 0.002), tobacco consumption (10.7 vs. 3.7%; p = 0.001), and alcohol consumption (58.4 vs. 44.4%; p < 0.001). In contrast, abdominal obesity was more predominant in women than in men (23.1 vs. 2.7%; p < 0.001). This study suggests a sex-specific distribution of several modifiable cardiovascular risk factors in students at the University of Kikwit. Design of sex-specific, student-targeted health promotion programs may be warranted to reduce the prevalence of risk factors and the subsequent burden of cardiovascular diseases.

Prevalence of overweight and obesity in Mozambique in 2005 and 2015

OBJECTIVE

The ongoing demographic, nutritional and epidemiological transitions in sub-Saharan Africa highlight the importance of monitoring overweight and obesity. We aimed to assess the prevalence of overweight and obesity in Mozambique in 2014/2015 and compare the estimates with those obtained in 2005.

DESIGN

Cross-sectional study conducted in 2014/2015, following the WHO Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). Prevalence estimates with 95 % CI were computed for different categories of BMI and abdominal obesity, along with age-, education- and income-adjusted OR. The age-standardized prevalence in the age group 25-64 years was compared with results from a STEPS survey conducted in 2005.

SETTING

Mozambique.

PARTICIPANTS

Representative sample of the population aged 18-64 years (n 2595).

RESULTS

Between 2005 and 2014/2015, the prevalence of overweight and obesity increased from 18·3 to 30·5 % (P < 0·001) in women and from 11·7 to 18·2 % (P < 0·001) in men. Abdominal obesity increased among women (from 9·4 to 20·4 %, P < 0·001), but there was no significant difference among men (1·5 v. 2·1 %, P = 0·395). In 2014/2015, the prevalence of overweight and obesity was more than twofold higher in urban areas and in women; in the age group 18-24 years, it was highest in urban women and lowest in rural men.

CONCLUSIONS

In Mozambique, there was a steep increase in the prevalence of overweight and obesity among adults between 2005 and 2014/2015. Overweight and obesity are more prevalent in urban areas and among women, already affecting one in five urban women aged 18-24 years.

Sociodemographic, socioeconomic, clinical and behavioural predictors of body mass index vary by sex in rural South African adults-findings from the AWI-Gen study

Background: Despite increasing obesity in South African adults, data on the prevalence and determinants of body mass index (BMI) from rural communities, home to a significant proportion of the population, are scarce.

Objectives: To investigate overall and sex-specific determinants of BMI in a rural adult South African population undergoing rapid social and epidemiological transitions.

Methods: Baseline cross-sectional demographic, socioeconomic, anthropometric, clinical and behavioural data were collected between 2015 and 2016 from 1388 individuals aged 40–60 years and resident in the Agincourt sub-district of Mpumalanga province, a setting typical of rural northeast South Africa. A Health and Socio-Demographic Surveillance System (HDSS) underpins the sub-district and contributes to the Africa Wits-INDEPTH partnership for Genomic Studies (AWI-Gen). Linear regression was used to investigate univariate associations between log-transformed BMI and individual variables and multiple linear regression was used to investigate independent predictors of BMI overall and in sex-stratified analyses.

Results: Median BMI was significantly higher in females (28.7 kg/m²[95% CI 24.2–33.2] vs 23.0 kg/m²[95% CI 20.3–26.8];p < 0.001) with male sex associated with 17% lower BMI. In sex-stratified multiple linear regression models, compared to those never married, BMI was 7% higher in currently married males and 6% in currently married females. Current smoking in men and former smoking in women were associated with reductions in BMI of 13% and 26% respectively, compared with non-smokers. Higher educational attainment in women and higher socioeconomic status in men were both associated with higher BMI, while being HIV-positive and alcohol consumption in women were associated lower BMI.

Conclusions: Female sex strongly predicts higher BMI in this rural African population. While some predictors of higher BMI differ by sex, married individuals in both sexes had a higher BMI, suggesting that, in addition to developing sex-specific interventions to combat overweight and obesity, targeting married couples may result in reduction in population BMI.

Nutrition transition, overweight and obesity among rural-to-urban migrant women in Kenya

OBJECTIVE

To assess the effect of rural-to-urban migration on nutrition transition and overweight/obesity risk among women in Kenya.

DESIGN

Secondary analysis of data from nationally representative cross-sectional samples. Outcome variables were women's BMI and nutrition transition. Nutrition transition was based on fifteen different household food groups and was adjusted for socio-economic and demographic characteristics. Stepwise backward multiple ordinal regression analysis was applied.

SETTING

Kenya Demographic and Health Survey 2014.

PARTICIPANTS

Rural non-migrant, rural-to-urban migrant and urban non-migrant women aged 15-49 years (n 6171).

RESULTS

Crude data analysis showed rural-to-urban migration to be associated with overweight/obesity risk and nutrition transition. After adjustment for household wealth, no significant differences between rural non-migrants and rural-to-urban migrants for overweight/obesity risk and household consumption of several food groups characteristic of nutrition transition (animal-source, fats and sweets) were observed. Regardless of wealth, migrants were less likely to consume main staples and legumes, and more likely to consume fruits and vegetables. Identified predictive factors of overweight/obesity among migrant women were age, duration of residence in urban area, marital status and household wealth.

CONCLUSIONS

Our analysis showed that nutrition transition and overweight/obesity risk among rural-to-urban migrants is apparent with increasing wealth in urban areas. Several predictive factors were identified characterising migrant women being at risk for overweight/obesity. Future research is needed which investigates in depth the association between rural-to-urban migration and wealth to address inequalities in diet and overweight/obesity in Kenya.

Factors associated with overweight and obesity among adults in northeast Ethiopia: a cross-sectional study

OBJECTIVE

Currently, the growing prevalence of overweight and obesity is an emerging public health problem in middle- and low-income countries such as Ethiopia. However, the prevalence of overweight and obesity among Ethiopian adults who live in the major cities is not well documented. Therefore, the study aimed to assess the prevalence and factors associated with overweight and obesity among adults in Dessie town, northeast Ethiopia.

SUBJECTS AND METHODS

A community-based cross-sectional study was conducted from March 15 to April 10, 2015. A total of 751 adults aged 18-64 years were included. Multistage followed by systematic random sampling method was used to select the study participants. Both bivariable and multivariable ordinal logistic regression were done. The proportional odds ratio (POR) with a 95% CI was reported to show the strength of association. A P-value <0.05 was considered statistically significant.

RESULTS

Of all participants, 19.9% (95% CI: 16.9%, 23.1%) were recorded to be overweight and 8.6% (95% CI: 6.6%, 10.9%) to be obese. The odds of being overnourished (overweight or obese) were higher among adults who had snack intake habit (POR =1.52; 95 CI: 1.04, 2.20), drank alcohol (POR =1.75; 95% CI: 1.04, 2.97), had higher wealth status (POR =2.29; 95% CI: 1.26, 4.19), and were married (POR =2.22; 95% CI: 1.49, 3.29) compared to their counterparts.

CONCLUSION

Compared to the previous local reports, the prevalence of overweight and obesity in the study area is high; this appears to be an emerging problem in Ethiopia. Hence, there is a need to develop a control and prevention strategy on potentially modifiable risk factors of overweight and obesity.

Prevalence and correlates of abdominal obesity among adults in Uganda: findings from a national cross-sectional, population based survey 2014

Background

Overweight and obesity are associated with health complications the gravity of which, vary with the regional deposition of the excess fat. The Body Mass Index (BMI) is often used to measure obesity although is an inferior predictor of cardiovascular disease risk mortality and morbidity compared with measures of abdominal obesity. We analyzed data from Uganda’s 2014 World Health Organization (WHO) STEPwise approach to surveillance of Non-communicable diseases (NCDs) survey to estimate the prevalence of abdominal obesity and associated factors to provide information on the prevention and control of overweight and obesity.

Methods

Data were collected using the WHO STEPS protocol. Waist measurement was taken using a non-stretchable standard tape measure mid-way between the lowest rib and iliac crest with the subject standing at the end of gentle expiration. Participants with waist circumference > 102 cm for men and 88 cm for women were classified as abdominally obese. We used weighted modified Poisson regression with robust error variance to estimate the prevalence of abdominal obesity and associated factors.

Results

Of the 3676 participants, 432 (11.8%) were abdominally obese; with the prevalence higher among females 412 (19.5%) compared with males 20 (1.3%). Compared with males, female participants were more likely to be abdominally obese Adjusted Prevalence Rate Ratio (APRR) 7.59 [5.58–10.33]. Participants who were married or cohabiting APRR 1.82 [1.29–2.57] and participants who were separated or divorced APRR 1.69 [1.17–2.46] were more likely to be abdominally obese compared with those who had never married before. Compared with rural dwellers, participants from urban areas were more likely to be abdominally obese APRR 1.29 [1.09–1.53]. Compared with participants with normal blood pressure, those with elevated blood pressure were more likely to be abdominally obese APRR 1.83 [1.57–2.14].Compared with participants without any education, those with secondary education were more likely to be abdominally obese APRR 1.42 [1.12–1.78].

Conclusions

There is a high prevalence of abdominal obesity among adults in Uganda which puts many at risk of developing associated metabolic complications. These data provide useful information for developing interventions and formulation of policies for the control and prevention of abdominal obesity in Uganda.

Reprint of OASIS - Obesity Awareness and Insight Scale

AIMS

Impaired illness awareness or not accepting that one has obesity is an understudied phenomenon that may negatively influence treatment adherence and clinical outcomes. The purpose of this study was to perform a systematic review of available measures of obesity awareness, and subsequently develop and validate a novel scale that measures the core domains of obesity awareness.

METHODS

A systematic review of the literature revealed no illness specific measure of subjective obesity awareness. As such, we designed the Obesity Awareness and Insight Scale (OASIS) to assess the following core domains of illness awareness: General Illness Awareness, Symptom Attribution, Awareness of Need for Treatment and the Negative Consequences attributable to the illness (www.illnessawarenessscales.com). Participants (n=100) were recruited from an online survey platform to assess the psychometric properties of OASIS.

RESULTS

The OASIS demonstrated strong internal consistency (Cronbach's alpha=0.89), convergent (r(98)=0.65, p<0.001) and discriminant validity, and test-retest reliability (intra-class correlation=0.76). An exploratory factor analysis of OASIS revealed a single latent component.

CONCLUSIONS

OASIS is an obesity-specific instrument that comprehensively measures subjective obesity awareness. OASIS can be used in epidemiological studies, intervention trials, and clinical practice to assess the impact of obesity awareness on treatment adherence and outcomes.

Sociodemographic Characteristics and Health Profile of the Elderly Seeking Health Care in Kampala, Uganda

Aging entails health challenges globally, but pertinent data from low-income countries like Uganda remains scarce. A cross-sectional study was carried out at Mulago National Referral Hospital in Kampala, among 134 patients (38% men and 62% women) aged ≥60 years. Data was collected on sociodemographic characteristics, medical disorders, cognitive function, hearing handicap, and functional status, that is, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL). The participants had high independency in BADL (89%) and IADL (75%). The most common medical conditions were bone/joint pain (35%), hypertension (24%), and visual problems (20%). More women (54%) than men (37%) reported bone and joint pain. The majority (80%) of the participants did not report any hearing handicap, and half (54%) did not have any cognitive impairment. Dependency in IADL was associated with advanced age, being female, and being financially dependent, and the risk of having a hearing handicap was higher among those above the median age (68 years). In adjusted models, the effects remained similar although statistical significance was only achieved for advanced age versus dependency in IADL (RR: 2.38, 95% CI: 1.12-5.08) and hearing handicap (RR: 2.67, 95% CI: 1.17-6.12). Thus, socioeconomic status and gender are relevant aspects when attempting to understand the health profile of the elderly in Kampala, Uganda.

OASIS: The Obesity Awareness and Insight Scale

Aims

Impaired illness awareness or not accepting that one has obesity is an understudied phenomenon that may negatively influence treatment adherence and clinical outcomes. The purpose of this study was to perform a systematic review of available measures of obesity awareness, and subsequently develop and validate a novel scale that measures the core domains of obesity awareness.

Methods

A systematic review of the literature revealed no illness specific measure of subjective obesity awareness. As such, we designed the Obesity Awareness and Insight Scale (OASIS) to assess the following core domains of illness awareness: General Illness Awareness,, Symptom Attribution,, Awareness of Need for Treatment and the Negative Consequences attributable to the illness (www.illnessawarenessscales.com). Participants (n=100) were recruited from an online survey platform to assess the psychometric properties of OASIS.

Results

The OASIS demonstrated strong internal consistency (Cronbach's alpha=0.89), convergent (r(98)=0.65, p<0.001) and discriminant validity, and test-retest reliability (intra-class correlation=0.76). An exploratory factor analysis of OASIS revealed a single latent component.

Conclusions

OASIS is an obesity-specific instrument that comprehensively measures subjective obesity awareness. OASIS can be used in epidemiological studies, intervention trials and clinical practice to assess the impact of obesity awareness on treatment adherence and outcomes.

Prevalence and Predictors of Overweight and Obesity among Somalis in Norway and Somaliland: A Comparative Study

BACKGROUND AND AIM

The knowledge about the health status of Somalis in Norway and Somaliland is limited. This paper reports the results of a comparative study on the prevalence and predictors of overweight/obesity among Somalis in Norway and Somaliland.

METHOD

We conducted two cross-sectional studies using the same tools and procedures, between 2015 and 2016. The study population was adults aged 20-69 years (n=1110 (Somaliland) and n=220 (Norway)).

RESULTS

The prevalence of obesity (body mass index (BMI) ≥30 kg/m²) was 44% and 31% in women in Norway and Somaliland, respectively. In contrast, the prevalence of obesity was low in men (9% in Norway; 6% in Somaliland). Although the prevalence of high BMI was higher in Somali women in Norway than women in Somaliland, both groups had the same prevalence of central obesity (waist circumference (WC) ≥ 88 cm). In men, the prevalence of central obesity (WC ≥ 102 cm) was lower in Somaliland than in Norway. For women in Somaliland, high BMI was associated with lower educational level and being married.

CONCLUSION

The prevalence of overweight and obesity is high among Somali immigrants in Norway, but also among women in Somaliland. The high prevalence of overweight and obesity, particularly among women, calls for long-term prevention strategies.

Undernutrition and obesity among elderly people living in two cities of developing countries: Prevalence and associated factors in the EDAC study

BACKGROUND

Nutritional status among elderly people living in Sub-Saharan Africa is poorly studied, even though undernutrition and obesity are known to cause many complications and are risk factors for progression and death in several diseases. The aims of this study were to assess the nutritional status of the elderly in Central Africa and to study the factors associated with nutritional disorders (undernutrition and obesity).

METHODS

Two cross-sectional population-based studies were carried out in the capitals of Central African Republic (CAR) and Republic of Congo (ROC) between 2008 and 2009. Participants were aged ≥65 years old and underwent nutritional assessment including the following measurements: weight, height, body mass index (BMI), waist circumference (WC). Diet was also investigated. Nutritional status was defined according to the WHO BMI classification (<18.5 = undernutrition; ≥30 = obesity). Multinomial regression analysis was performed in order to identify factors associated with nutritional status.

RESULTS

990 elderly people underwent nutritional assessment (482 in CAR and 508 in ROC). Mean BMI was 22.7 ± 4.8 kg/m². The prevalence of undernutrition was 19.2% and was lower in ROC than in CAR (9.5% vs. 29.5%; p < 0.0001). The prevalence of obesity was 8.8% and was higher in ROC than in CAR (14.6% vs. 2.7%; p < 0.0001). The mean WC was 85.3 ± 28.4 cm. Adjusted on study site, increasing age (OR = 1.6 [95% CI: 1.1-2.3] for 75-84 years, OR = 2.6 [95% CI: 1.4-4.8] for 85+ years), occupation as farmer/breeder (OR = 2.2 [95% CI: 1.1-4.2]), smoking (OR = 1.71 [95% CI: 1.14-2.56]) and low sugar consumption (OR = 1.7 [95% CI: 1.1-2.7]) were positively associated with undernutrition whereas only female sex was positively associated with obesity (OR = 5.0 [95% CI: 2.2-11.0]).

CONCLUSIONS

The prevalence of undernutrition is high in the elderly population of these countries, in contrast to obesity. Undernutrition and obesity are associated with different socio-economic factors and food consumption. Simple nutritional advice could contribute to improving the nutritional status of elderly people in Central Africa.

Validity of equations using knee height to predict overall height among older people in Benin

OBJECTIVES

Chumlea's formulas are a validated means of predicting overall height from knee height (KH) among people >60 y of age, but, to our knowledge, no formula is validated for use in African countries, including Benin. The aim of this study was to compare height provided by predictive formulas using KH to measured height in an elderly population in Benin.

METHODS

Individuals >60 y of age in Benin underwent nutritional assessment with determination of weight, body mass index (BMI), height, and KH. A Bland-Altman analysis was carried out by sex and age. The percentage of predictions accurate to ±5 cm compared with the measured height was calculated. The tested formulas were Chumlea's formulas for non-Hispanic Black people (CBP) and two formulas for use among Caucasians.

RESULTS

Data from 396 individuals (81.1% male) were analyzed. The three formulas achieved 98% accuracy, but with 4.6% risk for error (±2 SD: -6 to +9 cm), which appeared to make them unfit for the whole population. Nevertheless, if a level of prediction ±5 cm is considered acceptable in clinical practice, the CBP formula achieved 83.1% accuracy. Moreover, there was no significant difference in BMI calculated with the measured and the predicted height, and the nutritional status based on BMI did not differ.

CONCLUSION

CBP formulas seem applicable in 83% of cases (±5 cm) to assess the height with KH of older people in Benin and do not overestimate the prevalence of malnutrition.

Obesity in Low- and Middle-Income Countries: Burden, Drivers, and Emerging Challenges

We have reviewed the distinctive features of excess weight, its causes, and related prevention and management efforts, as well as data gaps and recommendations for future research in low- and middle-income countries (LMICs). Obesity is rising in every region of the world, and no country has been successful at reversing the epidemic once it has begun. In LMICs, overweight is higher in women compared with men, in urban compared with rural settings, and in older compared with younger individuals; however, the urban–rural overweight differential is shrinking in many countries. Overweight occurs alongside persistent burdens of underweight in LMICs, especially in young women. Changes in the global diet and physical activity are among the hypothesized leading contributors to obesity. Emerging risk factors include environmental contaminants, chronic psychosocial stress, neuroendocrine dysregulation, and genetic/epigenetic mechanisms. Data on effective strategies to prevent the onset of obesity in LMICs or elsewhere are limited. Expanding the research in this area is a key priority and has important possibilities for reverse innovation that may also inform interventions in high-income countries.

Complex association between rural/urban residence, household wealth and women's overweight: evidence from 30 cross-sectional national household surveys in Africa

BACKGROUND

We sought to demonstrate that the relationship between urban or rural residence and overweight status among women in Sub-Saharan Africa is complex and confounded by wealth status.

METHODS

We applied multilevel logistic regression to data from 30 sub-Saharan African countries which were collected between 2006 and 2012 to examine the association between women's overweight status (body mass index ≥ 25) and household wealth, rural or urban place of residence, and their interaction. Macro-level statistics from United Nations agencies were used as contextual variables to assess the link between progress in globalization and patterns of overweight.

RESULTS

Household wealth was associated with increased odds of being overweight in nearly all of the countries. Urban/rural living and household wealth had a complex association with women's overweight status, shown by 3 patterns. In one group of countries, characterised by low national wealth (median per capita gross national income (GNI) = $660 in 2012) and lower overall prevalence of female overweight (median = 24 per cent in 2010), high household wealth and urban living had independent associations with increased risks of being overweight. In the second group of less poor countries (median per capita GNI = $870) and higher national levels of female overweight (median = 29), there was a cross-over association where rural women had lower risks of overweight than urban women at lower levels of household wealth, but in wealthier households, rural women had higher risks of overweight than urban women. In the final group of countries, household wealth was an important predictor of overweight status, but the association between urban or rural place of residence and overweight status was not statistically significant. The median per capita GNI for this third group was $800 and national prevalence of female overweight was high (median = 32% in 2010).

CONCLUSIONS

As nations develop and household wealth increases, rural African women are at increased or higher risk of being overweight compared with urban women. Programmes and policies to address rising prevalence of overweight are needed in both rural and urban areas to avoid serious epidemics of non-communicable diseases.

Body mass index-measured adiposity and population attributability of associated factors: a population-based study from Buea, Cameroon

Background

Obesity is currently a global health challenge driven by a mix of behavioural, environmental and genetic factors. Up to date population-based disease burden estimates are needed to guide successful prevention and control efforts in African countries. We investigated the prevalence and population attributable fractions of overweight and obesity in Buea, the Southwest region of Cameroon.

Methods

Data are from a community-based cross-sectional study involving randomly selected adults conducted in 2016. Body mass index (BMI) was categorized according to the WHO classification. Multivariable logistic regressions were used to investigate factors independently associated with obesity. Corresponding population attributable fractions were estimated.

Results

Among the 1,139 participants, age-standardized prevalence (95% CI) of overweight and obesity were; 36.5 (33.7–39.3) and 11.1 (9.3–12.9) percent respectively. Mean BMI was 25.3 ± 4.3 kg/m²; women were heavier than men (25.8 vs. 24.4 kg/m²; p <0.0001). Factors associated with obesity were; female gender [odds ratio 3.20 (95% CI: 1.93–5.59)], age > 31 years [3.21 (1.86–5.28)] and being married [2.10 (1.60–3.51)]. At the population level; older age, being married, low level of education, high monthly income and physical inactivity accounted respectively for 11.9%, 21.8%, 11.6%, 6.4% and 8.7% of overweight and obesity among the women, while older age and being married explained 9.2% and 28.3% of overweight and obesity in men.

Conclusion

The prevalence of overweight and obesity in this semi-urban Cameroonian population is high, affecting over a third of individuals. Community-based interventions to control weight would need to take into account gender specificities and socio-economic status.

Burden of cumulative risk factors associated with non-communicable diseases among adults in Uganda: evidence from a national baseline survey

Background

Modification of known risk factors has been the most tested strategy for dealing with non-communicable diseases (NCDs). The cumulative number of NCD risk factors exhibited by an individual depicts a disease burden. However, understanding the risk factors associated with increased NCD burden has been constrained by scarcity of nationally representative data, especially in the developing countries and not well explored in the developed countries as well.

Methods

Assessment of key risk factors for NCDs using population data drawn from 3987 participants in a nationally representative baseline survey in Uganda was made. Five key risk factors considered for the indicator variable included: high frequency of tobacco smoking, less than five servings of fruit and vegetables per day, low physical activity levels, high body mass index and raised blood pressure. We developed a composite indicator dependent variable with counts of number of risk factors associated with NCDs per participant. A statistical modeling framework was developed and a multinomial logistic regression model was fitted. The endogenous and exogenous predictors of NCD cumulative risk factors were assessed.

Results

A novel model framework for cumulative number of NCD risk factors was developed. Most respondents, 38 · 6% exhibited one or two NCD risk factors each. Of the total sample, 56 · 4% had at least two risk factors whereas only 5.3% showed no risk factor at all. Body mass index, systolic blood pressure, diastolic blood pressure, consumption of fruit and vegetables, age, region, residence, type of residence and land tenure system were statistically significant predictors of number of NCD risk factors (p < 0 · 05). With exception to diastolic blood pressure, increase in age, body mass index, systolic blood pressure and reduction in daily fruit and vegetable servings were found to significantly increase the relative risks of exhibiting cumulative NCD risk factors. Compared to the urban residence status, the relative risk of living in a rural area significantly increased the risk of having 1 or 2 risk factors by a multiple of 1.55.

Conclusions

The non-communicable disease burden is on the increase, with more participants reporting to have at least two risk factors. Our findings imply that, besides endogenous factors, exogenous factors such as region, residence status, land tenure system and behavioral characteristics have significant causal effects on the cumulative NCD risk factors. Subsequently, while developing interventions to combat cumulative risk factors of NCDs, the Ministry of Health needs to employ a more holistic approach to facilitate equitable health and sensitization across age, residence and regional divide.

Urban-rural and geographic differences in overweight and obesity in four sub-Saharan African adult populations: a multi-country cross-sectional study

BACKGROUND

Overweight and obesity are on the rise in developing countries including sub-Saharan Africa. We undertook a four-country survey to show the collective burden of these health conditions as they occur currently in sub-Saharan Africa and to determine the differences between urban and rural populations and other socio-economic factors.

METHODS

Participants were nurses in two hospitals in Nigeria (200), school teachers in South Africa (489) and Tanzania (229), and village residents in one peri-urban (297) and one rural location in Uganda (200) who completed a standardised questionnaire. Their height and weight were measured and body mass index calculated. Factor analysis procedure (Principal component) was used to generate a wealth index. Univariate and multivariate analyses with binary logistic regression models were conducted to examine the associations between potential correlates and the prevalence of overweight and obesity with 95 % confidence intervals.

RESULTS

The prevalence of overweight and obese (combined) was 46 %, 48 %, 68 %, 75 % and 85 % in rural Uganda, peri-urban Uganda, Nigeria, Tanzania and South Africa (SA), respectively. Rural Uganda, Peri- urban Uganda, Nigeria, Tanzania and SA had obesity prevalence of 10 %, 14 %, 31 %, 40 % and 54 %, respectively (p < 0.001). Overall, prevalence of overweight was 374 (31 %) and obesity, 414 (34 %). Female sex was a predictor of overweight and obesity (combined) in peri-urban Uganda [AOR = 8.01; 95 % CI: 4.02, 15.96) and obesity in rural Uganda [AOR = 11.22; 95%CI: 2.27, 55.40), peri-urban Uganda [AOR = 27.80; 95 % CI: 7.13, 108.41) and SA [AOR = 2.17; 95 % CI: 1.19, 4.00). Increasing age was a predictor of BMI > =25 kg/m2 in Nigeria [Age > =45 - AOR = 9.11; 95 % CI: 1.72, 48.16] and SA [AOR = 6.22; 95 % CI: 2.75, 14.07], while marital status was predictor of BMI > =25 kg/m2 only in peri-urban Uganda. [Married - AOR = 4.49; 95 % CI: 1.74, 11.57]. Those in Nigeria [AOR = 2.56; 95 % CI: 1.45, 4.53], SA [AOR = 4.97; 95 % CI: 3.18, 7.78], and Tanzania [AOR = 2.68; 95 % CI: 1.60, 4.49] were more likely to have BMI > =25 kg/m2 compared with the rural and peri-urban sites.

CONCLUSION

The high prevalence of overweight and obesity in these sub-Saharan African countries and the differentials in prevalence and risk factors further highlights the need for urgent focused intervention to stem this trend, especially among women, professionals and urban dwellers.