Overweight and obesity and its socio-demographic correlates among urban Ethiopian women: evidence from the 2011 EDHS

Overweight and obesity trends and associated factors among reproductive women in Ethiopia

BACKGROUND

In low- and middle-income countries, the double burden of malnutrition is prevalent. Many countries in Africa are currently confronted with overweight and obesity, particularly among women, coupled with an increase in the prevalence of non-communicable diseases.

OBJECTIVE

This study examines trends in overweight and obesity among Ethiopian women of reproductive age from 2005 to 2016, and identifies associated factors.

METHODS

We used three consecutive datasets from 2005 (n = 14070), 2011 (n = 16515), and 2016 (n = 15683) demographic health survey years. Multilevel logistic regression was used to identify the determinant factors among individual- and cluster-level variables.

RESULTS

The prevalence of overweight and obesity among reproductive women in Ethiopia increased steadily from 6.09% in 2005 to 8.54% in 2011, and 10.16% in 2016. However, mixed patterns were observed among the regions of the country. We found that age, education, living in urban areas, and living in a rich community are associated with becoming overweight and obese. For instance, the odds of becoming overweight and obese among women aged 35-49 were higher than those among women aged 15-24 (odds ratio [OR] = 3.62, 95% Confidence Interval [CI]:2.64-4.97). Women who completed secondary school have higher odds than those without formal education (OR = 1.64, 95% CI:1.19-2.26).

CONCLUSION

To our knowledge, this is the first study to investigate trends in the nationwide prevalence of overweight and obesity and the associated factors among Ethiopian women. This study warrants further follow-up research to identify the pathways between overweight and obesity and their probable factors.

Differences in Associated Factors of Underweight and Overweight According to Rural-Urban Residence Strata among Ever-Married Non-Pregnant Women of Reproductive Age in Bangladesh

Background

This study sought to compare the prevalence of underweight and overweight among ever-married, non-pregnant women of reproductive age in Bangladesh by urban or rural residency status.

Methods

This study used Bangladesh Demographic and Health Survey (BDHS), 2017 data. Cross-sectional study design with two-stage stratified sampling method was employed. A sample of ever-married non-pregnant women of reproductive age was selected and multinomial logistic regression was utilised in analysis.

Results

It was found that around half of rural women (45.0%, N = 4,934) and more than half of urban women (60.3%, n = 3,913) were overweight. Nearly one in seven rural women (14.0%, n = 1,537) and 1 in 12 urban women (9.0%, n = 564) were reported as underweight. Our analyses revealed that being overweight was substantially connected with age, husband's occupation, economic status, television access, and division for both urban and rural areas. Women from poor households were significantly more likely to be underweight than women from middle- income households for both urban (P < 0.05; OR: 1.41; 95% CI: 1.03, 1.94) and rural (P < 0.05; OR: 1.23; 95% CI: 1.04, 1.46) areas. Interestingly, women without television access both in urban (P < 0.001; OR = 0.78; 95% CI: 0.67, 0.91) and rural (P < 0.001; OR = 0.75; 95% CI: 0.68, 0.84) areas had an inverse association with overweight/obesity compared to women with television access. In both areas, women in Sylhet and Mymensingh had higher likelihood of being underweight than Barisal division. Additionally, in both residential zones, women in Sylhet had lower likelihood of being overweight than Barisal division.

Conclusion

This study reveals that multiple characteristics are linked to both overweight and underweight among ever-married, non-pregnant women of reproductive age in Bangladesh. Addressing these variables should be a priority in public health efforts to combat the dual challenge of malnutrition in Bangladesh.

Double burden of malnutrition and associated factors among mother-child pairs at household level in Bahir Dar City, Northwest Ethiopia: community based cross-sectional study design

Introduction

The double burden of malnutrition refers to the simultaneous presence of under nutrition and overweight, obesity, or diet-related non-communicable diseases which might occur at the population, household, and individual level. The simultaneous presence of overweight/obese mothers with undernourished children in the same household, as well as overweight children with underweight mothers, holds particular significance. This phenomenon primarily impacts low-income and middle-income countries. The prevalence of double-burden malnutrition at the household level has increased significantly in sub-Saharan African countries. However, there is limited knowledge regarding the extent and factors associated with the double burden of malnutrition among mother-child pairs in Ethiopia. Consequently, the objective of this study was to assess the prevalence and determinants of the double burden of malnutrition among mother-child pairs at the household level in Bahir Dar City, Ethiopia.

Method

In the year 2021, a community-based cross-sectional study design was employed among 702 mother-child pairs in Bahir Dar City from February 28 to March 23. A multistage sampling technique was used to identify study participants who were interviewed using an interviewer-administered questionnaire. The nutritional status of children was evaluated using WHO Anthro Software. To determine the strength of the association, multivariable logistic regression analysis was performed, and adjusted odds ratios with their respective 95% confidence intervals were computed.

Results

The prevalence of the double burden of malnutrition among mother-child pairs was 14.5% (95% CI: 12.8, 15.7%}. Participants who were in the richest wealth index were 2.72 {AOR = 2.72, 95% CI 2.01, 5.63} times more odds of double burden of malnutrition than the poorest. The odds of the double burden of malnutrition among children who had high dietary diversity decreased by 63% {AOR = 0.37, 95% CI 0.22, 0.61} than low dietary diversity. Food secure households were 1.96 {AOR = 1.96, 95% CI 1.13, 3.39} times more likely to have the double burden of malnutrition than food insecure households. The odds of the double burden of malnutrition among mothers who completed college and above decreased by 74% {AOR = 0.26 95% CI 0.121, 0.549} than those unable to read and write.

Conclusions and recommendation

The magnitude of the double burden of malnutrition was lower than the Ethiopian Demographic and Health Survey. Wealth index, dietary diversity, food security, and educational status were significantly associated with the double burden of malnutrition. Therefore, it is recommended to implement public health interventions that target the identified associated factors in order to reduce the burden of double malnutrition.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

Cross-sectional study design.

SETTING

33 SSA countries.

PARTICIPANTS

240 414 women of reproductive age.

PRIMARY AND SECONDARY OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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

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

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

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

AIM

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

METHOD

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

RESULT

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

CONCLUSION

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

Double burden of malnutrition among women in reproductive Age (15-49 years) in Sierra Leone: a secondary data analysis of the demographic health survey 2019 (SLDHS-2019)

BACKGROUND

The double burden of malnutrition (DBM) is rising globally, particularly in sub-Saharan Africa. In Sierra Leone, the incidence of overweight, obesity (OWOB), and overnutrition among women has sharply increased. This finding accompanies the high incidence of undernutrition, which has been prevalent for decades. This study aimed to determine the prevalence of different malnutrition categories (underweight, overweight, obesity, and overnutrition) and associated factors among women of reproductive age (15-49 years) in Sierra Leone using secondary data analysis of the Sierra Leone Demographic Health Survey of 2019 (SLDHS-2019).

METHODS

We conducted secondary data analysis of the SLDHS-2019 of 7,514 women aged 15-49 years. We excluded pregnant, post-natal, lactating, and post-menopausal women. Data was collected using validated questionnaires, and respondents were selected through a multistage stratified sampling approach. A multivariable logistic regression analysis was used to determine factors associated with malnutrition among 15-49-year-old women in Sierra Leone.

RESULTS

Among 15-49-year-old women in Sierra Leone, the prevalence of underweight was 6.7% (95%CI: 4.5-8.9%); overweight at 19.7% (95%CI: 17.7-21.7%); obesity was 7.4% (95% CI: 5.2-9.6%); and overnutrition, 27.1% (95%CI: 25.2-29.0%). Women aged 25-34 years were more likely to be underweight (adjusted Odds Ratios, aOR = 1.670, 95%CI: 1.254-2.224; p < 0.001) than those aged 15-24 years; women who were not married were less likely to be underweight (aOR = 0.594, 95%CI: 0.467-0.755; p < 0.001) than married women. Women from the North were less likely to be underweight (aOR = 0.734, 95%CI: 0.559-0.963; p = 0.026) than the East, and those who did not listen to the radio were less likely to be underweight (aOR = 0.673; 95%CI: 0.549-0.826; p < 0.001) than those who did. Overweight was less likely among 25-34 years (aOR = 0.609, 95%CI: 0.514-0.722; p < 0.001) and 35-49 years (aOR = 0.480, 95%CI: 0.403-0.571; p < 0.001) age-groups than 15-24 years; more likely among not married women (aOR = 1.470, 95%CI:1.249-1.730; p < 0.001) than married; less likely among working-class (aOR = 0.840, 95%CI: 0.720-0.980; p = 0.026) than not working-class; most likely in women from the North (aOR = 1.325, 95%CI:1.096-1.602; p = 0.004), and less likely among women from the South (aOR = 0.755, 95%CI: 0.631-0.903; p = 0.002) than the East; less likely among women of middle-wealth-index (aOR = 0.656, 95%CI: 0.535-0.804; p < 0.001), richer-wealth-index (aOR = 0.400, 95%CI: 0.309-0.517; p < 0.001), and richest-wealth-index (aOR = 0.317, 95%CI: 0.234-0.431; p < 0.001) than the poorest-wealth-index; and more likely among women who did not listen to radios (aOR = 1.149; 95%CI:1.002-1.317; p = 0.047) than those who did. The predictors of overweight among women 15-49 years are the same as obesity and overnutrition, except overnutrition and obesity were less likely in female-headed households (aOR = 0.717,95%CI: 0.578-0.889; p < 0.001).

CONCLUSION

The prevalence of all categories of malnutrition among women of reproductive age in Sierra Leone is high, affirming a double burden of malnutrition in this study population. Underweight was more likely among the 25-34-year age group than 15-24-year. The predictors of overweight, obesity, and overnutrition were being unmarried/single, residing in the North, and not listening to the radio. There is an urgent need for policymakers in Sierra Leone to design comprehensive educational programs for women of reproductive age on healthy lifestyles and the dangers of being underweight or over-nourished.

Magnitude of erectile dysfunction and associated factors among adult diabetic men on follow-up at Goba and Robe hospitals, Bale Zone, South East Ethiopia: hospital-based cross-sectional study

PURPOSE

Erectile dysfunction is defined as the inability to achieve and/or maintain an erection of sufficient rigidity and duration to permit satisfactory sexual performance. The purpose of this study is to assess the prevalence of erectile dysfunction and associated factors among adult diabetic men on follow-up at Goba and Robe hospitals, Bale Zone, South East Ethiopia,2022.

METHODS

Hospital-based cross-sectional study design was used among 420 adult diabetic men from March 1 to April 30 using a systematic random sampling technique. An international index of erectile function questionnaire containing five questions was used to assess the outcome variable. The data were entered, edited, and coded using Epidata version 4.6 and analyzed using SPSS version 26. Bivariable and multivariable binary logistic regression analysis were performed to identify factors associated with erectile dysfunction. Adjusted odds ratios with their corresponding 95% confidence interval were computed to estimate the strength of association. Statistical significance was declared at p-value < 0.05.

RESULTS

The prevalence of erectile dysfunction was found to be 354 (84.3%). Multivariable logistic regression revealed that erectile dysfunction is significantly associated with old age (AOR = 12.39, 95% CI:5.10-30.08), inadequate physical activity (AOR = 4.15, 95% CI:1.33-12.97), and being rich (AOR = 2.62, 95% CI = 1.21-5.66).

CONCLUSION

The prevalence of erectile dysfunction in this study population is nearly nine out of ten. Age, inadequate physical activity, and wealth index were independent predictors of erectile dysfunction. Assessment and management of erectile dysfunction in diabetic clinics should be routine medical care.

Developing feasible healthy diets for Ethiopian women of reproductive age: a linear goal programming approach

OBJECTIVE

To develop a healthy diet for Ethiopian women closely resembling their current diet and taking fasting periods into account while tracking the cost difference.

DESIGN

Linear goal programming models were built for three scenarios (non-fasting, continuous fasting and intermittent fasting). Each model minimised a function of deviations from nutrient reference values for eleven nutrients (protein, Ca, Fe, Zn, folate, and the vitamins A, B1, B2, B3, B6, and B12). The energy intake in optimised diets could only deviate 5 % from the current diet.

SETTINGS

Five regions are included in the urban and rural areas of Ethiopia.

PARTICIPANTS

Two non-consecutive 24-h dietary recalls (24HDR) were collected from 494 Ethiopian women of reproductive age from November to December 2019.

RESULTS

Women's mean energy intake was well above 2000 kcal across all socio-demographic subgroups. Compared to the current diet, the estimated intake of several food groups was considerably higher in the optimised modelled diets, that is, milk and dairy foods (396 v. 30 g/d), nuts and seeds (20 v. 1 g/d) and fruits (200 v. 7 g/d). Except for Ca and vitamin B12 intake in the continuous fasting diet, the proposed diets provide an adequate intake of the targeted micronutrients. The proposed diets had a maximum cost of 120 Ethiopian birrs ($3·5) per d, twice the current diet's cost.

CONCLUSION

The modelled diets may be feasible for women of reproductive age as they are close to their current diets and fulfil their energy and nutrient demands. However, the costs may be a barrier to implementation.

Spatial distribution and associated factors of poor tetanus toxoid immunization among pregnant women in Ethiopia: spatial and multilevel analysis

Background

Neonatal mortality from tetanus can be reduced by 94% when pregnant women receive at least two doses of tetanus toxoid. In Ethiopia, immunization programs are suboptimal despite their importance. Therefore, the aim of this study was to examine the geographic distribution and associated factors of poor tetanus toxoid (TT) immunization among pregnant women in Ethiopia.

Methods

Secondary data analysis was used using the 2016 Ethiopian Demographic and Health Survey (EDHS). ArcGIS version 10.8 statistical software was used to explore the spatial distribution of poor TT immunization and SaTScan version 9.6 software was used to identify significant hotspot areas of poor TT immunization. For associated factors, a multilevel binary logistic regression model was fitted using STATA version 14 software. In the multivariable multilevel analysis, adjusted OR (AOR) with 95% CI was reported to reveal significantly associated factors of poor TT immunization.

Result

In Ethiopia, the spatial distribution of poor tetanus toxoid immunization was clustered with Global Moran's I = 0.59 at p-value of <0.0001. The highest poor TT immunization clusters were observed in the East and South Tigray, the central part of Amhara, West Afar, East Somali, and West Gambella. Pregnant women with no Antenatal care (ANC) visits [Adjusted Odds Ratio (aOR) = 10.46, 95% CI: (8.82, 12.41))], pregnant women with 1-3 ANC visits [aOR = 1.51, 95% CI: (1.31, 1.73)], media exposure [aOR = 1.45, 95% CI: (1.26, 1.67)], poor wealth index [aOR = 1.22; 95% CI: (1.03, 1.45)], middle wealth index [aOR = 1.23; 95% CI: (1.03, 1.47)], family planning use [aOR = 1.28; 95% CI: (1.11, 1.57)] and community level education [aOR = 1.43, 95% CI: (1.14, 1.80)] were significantly associated with poor tetanus toxoid immunization.

Conclusion

Poor tetanus toxoid immunization among pregnant women varies in Ethiopia. It was highest in East and South Tigray, the central part of Amhara, West Afar, East Somali, and West Gambella. Therefore, public health programs should design targeted interventions in identified hot spots to improve tetanus toxoid immunization. Health programmers should be promoting optimal ANC visits, women's education, and family planning use.

Socio-demographic correlates of unhealthy lifestyle in Ethiopia: a secondary analysis of a national survey

BACKGROUND

Multiple lifestyle risk factors exhibit a stronger association with non-communicable diseases (NCDs) compared to a single factor, emphasizing the necessity of considering them collectively. By integrating these major lifestyle risk factors, we can identify individuals with an overall unhealthy lifestyle, which facilitates the provision of targeted interventions for those at significant risk of NCDs. The aim of this study was to evaluate the socio-demographic correlates of unhealthy lifestyles among adolescents and adults in Ethiopia.

METHODS

A national cross-sectional survey, based on the World Health Organization's NCD STEPS instruments, was conducted in Ethiopia. The survey, carried out in 2015, involved a total of 9,800 participants aged between 15 and 69 years. Lifestyle health scores, ranging from 0 (most healthy) to 5 (most unhealthy), were derived considering factors such as daily fruit and vegetable consumption, smoking status, prevalence of overweight/obesity, alcohol intake, and levels of physical activity. An unhealthy lifestyle was defined as the co-occurrence of three or more unhealthy behaviors. To determine the association of socio-demographic factors with unhealthy lifestyles, multivariable logistic regression models were utilized, adjusting for metabolic factors, specifically diabetes and high blood pressure.

RESULTS

Approximately one in eight participants (16.7%) exhibited three or more unhealthy lifestyle behaviors, which included low fruit/vegetable consumption (98.2%), tobacco use (5.4%), excessive alcohol intake (15%), inadequate physical activity (66%), and obesity (2.3%). Factors such as male sex, urban residency, older age, being married or in a common-law relationship, and a higher income were associated with these unhealthy lifestyles. On the other hand, a higher educational status was associated with lower odds of these behaviors.

CONCLUSION

In our analysis, we observed a higher prevalence of concurrent unhealthy lifestyles. Socio-demographic characteristics, such as sex, age, marital status, residence, income, and education, were found to correlate with individuals' lifestyles. Consequently, tailored interventions are imperative to mitigate the burden of unhealthy lifestyles in Ethiopia.

The prevalence and determinant of overweight and obesity among residents aged 40-69 years in high-risk regions for upper gastrointestinal cancer in southeast China

Being overweight or obese is one of the public health concerns worldwide, and its prevalence is gradually increasing. Obesity has been proven to be associated with some cancers, including upper gastrointestinal cancer (UGC). However, studies on the prevalence of obesity among residents of areas at high risk of UGC in China are minimal. The aim of this study is to assess the prevalence of obesity and its influencing factors among people aged 40-69 years (high-risk population) in high-risk areas for UGC in Jiangsu Province, southeast China. This cross-sectional study involved 45,036 subjects aged 40-69 years identified in the Rural Early Diagnosis and Treatment of UGC Project database in Jiangsu Province from 2017 to 2021. Differences in prevalence across gender and age were assessed using the Chi-square test. Using a multinomial logistic regression model, we examined independent risk factors for overweight/obesity and their gender and age differences. The prevalence of overweight, obesity, and overweight/obesity varied based on the standards used: Chinese standard (42.1%, 11.9%, and 54.0%) and WHO standard (34.7%, 4.7%, and 39.4%), respectively. Being overweight was more common in men than women, while obesity was more common in women than men. Age of 50-59 years, married, household size of 7-9, drinking, soy products, pickled food, and hot food intake were positively associated with overweight/obesity. Females, 60-69 years, higher education level, household size of 4-6, annual family income of more than 60,000 CNY, smoking, and fresh fruit intake were negatively associated with overweight/obesity. Stratified analysis showed that the effects of age, education and meat, egg and dairy products on overweight/obesity were different across gender. The impact of fresh fruit and vegetables on overweight/obesity was also heterogeneous between the younger (40-59 years) and older (60-69 years) groups. In conclusion, the prevalence of overweight and obesity is high among adults aged 40-69 years from high-risk areas for UGC of Jiangsu Province, southeast China. Independent influencing factors of being overweight/obese included gender, age, marital status, education, household size, annual family income, smoking, drinking, fresh fruit, soy products, pickled food and hot food intake, and may vary by gender and age. Screening-based interventions should be considered to control obesity levels among screened participants. Besides, heterogeneity of influencing factors across subgroups could be focused on to improve intervention effectiveness.

Determinants of quality contraceptive counselling information among young women in Sierra Leone: insights from the 2019 Sierra Leone demographic health survey

BACKGROUND

The quality of contraceptive counseling information received by prospective clients of family planning services can greatly influence both the uptake and continued use of contraceptives. Therefore, an understanding of the level and determinants of quality contraception information among young women in Sierra Leon could inform family programs, with the aim of reducing the high unmet need in the country.

METHODS

We analyzed secondary data from the 2019 Sierra Leone Demographic Health Survey (SLDHS). Participants were young women aged 15-24 years, who were using a family planning method (n = 1,506). Good quality family planning counselling was defined a composite variable that included; a woman being told about side effects, how to deal with side effects, and the availability of other family planning methods/options. Logistic regression was performed using SPSS software version 25.

RESULTS

Out of 1,506 young women, 955 (63.4%, 95% CI: 60.5-65.3) received good quality family planning counselling services. Of the 36.6% that received inadequate counselling, 17.1% received no counselling at all. Good quality family planning counselling services was positively associated with receiving family planning services from government health facilities (aOR: 2.50, 95% CI: 1.83-3.41), having no major challenges with distance to access healthcare (aOR: 1.45, 95% CI: 1.10-1.90), having visited a health facility (AOR: 1.93, 95% CI: 1.45-2.58), and having been visited by a health field worker within the last 12 months (aOR: 1.67, 95% CI: 1.24-2.26) while residing in the southern region ( aOR: 0.39, 95% CI: 0.22-0.69) and belonging to the richest wealth quintile (aOR: 0.49, 95% CI: 0.24-0.98) were associated with less odds of receiving good quality family planning counselling services.

CONCLUSION

About 37% of the young women in Sierra Leone do not receive good quality family planning counselling services of which 17.1% received none. Based on the study's findings, it is important to emphasize the need to ensure that all young women have access to proper counselling services especially for those receiving these services from private health units, from the southern region and richest wealth quintile. Ensuring easier access through increasing affordable and friendly access points and strengthening field health workers' capacity in providing family planning services could also help improve access to good quality family planning services.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Spatial distribution and determinants of high-risk fertility behavior among reproductive-age women in Ethiopia

BACKGROUND

In low-and-middle-income, including Ethiopia, high-risk fertility behavior is a major public health concern. High-risk fertility behavior has an adverse influence on maternal and child health, which hampered efforts to reduce maternal and child morbidity and mortality in Ethiopia. Therefore, this study aimed to assess the spatial distribution and associated factors of high-risk fertility behavior among reproductive-age women in Ethiopia using recent nationally representative data.

METHODS

Secondary data analysis was done with a total weighted sample of 5865 reproductive-aged women using the latest mini EDHS 2019. The spatial distribution of high-risk fertility behavior in Ethiopia was determined using spatial analysis. Multilevel multivariable regression analysis was used to identify predictors of high-risk fertility behavior in Ethiopia.

RESULTS

The prevalence of high-risk fertility behavior among reproductive-age women in Ethiopia was 73.50% (95% CI 72.36%, 74.62%). Women with primary education [AOR = 0.44; 95%CI; 0.37, 0.52], women with secondary and above education [AOR = 0.26; 95%CI; 0.20, 0.34], being Protestant religion followers [AOR = 1.47; 95%CI; 1.15, 1.89], being Muslim religion follower [AOR = 1.56; 95%CI; 1.20, 2.01], having television [AOR = 2.06; 95%CI; 1.54, 2.76], having ANC visit [AOR = 0.78; 95%CI; 0.61, 0.99], using contraception [AOR = 0.77; 95%CI; 0.65, 0.90], living in rural areas [AOR = 1.75; 95%CI; 1.22, 2.50] were significantly associated with high-risk fertility behavior. Significant hotspots of high-risk fertility behavior were detected in Somalia, SNNPR, Tigray region, and Afar regions of Ethiopia.

CONCLUSIONS

A significant proportion of women in Ethiopia engaged in high-risk fertility behavior. High-risk fertility behavior was distributed non-randomly across Ethiopian regions. Policymakers and stakeholders should design interventions that take into account the factors that predispose women to have high-risk fertility behaviors and women who reside in areas with a high proportion of high-risk fertility behaviors to reduce the consequences of high-risk fertility behaviors.

Trends and factors contributing to health facility delivery among adolescent women in Ethiopia: multivariate decomposition analysis

BACKGROUND

Although an increase in health facility delivery in Ethiopia over time, adolescent women giving birth at health facilities is still low. Health facility delivery is crucial to improving the health of women and their newborns' health by providing safe delivery services. We aimed to examine the trend change and identify factors contributing to health facility delivery in Ethiopia.

METHODS

We analyzed the data on adolescent women obtained from three Ethiopian Demographic and Health Surveys. A total of weighted samples were 575 in 2005, 492 in 2011, and 378 in 2016. Data management and further statistical analysis were done using STATA 14. Trends and multivariate decomposition analysis were used to examine the trends in health facility delivery over time and the factors contributing to the change in health facility delivery.

RESULTS

This study showed that the prevalence of health facility delivery among adolescent women in Ethiopia increased significantly from 4.6% (95% CI 3.2-6.7) in 2005 to 38.7% (95% CI 33.9-43.7) in 2016. Decomposition analysis revealed that around 78.4% of the total change in health facility delivery over time was due to the changes in the composition of adolescent women and approximately 21.6% was due to the changes in their behavior. In this study, maternal age, place of residency, wealth index, maternal education, frequency of ANC visits, number of living children, and region were significant factors contributing to an increase in health facility delivery over the study periods.

CONCLUSION

The prevalence of health facility delivery for adolescent women in Ethiopia has increased significantly over time. Approximately 78.4% increase in health facility delivery was due to adolescent women's compositional changes. Public health interventions targeting rural residents and uneducated women would help to increase the prevalence of health facility delivery.

Rural-urban correlates of modern contraceptives utilization among adolescents in Zambia: a national cross-sectional survey

Background

Modern contraceptive use among adolescents is low despite the adverse effects of adolescent pregnancies. Understanding correlates of modern contraceptive use in different settings is key to the design of effective context-specific interventions. We aimed to determine factors associated with modern contraceptives use among adolescents in rural and urban settings of Zambia.

Methods

We analyzed secondary data from 2018 Zambia demographic and health survey (ZDHS) focusing on adolescent girls aged 15–19 years. We used multivariable logistic regression in SPSS version 25 to examine rural-urban variations in factors associated with modern contraceptive utilization.

Results

Overall, 12.0% (360/3000, 95% CI: 10.9–13.2) of adolescents in Zambia were using modern contraceptives. Use of modern contraceptives was higher in rural areas at 13.7% (230/1677, 95% CI: 12.1–15.3) compared to 9.8% (130/1323, 95% CI: 8.3–11.6) in urban areas. In the rural areas, having a child (aOR = 13.99; 95% CI 8.60–22.77), being married (aOR = 2.13; 95% CI 1.42–3.18), being older at 19 years (aOR = 3.90; 95% CI 1.52–10.03), having been visited by a field health worker (aOR = 1.62; 95% CI 1.01–2.64), having been exposed to family planning messages on mass media (aOR = 2.87; 95% CI 1.01–8.18) and belonging to the richest wealth quintile (aOR = 2.27; 95% CI 1.43–3.62) were associated with higher odds of contraceptive utilization. Furthermore, adolescents in the Northern (aOR = 0.29; 95% CI 0.11–0.80) and Luapula (aOR = 0.35; 95% CI 0.15–0.81) provinces were associated with less odds of utilizing contraceptives compared to those in Western province. In the urban areas, older age at 19 years (aOR = 4.80; 95% CI 1.55–14.84) and having a child (aOR = 18.52; 95% CI 9.50–36.14) were the only factors significantly associated with modern contraceptive utilization.

Conclusion

Age and having a child were associated with modern contraceptive use in both rural and urban areas. In rural areas (province, marital status, being visited by field health workers, family planning messages exposure and wealth index) were the only associated factors. This indicates that interventions aiming to increase contraceptive utilization should be context specific.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01914-8.

Maternal overweight and obesity and its associated factors and outcomes in human immunodeficiency virus (HIV)-infected and HIV-uninfected black South African pregnant women

AIM

This study aimed to investigate various variables between maternal overweight and/or obesity versus normal-weight pregnant black South African women living with and without human immunodeficiency virus (HIV).

METHODS

A cross-sectional study design was employed. A total of 200 pregnant women were enrolled in the study, categorized according to body mass index (BMI) (kg/m² ) into two groups: (1) overweight/obese (≥25 kg/m² ) (n = 97); and (2) nonoverweight/nonobese (<25 kg/m² ) (n = 103), where 90 were HIV-infected and 110 were HIV-uninfected. The differences between the maternal BMI categories were assessed using Fisher's exact t-test and the χ² test. Simple and multiple logistic regression analyses were used to determine factors associated with maternal overweight and obesity.

RESULTS

Multiple logistic regression analysis showed that maternal age (odds ratio [OR]: 1.061; 95% confidence interval [CI] 1.008-1.117; p = 0.023) and gestational age (OR: 1.121; 95% CI 1.005-1.251; p = 0.041) were significantly associated with maternal overweight/obesity in both HIV-infected and HIV-uninfected. For maternal health outcomes, multiple logistic regression analysis showed that hypertensive disorders (OR: 0.273; 95% CI 0.124-0.601; p = 0.001) and anemia (OR: 2.420; 95% CI 1.283-4.563; p = 0.006) were significantly associated with maternal overweight/obesity in both HIV-infected and HIV-uninfected. The overweight/obese HIV-infected participants (OR: 0.233; 95% CI 0.075-0.717; p = 0.011) had increased odds for developing hypertensive disorders compared to HIV-uninfected overweight/obese participants (OR: 0.471; 95% CI 0.172-1.291; p = 0.143).

CONCLUSIONS

Maternal overweight/obesity in both HIV-infected and HIV-uninfected pregnant black South African women was significantly associated with maternal age, gestational age, HPT disorders, and anemia. Maternal overweight/obesity decreased the odds for anemia, but increased the odds for the development of HPT disorders, especially in the HIV-infected pregnant women.

Association between socio-economic factors and the risk of overweight and obesity among Chinese adults: a retrospective cross-sectional study from the China Health and Nutrition Survey

BACKGROUND

With the rising prevalence of obesity and overweight, increasing number of scholars paid attention to the negative effects on human health and life. Recent years, many studies have focused on the relation of socio-economic factors with the risk of overweight or obesity, but findings have been inconsistent. This study investigated the relationship between socio-economic factors and the risk of overweight and obesity among Chinese adults.

METHODS

This study was based on the survey of the China Health and Nutrition Survey in 2015, with 9245 Chinese adults aged 18-65 years old. Overweight and obesity were assessed by physical measurements of weight, height, and waist circumference. Multiple logistic models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the association.

RESULTS

Overall, the prevalence rates of general obesity and abdominal obesity were 15.5% and 22.6%, respectively. We found that education and per capita household income were positively associated with overweight and obesity risk in men. However, the association between education and obesity status was negative in women [general obesity: OR = 0.64, 95% CI (0.50-0.81); abdominal obesity: OR = 0.62, 95% CI (0.51-0.76)]. Occupational status was only associated with general overweight in men.

CONCLUSIONS

Results suggested that higher education and per capita household income were associated with an increased risk of overweight and obesity among Chinese men, whereas the associations were negative for women. We recommended that men with high levels of education and income, women with low levels of education, can engage in some physical activity, modify dietary, and adopt a new way of life to maintain their weight and general health.

Association between exposure to family planning messages on different mass media channels and the utilization of modern contraceptives among young women in Sierra Leone: insights from the 2019 Sierra Leone Demographic Health Survey

Background

Access to sexual and reproductive health information enables young women to make appropriate decisions. We examined the association between exposure to family panning messages on different mass media and the use of modern contraceptives among young women in Sierra Leone.

Methods

This was a secondary analysis of the 2019 Sierra Leone Demographic and Health Survey data of young women aged 15–24 years. Multistage stratified sampling was used to select study participants in the survey. We used multivariable logistic regression to determine the association between exposure to family panning messages on different types mass media channels and utilization of modern contraceptives. All our analyses were done using SPSS version 25.

Results

Out of 6055 young women, 1506 (24.9%, 95% CI 24.0–26.2) were utilizing a modern contraceptive method with the prevalence higher among urban women (26.5%) compared to rural women (23.1%). Less than half (45.6%) had been exposed to family planning messages on mass media (radio 28.6%, television 10.6%, mobile phones 4.2% and newspapers or magazines 2.2%). Young women who had exposure to family planning messages on radio (AOR: 1.26, 95% CI 1.06–1.50) and mobile phones (AOR: 1.84, 95% CI 1.25–2.69) had higher odds of using modern contraceptives compared to their counterparts without the same exposure. Furthermore, having access to internet (AOR: 1.45, 95% CI 1.19–1.78), working (AOR: 1.49, 95% CI 1.27–1.74), being older (20–24 years) (AOR: 1.75, 95% CI 1.46–2.10), being married (AOR: 0.33, 95% CI 0.26–0.42), having visited a health facility within the last 12 months (AOR: 1.34, 95% CI 1.10–1.63), having secondary (AOR: 2.83, 95% CI 2.20–3.64) and tertiary levels of education (AOR: 3.35, 95% CI 1.83–6.13), higher parity (having above one child) AOR: 1.57, 95% CI 1.19–2.08) and residing in the southern (AOR: 2.11, 95% CI 1.61–2.79), northwestern (AOR: 1.87, 95% CI 1.39–2.52), northern (AOR: 2.11, 95% CI 1.59–2.82) and eastern (AOR: 1.68, 95% CI 1.27–2.22) regions of residence were associated with higher odds of modern contraceptives utilization.

Conclusion

In Sierra Leon, only one in four young women were using modern contraception and more than half of them had not had any exposure to family planning messages on the different types of mass media channels. Behavior change communicators can prioritize family planning messages using radio, mobile phones and the internet. In order to publicize and encourage young women to adopt healthy behaviours and increase uptake of modern contraceptive.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01974-w.

Prevalence of adequate postnatal care and associated factors in Rwanda: evidence from the Rwanda demographic health survey 2020

Background

Although quality postnatal care (PNC) is a known significant intervention for curbing maternal and newborn morbidity and mortality, it is underutilized in most developing countries including Rwanda. Thus, it is crucial to identify factors that facilitate or occlude receipt of adequate PNC. This study aimed at assessing the prevalence of adequate PNC content and the associated factors in Rwanda.

Methods

We used weighted data from the Rwanda Demographic and Health Survey (RDHS) of 2020, comprising of 4456 women aged 15–49 years, who were selected using multistage sampling. Adequate PNC was considered if a woman had received all of the five components; having the cord examined, temperature of the baby measured, counselling on newborn danger signs, counselling on breastfeeding and having an observed breastfeeding session. We, then, conducted multivariable logistic regression to explore the associated factors, using SPSS version 25.

Results

Out of the 4456 women, 1974 (44.3, 95% confidence interval (CI): 43.0–45.9) had received all the PNC components. Having no radio exposure (adjusted odds ratio (AOR) =1.41, 95% CI: 1.18–1.68), visited by a fieldworker (AOR = 1.35, 95% CI: 1.16–1.57), no big problem with distance to a health facility (AOR = 1.50, 95% CI:1.24–1.81), and residing in the Southern region (AOR = 1.75, 95% CI: 1.42–2.15) were associated with higher odds of adequate PNC compared to their respective counterparts. However, having no exposure to newspapers/magazines (AOR = 0.74, 95% CI: 0.61–0.89), parity of less than 2 (AOR = 0.67, 95% CI: 0.51–0.86), being a working mother (AOR = 0.73, 95% CI: 0.62–0.85), no big problem with permission to seek healthcare (AOR = 0.54, 95% CI: 0.36–0.82), antenatal care (ANC) frequency of less than 4 times (AOR = 0.79, 95% CI: 0.62–0.85), inadequate ANC quality (AOR = 0.56, 95% CI: 0.46–0.68), and getting ANC in a public facility (AOR = 0.57, 95% CI: 0.38–0.85) were associated with lower odds of adequate PNC.

Conclusions

Less than half of the mothers in Rwanda had received adequate PNC, and this was associated with various factors. The results, thus, suggested context-specific evidence for consideration when rethinking policies to improve adequate PNC, including a need for intensified PNC education and counselling during ANC visits, continued medical education and training of PNC providers, and strengthening of maternal leave policies for working mothers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00964-6.

Magnitude and determinants of suicide among overweight reproductive-age women, Chacha and Debre Berhan Town, Ethiopia: community based cross-sectional study

Background

The magnitude and impact of women's suicidal behaviors, like suicidal ideation and suicidal attempts, are an important public health problem in low and middle-income countries, including Ethiopia. Suicidal behavior and being overweight are typical complications of reproductive age with many undesired consequences. Despite both having a serious impact on women of reproductive age, they are neglected in Ethiopia. Accordingly, this study aimed to examine the magnitude and determinants of suicide among overweight reproductive-age women in Chacha and Debre Berhan towns, Ethiopia.

Methods

A community-based cross-sectional study design was once employed from April 1, 2020 to June 1, 2020. The Composite International Diagnostic Interview was used to measure suicidal attempts and ideation, and the data was collected by direct interview. All collected data were entered into Epi Data version 4.6 and analyzed with SPSS version 25. Bivariate and multivariable regression models were used to determine the factors associated with a suicidal attempt and ideation. A p-value of less than 0.05 was considered statistically significant.

Result

Of the total participants, 523 were included, with a response rate of 93.7%. The prevalence of suicidal ideation was 13.0% (95% CI 10.1–15.9), whereas suicidal attempt was 2.3% (95% CI 1.1–3.6). Based on multivariable regression analysis, the odds of suicidal ideation have been higher among overweight women with stressful life events, depression, and younger age groups.

Conclusion

Suicidal ideation was frequent in overweight reproductive-age women. Preventing, treating, and using coping mechanisms regarding identified factors is a good way to minimize the burden of suicide.

Risk Factors for Maternal Body Mass Index and Gestational Weight Gain in Twin Pregnancies

Objective This retrospective cohort study analyzes risk factors for abnormal pre-pregnancy body mass index and abnormal gestational weight gain in twin pregnancies.

Methods Data from 10 603/13 682 twin pregnancies were analyzed using uni- and multivariable logistic regression models to determine risk factors for abnormal body mass index and weight gain in pregnancy.

Results Multiparity was associated with pre-existing obesity in twin pregnancies (aOR: 3.78, 95% CI: 2.71 – 5.27). Working in academic or leadership positions (aOR: 0.57, 95% CI: 0.45 – 0.72) and advanced maternal age (aOR: 0.96, 95% CI: 0.95 – 0.98) were negatively associated with maternal obesity. Advanced maternal age was associated with a lower risk for maternal underweight (aOR: 0.95, 95% CI: 0.92 – 0.99). Unexpectedly, advanced maternal age (aOR: 0.98, 95% CI: 0.96 – 0.99) and multiparity (aOR: 0.6, 95% CI: 0.41 – 0.88) were also associated with lower risks for high gestational weight gain. Pre-existing maternal underweight (aOR: 1.55, 95% CI: 1.07 – 2.24), overweight (aOR: 1.61, 95% CI: 1.39 – 1.86), obesity (aOR: 3.09, 95% CI: 2.62 – 3.65) and multiparity (aOR: 1.64, 95% CI: 1.23 – 2.18) were all associated with low weight gain. Women working as employees (aOR: 0.85, 95% CI: 0.73 – 0.98) or in academic or leadership positions were less likely to have a low gestational weight gain (aOR: 0.77, 95% CI: 0.64 – 0.93).

Conclusion Risk factors for abnormal body mass index and gestational weight gain specified for twin pregnancies are relevant to identify pregnancies with increased risks for poor maternal or neonatal outcome and to improve their counselling. Only then, targeted interventional studies in twin pregnancies which are desperately needed can be performed.

Socioeconomic inequalities in intergenerational overweight and obesity transmission from mothers to offsprings in South Africa

This study assesses socioeconomic inequality in the intergenerational transmission of overweight and obesity from mothers to offsprings in South Africa, including the factors contributing to inequality. Data were drawn from the 2017 National Income Dynamic Study, which collected anthropometric and socioeconomic information. Non-pregnant mothers aged 15–49 years and their offsprings 0–14 years were included in the analysis. The dependent variables used in the study were the intergenerational transmission of overweight and obesity. Socioeconomic inequality was assessed using the concentration index. A positive index means that intergenerational overweight and obesity is more likely among the wealthier populations, while a negative index signifies the opposite. The concentration index was decomposed to understand the factors that explain inequalities in the transmission of overweight and obesity from mothers to offsprings. Concentration indices for the intergenerational transmission of overweight and obesity were positive for boys (0.17) and girls (0.23). Thus the intergenerational transmission of overweight and obesity occurs more among wealthier mothers. Although factors explaining socioeconomic inequality in the intergenerational transmission of overweight and obesity differed by offspring sex, mother's marital status (+38%) and socioeconomic status (around +8%) were central determinants of socioeconomic inequalities in intergenerational overweight, while mother's smoking (around +25%), education (about +13%) and employment status (around +12%) contributed to intergenerational obesity inequality. Policies to reduce overweight and obesity burdens and the intergenerational transmission of overweight and obesity in South Africa should target women who bear a significant burden of overweight and obesity and could transmit them to their offsprings. The policies should also recognise the key factors explaining these socioeconomic inequalities. This approach will reduce the future burden of diseases associated with overweight and obesity in South Africa and improve the country's overall health outcomes.

•

Intergenerational overweight and obesity occurs more among richer mothers.

•

Mother's marital status influenced intergenerational overweight inequality.

•

Intergenerational obesity inequality was attributed to mother's smoking status.

•

Factors explaining intergenerational health inequalities differed by offspring sex.

Overweight and obesity and associated factors among adult ART patients at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia

BACKGROUND

Overweight and obesity complicates the care and treatment of ART patients and predispose them to chronic non-communicable diseases. However, there is a shortage of research evidence on overweight and obesity and its associated factors among adult ART patients in our setting. Therefore, this study aimed to asses overweight and obesity and associated factors among adult ART patients at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia.

METHODS

A facility-based cross-sectional study design was conducted by using systematic sampling technique. Primary and secondary data were collected from 369 adult ART patients from February to May 2017. Structured interviewer-administered questionnaire and laboratory outputs were used as primary data. The patient's baseline medical records were used as secondary data. Ethiopian Ministry of Health ART patient's follow-up tool was used to collect the required information. The standard laboratory and well-calibrated digital Seca Scale and portable Stadio-meter were used to collect medical and anthropometric data. Data were entered into Epi- data version 3.1 and exported to SPSS version 20 for analysis. Descriptive statistics were calculated and presented by tables, graphs and texts. Binary and multivariable logistic regression analyses were computed and the level of statistical significance was declared at p-value < 0.05.

RESULTS

The prevalence of overweight and obesity (BMI ≥ 25 kg/m2) was 43.4% (95% CI = 43.35, 43.45). The difference in the overweight and obesity between the study period and initial commencement of ART was 35%. The course of HIV chronic care since the commencement of ART and during the study was 35%. Higher recent CD4 counts (200-499cells/mm3) (AOR = 3.15, 95%CI = 1.04-9.49) and (≥ 500 cells/mm3) (AOR = 7.58, 95%CI = 2.49-23.08), hypertension (AOR = 2.57, 95%CI = 1.24-5.35), higher baseline BMI status (AOR = 5.93, 95%CI = 2.62-13.40) and abdominal obesity (AOR = 1.82, 95%CI = 1.07-3.10) were significantly associated with overweight and obesity.

CONCLUSION

In this study, a high prevalence of overweight and obesity among adult ART patients was reported compared to general adult population in Ethiopia. Overweight and obesity were significantly higher among hypertensive, with higher recent CD4 counts and abdominal obese ART patients. Thus, screening of overweight and obesity, incorporating nutritionist/dietician into the routine chronic care, and regular monitoring of the nutritional status of ART patients is recommended.

Factors associated with utilization of quality antenatal care: a secondary data analysis of Rwandan Demographic Health Survey 2020

Background

Over the last decade, progress in reducing maternal mortality in Rwanda has been slow, from 210 deaths per 100,000 live births in 2015 to 203 deaths per 100,000 live births in 2020. Access to quality antenatal care (ANC) can substantially reduce maternal and newborn mortality. Several studies have investigated factors that influence the use of ANC, but information on its quality is limited. Therefore, this study aimed to identify the determinants of quality antenatal care among pregnant women in Rwanda using a nationally representative sample.

Methods

We analyzed secondary data of 6,302 women aged 15–49 years who had given birth five years prior the survey from the Rwanda Demographic and Health Survey (RDHS) of 2020 data. Multistage sampling was used to select RDHS participants. Good quality was considered as having utilized all the ANC components. Multivariable logistic regression was conducted to explore the associated factors using SPSS version 25.

Results

Out of the 6,302 women, 825 (13.1%, 95% CI: 12.4–14.1) utilized all the ANC indicators of good quality ANC); 3,696 (60%, 95% CI: 58.6–61.1) initiated ANC within the first trimester, 2,975 (47.2%, 95% CI: 46.1–48.6) had 4 or more ANC contacts, 16 (0.3%, 95% CI: 0.1–0.4) had 8 or more ANC contacts. Exposure to newspapers/magazines at least once a week (aOR 1.48, 95% CI: 1.09–2.02), lower parity (para1: aOR 6.04, 95% CI: 3.82–9.57) and having been visited by a field worker (aOR 1.47, 95% CI: 1.23–1.76) were associated with more odds of receiving all ANC components. In addition, belonging to smaller households (aOR 1.34, 95% CI: 1.10–1.63), initiating ANC in the first trimester (aOR 1.45, 95% CI: 1.18–1.79) and having had 4 or more ANC contacts (aOR 1.52, 95% CI: 1.25–1.85) were associated with more odds of receiving all ANC components. Working women had lower odds of receiving all ANC components (aOR 0.79, 95% CI: 0.66–0.95).

Conclusion

The utilization of ANC components (13.1%) is low with components such as having at least two tetanus injections (33.6%) and receiving drugs for intestinal parasites (43%) being highly underutilized. Therefore, programs aimed at increasing utilization of ANC components need to prioritize high parity and working women residing in larger households. Promoting use of field health workers, timely initiation and increased frequency of ANC might enhance the quality of care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08169-x.

Inequalities in overweight and obesity among reproductive age group women in India: evidence from National Family Health Survey (2015-16)

Background

In developing nations like India, fertility and mortality have decreased, and diseases related to lifestyle have become more common. Females in India are more prone to being overweight and obese than their male counterparts, more specifically in affluent families than the poor ones. Understanding the overweight and obesity trend may help develop feasible public health interventions to reduce the burden of obesity and associated adverse health outcomes.

Methods

The study utilizes the fourth round of the National Family Health Survey (NFHS-4), 2015–16. Descriptive statistics, bivariate and multivariate analysis was used to check the significant relationship between overweight and obesity, and other background characteristics. Income-related inequality in overweight and obesity among women was quantified by the concentration index and the concentration curve. Further, Wagstaff decomposition analysis was done to decompose the concentration index, into the contributions of each factor to the income-related inequalities.

Results

Overweight & obesity among women had a significant positive association with their age and educational level. The odds of overweight and obesity were 57% more likely among women who ever had any caesarean births than those who did not [AOR: 1.57; CI: 1.53–1.62]. The likelihood of overweight and obesity was 4.31 times more likely among women who belonged to richest [AOR: 5.84; CI: 5.61–6.08] wealth quintile, than those who belonged to poor wealth quintile. Women who ever terminated the pregnancy had 20% higher risk of overweight and obesity than those who did not [AOR: 1.20; CI: 1.17–1.22]. The concentration of overweight and obesity among women was mostly in rich households of all the Indian states and union territories. Among the geographical regions of India, the highest inequality was witnessed in Eastern India (0.41), followed by Central India (0.36).

Conclusion

The study results also reveal a huge proportion of women belonging to the BMI categories of non-normal, which is a concern and can increase the risks of developing non-communicable diseases. Hence, the study concludes and recommends an urgent need of interventions catering to urban women belonging to higher socio-economic status which can reduce the risks of health consequences due to overweight and obesity. Development nutrition-specific as well as sensitive interventions can be done for mobilization of local resources that addresses the multiple issues under which a woman is overweight or obese.

Regional education and wealth-related inequalities in malnutrition among women in Bangladesh

OBJECTIVES

This paper examines the associations of socio-economic and demographic correlates with malnutrition among women and investigates education and wealth-related inequalities in malnutrition among women by region.

DESIGN

We utilise a two-level mixed-effects logistic regression model to evaluate the associations and employ the concentration, Wagstaff and Erreygers's correction indices to measure socio-economic inequalities in malnutrition among women.

SETTING

Bangladesh Demographic and Health Survey data.

PARTICIPANTS

Non-pregnant women aged 15-49 years.

RESULTS

We find evidence of a significant cluster effect in the data. Women's age, marital status, total children ever born, education level, husband's/partner's education level, residence and wealth index appear to be significantly associated with women underweight and overweight/obesity status. Underweight status is higher among less-educated women and women from poor households, whereas overweight/obesity is more concentrated among higher educated women and women from wealthy households. The southwestern region of the country demonstrates lower education and wealth-related inequalities in malnutrition among women. In contrast, the central and the northeastern areas apparently experience the highest education and wealth-related inequalities in malnutrition among women. The regional differences in predicted probabilities of being underweight shrink at higher education level and the richest quintile, whereas the differences in overweight/obese diminish at the primary education level and lower quintile households.

CONCLUSIONS

Our findings strengthen the evidence base for effective regional policy interventions to mitigate education and wealth-related inequalities in malnutrition among women. There is a need for developing regional awareness programmes and establishing regional monitoring cells to ensure proper health and nutrition facilities in underprivileged regions.

Household Solid Fuel Use and Associated Factors in Ethiopia: A Multilevel Analysis of Data From 2016 Ethiopian Demographic and Health Survey

Solid fuels are types of fuel that comprise coal, biomass, charcoal, wood, or straw and are used for cooking, heating, lighting, boiling water, and generating revenue at home. Globally, 3 billion of the world's poorest people continue to rely on inefficient solid fuels, which produce health-damaging contaminants. In Ethiopia, more than 90% of households rely on wood as their primary source of energy. The actual and potential determinants of solid fuel use have not been fully identified, particularly at the national level in Ethiopia. Therefore, this study aimed to determine the magnitude of solid fuel use and its associated factors in Ethiopia. We used the Ethiopian Demographic and Health Survey (EDHS), which was conducted in 2016. The data was conducted using a 2-stage stratified cluster sampling approach. A total of 16 650 weighted samples were taken. Multilevel logistic regression models were fitted to identify factors associated with solid fuel use, and a cluster-level random intercept was introduced in the mixed model. An adjusted odds ratio with a 95% confidence level was reported to show the strength of the association and its significance. The goodness of fit of the model was checked using proportional change deviance (PCV). The magnitude of solid fuel use among households in Ethiopia was 94.03% (95% CI = 93.66, 94.37). Household heads completed in primary school (AOR, 3.09, 95% CI = 2.44, 3.91), outdoor cooking places (AOR, 4.13, 95% CI = 2.96, 5.76), and small peripheral regions (AOR, 14.44, 95% CI = 6.12, 34.04) were all significantly associated with solid fuel use. The intra-cluster correlation coefficient (ICC) showed that about 81% of the variations in the use of solid fuel were attributed to the difference at the 643 cluster level, but the remaining 19% were attributed to individual household factors. The PCV was 90%, which showed that the variation in solid fuel use among study households was explained by factors at both the individual and community levels. The deviation test of the fourth model had the lowest value (3528) and was chosen as the best-fitted model. Due to different influencing factors, the use of solid fuel is still high in Ethiopia. Promoting access to education and raising awareness toward solid fuel impact is very important.

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.

Individual and community-level determinants of non-use of contraceptive among women with no fertility desire in Ethiopia: a multilevel mixed-effect analysis

BACKGROUND

In Ethiopia, about two-third of women in the reproductive-age do not use any method of contraception. Moreover, evidence on non-use of contraceptives among women who do not have future fertility desires are limited. Therefore, this study intended to identify both individual and community-level determinants of non-use of contraceptives among this group in Ethiopia using a multilevel mixed effect analysis.

METHODS

Data retrieved from the demographic and health survey program official database website ( http://dhsprogram.com ) were used in this study. The suvey was conducting using a multistage cluster sampling technique and a weighted sample of 4398 reproductive-age women with no fertility desire was used in this study. Four models were fitted using a multilevel multivariable logistic regression to identify determinants of non-use of contraceptives and model with the lowest Akaike's Information Criterion was selected as a best fitted model. Adjusted odds ratio with its corresponding 95% confidence interval was used to declare the statistical significance of the independent variables.

RESULTS

Overall, 65.3% [95% CI (63.9%, 66.7%)] of women with no fertility desire were not using any contraceptive method. Living in large central [AOR (95% CI)  0.45 (0.31, 0.67)] and metropolitan regions [AOR (95% CI) 0.39 (0.22, 0.68)] and being from household with middle [AOR (95% CI)  0.65 (0.42, 0.93)] and rich wealth index [AOR (95% CI)  0.67 (0.44, 0.98)] were negatively associated with non-use of contraceptives. Besides, being from a community with high women illiteracy [AOR (95% CI)  1.38 (1.15, 1.67)], being Muslim [AOR (95% CI)  1.86 (1.22, 2.85)], having history of pregnancy termination [AOR (95% CI) 1.59 (1.10, 2.31)], having a husband who desire to have more children [AOR (95% CI)  1.46 (1.02, 2.09)] were the positive determinants of non-utilization of contraceptives.

CONCLUSION

Nearly two-third of reproductive-age women with no fertility desire in Ethiopia do not use any contraceptive method. Awareness creation interventions on the benefits of contraceptives targeting Muslim religion followers and improving women education and their economic empowerment at household level may decrease the proportion of non-use of contraceptives at a national level.

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

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

Overweight and obesity in non-pregnant women of childbearing age in South Africa: subgroup regression analyses of survey data from 1998 to 2017

Background

Overweight and obesity in adults are increasing globally and in South Africa (SA), contributing substantially to deaths and disability from non-communicable diseases. Compared to men, women suffer a disproportionate burden of obesity, which adversely affects their health and that of their offspring. This study assessed the changing patterns in prevalence and determinants of overweight and obesity among non-pregnant women in SA aged 15 to 49 years (women of childbearing age (WCBA)) between 1998 and 2017.

Methods

This paper conducts secondary data analysis of seven consecutive nationally representative household surveys—the 1998 and 2016 SA Demographic and Health Surveys, 2008, 2010–2011, 2012, 2014–2015 and 2017 waves of the National Income Dynamics Survey, containing anthropometric and sociodemographic data. The changing patterns of the overweight and obesity prevalence were assessed across key variables. The inferential assessment was based on a standard t-test for the prevalence. Adjusted odds ratios from logistic regression analysis were used to examine the factors associated with overweight and obesity at each time point.

Results

Overweight and obesity prevalence among WCBA in SA increased from 51.3 to 60.0% and 24.7 to 35.2%, respectively, between 1998 and 2017. The urban-rural disparities in overweight and obesity decreased steadily between 1998 and 2017. The prevalence of overweight and obesity among WCBA varied by age, population group, location, current smoking status and socioeconomic status of women. For most women, the prevalence of overweight and/or obesity in 2017 was significantly higher than in 1998. Significant factors associated with being overweight and obese included increased age, self-identifying with the Black African population group, higher educational attainment, urban area residence, and wealthier socioeconomic quintiles. Smoking was inversely related to being overweight and obese.

Conclusions

The increasing trend in overweight and obesity in WCBA in SA demands urgent public health attention. Increased public awareness is needed about obesity and its health consequences for this vulnerable population. Efforts are needed across different sectors to prevent excessive weight gain in WCBA, focusing on older women, self-identified Black African population group, women with higher educational attainment, women residing in urban areas, and wealthy women.

Central Obesity and Associated Factors Among Urban Adults in Dire Dawa Administrative City, Eastern Ethiopia

BACKGROUND

Central obesity (CO) is a medical problem in which extra fat is accumulated in the abdomen and stomach extent that it may harm health. Furthermore, previous studies in Ethiopia predominantly relied on body mass index used to measure obesity and do not show distribution of fat. However, there is a paucity of information on the measurement of central obesity using waist circumference and associated factors in Ethiopia particularly in the study area. Hence, the purpose of this study is to assess the prevalence of central obesity and associated factors among urban adults in Dire Dawa, administrative city, Eastern Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 633 adults in selected kebeles of administrative city from October 15 to November 15, 2020. A multistage and systematic sampling procedure was used to select study participants. Central obesity is defined as a condition with waist circumference ≥83.7 cm for men and ≥78 cm for women with or without general obesity (GO). Odds ratio along with 95% confidence interval was estimated to identify factors associated with central obesity using multiple logistic regression analysis.

RESULTS

The overall prevalence of central obesity was 76.1%; at 95% CI (73%, 80%). Associated factors of central obesity were age 45 years and above [AOR = 3.75, 95% CI (1.86, 7.55)], being female [AOR = 2.52, 95% CI: (1.62, 3.94)], alcohol consumption [AOR = 2.61, 95% CI: (1.69, 4.05], physical inactivity [AOR = 2.05, 95% CI: (1.23, 3.42)], and two hour and more time spent on watching television [AOR = 3.30, 95% CI: (1.59, 6.82)].

CONCLUSION

The study shows central obesity was high in the study area. Age 45 years and above, being females, married, physically inactive, alcohol consumption, and spending a long time watching television was associated with central obesity. Having regular physical activity, limiting alcohol drinking, and limiting time spent watching television were recommended to prevent central obesity and associated risk among adults.

Prevalence and factors associated with underweight, overweight and obesity among 15-49-year-old men and women in Timor-Leste

Background

Underweight and overweight both have a long-lasting significant effect on human health at the individual and population levels. However, in the context of Timor-Leste, a country that achieved independence around two decades ago, there is a severe scarcity of evidence regarding the underweight and obesity burden. We conducted this study to find out the prevalence of underweight, overweight and obesity and their associated factors.

Methods

This study used the nationally representative data of Timor-Leste Demographic Health Survey 2016 data. We conducted descriptive analysis followed by multivariable logistic regression analysis to find out the prevalence and investigate the associated factors. Both crude and adjusted odds ratio of covariates were reported with 95% confidence interval (CI).

Results

This study analyzed the data from a weighted sample of 16,488 Timorese aged 15–49 years. The prevalence of normal weight, underweight, and overweight or obesity were found to be 55.2% (95% CI: 54.2%-56.2%), 25.5% (95% CI: 24.4%-26.7%), and 19.3% (95% CI: 18.3%-20.3%), respectively. For underweight, age, sex, type of settlement (urban/rural), township, and wealth, marital, and educational status were found to have a statistically significant relationship (p < 0.05) with Body Mass Index(BMI). After adjustment for the covariates in the logistic regression model age, sex, township, and wealth and marital status were found to be statistically significant correlates (p < .05) of underweight. For overweight and obesity, all the background characteristics included in this study (i.e, age, sex, type of settlement, township, and wealth, marital, and educational status) were found to be statistically significant correlates, after adjustment for the covariates.

Conclusion

This study concludes that Timor-Leste has a significant underweight and overweight burden which needs to be addressed through appropriate interventions. Further studies are also warranted to delve deeper into the complex interplay of factors associated with underweight and overweight.

Married women’s decision-making autonomy on contraceptive use and its associated factors in Ethiopia: A multilevel analysis of 2016 demographic and health survey

Introduction:

Women’s decision-making autonomy has a positive effect on the scale-up of contraceptive use. In Ethiopia, evidence regarding women’s decision-making autonomy on contraceptive use and associated factors is limited and inconclusive. Therefore, this study was intended to assess married women’s decision-making autonomy on contraceptive use and associated factors in Ethiopia using a multilevel logistic regression model.

Methods:

The study used data from the 2016 Ethiopia Demographic and Health Survey that comprised of a weighted sample of 3668 married reproductive age women (15–49 years) currently using contraceptives. A multilevel logistic regression model was fitted to identify factors affecting married women’s decision-making autonomy on contraceptive use. Akaike’s information criterion was used to select the best-fitted model.

Results:

Overall, 21.6% (95% confidence interval = 20.3%–22.9%) of women had decision-making autonomy on contraceptive use. Community exposure to family planning messages (adjusted odds ratio = 2.22, 95% confidence interval = 1.67–3.05), media exposure (adjusted odds ratio = 2.13, 95% confidence interval = 1.52–3.23), age from 35 to 49 years (adjusted odds ratio = 2.09, 95% confidence interval = 1.36–4.69), living in the richer households (adjusted odds ratio = 1.67, 95% confidence interval = 1.32–3.11), and visiting health facility (adjusted odds ratio = 2.01, 95% confidence interval = 1.34–3.87) were positively associated with women’s decision-making autonomy on contraceptive use. On the contrary, being Muslim (adjusted odds ratio = 0.53, 95% confidence interval = 0.29–0.95), being married before the age of 18 years (adjusted odds ratio = 0.33, 95% confidence interval = 0.12–0.92), and residing in rural residence (adjusted odds ratio = 0.48, 95% confidence interval = 0.23–0.87) were negatively associated with women’s independent decision on contraceptive use.

Conclusion:

Less than one-fourth of married reproductive age women in Ethiopia had the decision-making autonomy on contraceptive use. Media exposure, women’s age, household wealth, religion, age at marriage, visiting health facilities, community exposure to family planning messages, and residence were the factors associated with women’s decision-making autonomy on contraceptive use. The government should promote women’s autonomy on contraceptive use as an essential component of sexual and reproductive health rights through mass media, with particular attention for adolescent women, women living in households with poor wealth, and those residing in rural settings.

Overweight and Its Associated Factors among Women of Reproductive Age in Dire Dawa, Eastern Ethiopia, 2021: Community-Based Cross-Sectional Study

BACKGROUND

Overweight in women of reproductive age is a major public health concern in developing countries because of overconsumption of low-quality food. Currently, being overweight is a major health concern worldwide. It exposes humans to various health problems. In Ethiopia, despite the trend indicated increasing in overweight, priority is given for undernutrition. In Dire Dawa, there is scarce evidence regarding reproductive age overweight. Therefore, this study is designed to assess the prevalence of overweight and its associated factors among women of reproductive age in eastern Ethiopia.

METHODS

A community-based cross-sectional study was conducted from May 15 to June 15, 2021, in Dire Dawa, Eastern Ethiopia; a multi-stage systematic sampling technique was used to select 559 women aged 15-49 years. Data were collected through face-to-face interviews using a structured pretested questionnaire. Ninety-five percent CI was used to identify the factors associated with overweight while controlling for all possible confounders using multivariable logistic regression. Statistical significance was set at a P-value of 0.05.

RESULTS

The results of this study revealed that the prevalence of overweight was 63.1% (95% CI: 59.0, 67.2). Overweight was significantly associated with weekly discretionary calories (AOR = 3.964, 95% CI (1.131, 13.894)), contraceptive use (AOR = 2.838, 95% CI (1.443, 5.580)), and monthly family income (AOR = 3.916, 95% CI (1.352, 11.340)).

CONCLUSION

Overweight among women of reproductive age was high in Dire Dawa city. Discretionary calories per week, family monthly income, and contraceptive use were significantly associated with overweight. Developing and implementing community-based culturally sensitive, feasible, and potentially high-impact intervention to address the modifiable risk factors among women of reproductive age is critical.

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

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

Underweight, Overweight and Obesity among Reproductive Bangladeshi Women: A Nationwide Survey

The double burden of malnutrition is becoming more prevalent among Bangladeshi women. Underweight, overweight, and obesity were examined among women aged 15-49 years using the 2017-2018 Bangladesh Demographic and Health Survey (BDHS). A dataset of 20,127 women aged 15-49 years with complete Body Mass Index (BMI) measurements were extracted and categorized as underweight, normal weight, overweight, and obesity. A multiple logistic regression that adjusts for clustering and sampling weights was used to examine underweight, overweight, and obesity among reproductive age Bangladeshi women. Our analyses revealed that the odds of being overweight and obese were higher among women who completed primary and secondary or more levels of education, rich households, breastfeeding women, and women exposed to media (newspapers and television (TV). Women from the poorest households were significantly more likely to be underweight (AOR = 3.86, 95%CI: 2.94-5.07) than women from richer households. The likelihood of being underweight was higher among women with no schooling, adolescent women, and women not using contraceptives. Conclusions: Overweight and obesity was higher among educated and affluent women while underweight was higher among women from low socioeconomic status, indicating that tailored messages to combat overweight and obesity should target educated and affluent Bangladeshi women while improving nutrition among women from low socioeconomic status.

Metabolic risk factors for non-communicable diseases in Ethiopia: a systematic review and meta-analysis

OBJECTIVES

Non-communicable diseases (NCDs) are causing a new and yetsignificant health challenge in low-income countries. In Ethiopia, although 39% of deaths are NCD related, the health system remains underprepared, highlighting the clear need for evidence on risk factor distributions to inform resource planning and the health response. Therefore, this review investigates prevalence distributions and sex and age variations of metabolic risk factors among Ethiopian adults.

RESEARCH DESIGN AND METHODS

This systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published until 6 January 2021 were searched from PubMed, Scopus, ProQuest and Web of Science databases, reference lists of selected studies and grey literature. Studies reporting prevalence of metabolic risk factors: overweight/obesity, hypertension, impaired glucose homoeostasis and metabolic syndrome among Ethiopian adults were eligible for this systematic review and meta-analysis. Two authors independently extracted data and used the Joanna Briggs Institute tool for quality appraisal. The random effects model was used to conduct meta-analysis using Stata V.16. Subgroup analyses examined prevalence differences by region, study year, sample size and settings.

RESULTS

From 6087 records, 74 studies including 104 382 participants were included. Most showed high prevalence of metabolic risk factors. Meta-analysis revealed pooled prevalence of metabolic risk factors from 12% to 24% with the highest prevalence observed for overweight/obesity (23.9%, 95% CI 19.9% to 28.0%) and hypertension (21.1%, 95% CI 18.7% to 23.5%), followed by metabolic syndrome (14.7%, 95% CI 9.8% to 19.6%) and impaired glucose tolerance (12.4%, 95% CI 8.7% to 16.1%). The prevalence of overweight/obesity was higher in women. All metabolic risk factors were higher among people aged above 45 years.

CONCLUSIONS

A signficant proportion of Ethiopian adults have at least one metabolic risk factor for NCDs. Despite heterogeneity of studies limiting the certainty of evidence, the result suggests the need for coordinated effort among policymakers, healthcare providers, non-governmental stakeholders and the community to implement appropriate preventive measures to reduce these factors.

Malnutrition and contributing factors among newborns delivered at the University of Gondar Hospital, Northwest Ethiopia: a cross-sectional study

OBJECTIVES

To estimate the prevalence of various indicators of malnutrition (stunting, wasting, low birth weight, concurrent stunting and wasting, overweight/obesity and double burden malnutrition) among newborns and to investigate factors associated with these nutritional disorders.

METHODS

A hospital-based cross-sectional study was conducted from 10 March through to May 2020. A total of 419 newborns were recruited into the study to estimate the prevalence of low birth weight and stunting. After excluding 28 newborns whose length was less than 45 cm, 394 newborn-mother dyads were approached to estimate wasting and overweight/obesity. A systematic random sampling technique was used to select participants. All independent variables were entered into the multivariable logistic regression model and variables that had significant associations were identified based on a p value.

RESULTS

A very small proportion of the newborns 2.5% (0.9% to 4.1%) were concurrently wasted and stunted. The prevalence rates of low birth weight and wasting were 20.8% (16.8% to 24.6%) and 10.9% (7.82% to 14.01%), respectively. The magnitude of overweight/obesity was 12.7% (9.3% to 15.9%) where 2.8% (1.1% to 4.4%) of newborns have the double burden of malnutrition. Having a father with a primary level of education 2.82 (1.19 to 6.65) and being stunted at birth 3.17 (1.6 to 6.0) were variables that were associated with increased odds of low birth weight. The odds of being overweight/obese are significantly higher among newborns born to mothers who are urban dwellers 0.35 (0.12 to 0.99).

CONCLUSIONS

The study underscores that malnutrition is a pressing public health concern that demands due emphasis. Fathers' educational status (low level) and being stunted are associated with a high burden of low birth weight. Mothers' residency (being urban) is associated with an elevated risk of overweight/obesity among newborns. Thus, improving the health literacy of fathers and preventing stunting at birth are recommended to mitigate low birth weight.

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

Background

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

Methods

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

Results

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

Conclusion

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

Over-nutrition and associated factors among 20 to 49-year-old women in Uganda: evidence from the 2016 Uganda demographic health survey

Introduction

low- and middle-income countries are currently faced with a double burden of malnutrition. There has, however, been little focus on research and interventions for women with over-nutrition. We aimed to determine the prevalence and factors associated with over-nutrition among 20 to 49-year-old women in Uganda.

Methods

we used the Uganda demographic and health survey (UDHS) 2016 data of 4,640 women. We analysed data using SPSS (version 25), and we used multivariable logistic regression to determine factors associated with over-nutrition among 20 to 49-year-old women in Uganda.

Results

the prevalence of over-nutrition was 28.2% (95% confidence interval (CI): 26.8-29.4) with overweight at 19.3% and obesity at 8.9%. Women belonging to the poorer (adjusted odds ratio (AOR)=1.63; 95% CI: 1.17-2.28), middle (AOR=2.24; 95% CI: 1.61-3.13), richer (AOR=3.02; 95% CI: 2.14-4.25) and richest (AOR=6.35; 95% CI: 4.52-8.93) wealth index quintiles were more likely to be over-nourished compared to women in the poorest wealth index quintile. Married women (AOR=1.52; 95% CI: 1.26-1.83) were more likely to be over-nourished compared to non-married women. Older women were more likely to be over-nourished compared to younger women. Women in the Western (AOR=2.12; 95% CI: 1.66-2.71), Eastern (AOR=1.40; 95% CI: 1.04-1.88) and Central (AOR=2.25; 95% CI: 1.69-2.99) regions were more likely to be over-nourished compared to women in the Northern region.

Conclusion

the design of multi-faceted over-nutrition reduction programs with an emphasis on older, married, financially stable women, and those living in the Western, Eastern and Central regions of the country is needed.

Factors associated with health facility utilization during childbirth among 15 to 49-year-old women in Uganda: evidence from the Uganda demographic health survey 2016

BACKGROUND

Almost all maternal deaths and related morbidities occur in low-income countries. Childbirth supervised by a skilled provider in a health facility is a key intervention to prevent maternal and perinatal morbidity and mortality. Our study aimed to establish the factors associated with health facility utilization during childbirth in Uganda.

METHODS

We used the Uganda Demographic and Health Survey 2016 data of 10,152 women aged 15 to 49 years. The study focused on their most recent live birth in 5 years preceding the survey. We applied multistage stratified sampling to select study participants and we conducted multivariable logistic regression to establish the factors associated with health facility utilization during childbirth, using SPSS (version 25).

RESULTS

The proportion of women who gave birth at a health facility was 76.6% (7780/10,152: (95% confidence interval, CI, 75.8-77.5). The odds of women aged 15-19 years giving birth at health facilities were twice as those of women aged 40 to 49 years (adjusted odds ratio, AOR = 2.29; 95% CI: 1.71-3.07). Residing in urban areas and attending antenatal care (ANC) were associated with health facility use. The odds of women in the northern region of Uganda using health facilities were three times of those of women in the central region (AOR = 3.13; 95% CI: 2.15-4.56). Women with tertiary education (AOR = 4.96; 95% CI: 2.71-9.11) and those in the richest wealth quintile (AOR = 4.55; 95% CI: 3.27-6.32) had higher odds of using a health facility during child birth as compared to those with no education and those in the poorest wealth quintile, respectively. Muslims, Baganda, women exposed to mass media and having no problem with distance to health facility had higher odds of utilizing health facilities during childbirth as compared to Catholic, non Baganda, women not exposed to mass media and those having challenges with distance to access healthcare.

CONCLUSION

Health facility utilization during childbirth was high and it was associated with decreasing age, increasing level of education and wealth index, urban residence, Northern region of Uganda, ANC attendance, exposure to mass media, tribe, religion and distance to the nearby health facility. We recommend that interventions to promote health facility childbirths in Uganda target the poor, less educated, and older women especially those residing in rural areas with less exposure to mass media.

Overweight and obesity among non-pregnant women of reproductive age in Nigeria: findings from the 2008-2018 Nigerian Demographic and Health Survey

OBJECTIVES

Overweight and obesity are known risk factors for diabetes, heart disease, certain cancers and pregnancy-related problems. This study aimed to determine the prevalence and change in prevalence of overweight and obesity among non-pregnant women of reproductive age and relationship with individual- and community-level factors over a decade.

STUDY DESIGN

This was a cross-sectional survey with two-stage probability sampling design.

METHODS

Data sets were pooled from the 2008, 2013 and 2018 Nigerian Demographic and Health Survey - a cross-sectional, nationally representative sample of the entire Nigerian population aged 15-49 years. Body mass index (BMI) was used to classify overweight and obesity. Multilevel logistic regression was used to assess associations between overweight (25.0-29.9 kg/m²), obesity (≥30.0 kg/m²) and individual and community factors.

RESULTS

There were 76,729 non-pregnant women (38.0% in 2008, 44.5% in 2013 vs 17.5% in 2018) with a mean age of 29.0 years and a BMI of 23.0 kg/m² across the three survey periods. Overweight and obesity prevalence were 16.0% and 6.2% in 2008, 17.2% and 7.5% in 2013 and 18.1% and 9.9% in 2018, respectively. There was 76% (95% confidence interval: 44% to twofold) increased odds of obesity in 2018 compared with 2008 in adjusted analysis. Older women with at least primary education living in urban areas, ever married and from wealthier households are at a greater odd of being overweight and obese.

CONCLUSION

Over a decade, overweight and obesity prevalence increased among non-pregnant women of reproductive age in Nigeria. There is an urgent need for public health strategies and interventions to improve on deficient knowledge and low awareness about healthy foods and physical activity at individual and community levels especially in urban areas.

Epidemiology, risk factors, social determinants of health, and current management for non-alcoholic fatty liver disease in sub-Saharan Africa

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease globally and is estimated to affect approximately 25% of the world's population. Data about the prevalence and incidence of NAFLD in Africa are scarce, but the prevalence is estimated to be 13·5% for the general population. This is likely to be an underestimate considering the increasing burden of non-communicable diseases, particularly the rising prevalence of obesity and type 2 diabetes, driven by the overlapping challenges of food insecurity, nutritional transition, and associated increased consumption of calorie-dense foods. Establishing the true prevalence of NAFLD, raising public awareness around the risk factors behind the increase in NAFLD, and proactively addressing all components of metabolic syndrome will be important to combat this silent epidemic, which will have long-term health-care costs and economic consequences for the region.

Observed magnitude and trends in socioeconomic and geographic area inequalities in obesity prevalence among non-pregnant women in Chad: evidence from three waves of Chad demographic and health surveys

BACKGROUND

While the prevalence of obesity is increasing worldwide, the growing rates of overweight and obesity in developing countries are disquieting. Obesity is widely recognized as a risk factor for non-communicable diseases (NCDs), including diabetes, cancer and cardiovascular diseases. Available evidence on whether obesity has been more prevalent among higher or lower socioeconomic groups, across regions and urban-rural women's are inconsistent. This study examined magnitude of and trends in socioeconomic, urban-rural and sub-national region inequalities in obesity prevalence among non-pregnant women in Chad.

METHOD

Using cross-sectional data from Chad Demographic and Health Surveys (DHSs) conducted in 1996, 2004 and 2014; we used the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) to analyze socio-economic, urban-rural and regional inequalities in obesity prevalence among non-pregnant women aged 15-49 years. Inequalities were assessed using four equity stratifiers namely wealth index, educational level, place of residence and subnational region. We presented inequalities using simple and complex as well as relative and absolute summary measures such as Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF) and Ratio (R).

RESULTS

Though constant pattern overtime, both wealth-driven and place of residence inequality were observed in all three surveys by Difference measure and in the first and last surveys by Ratio measure. Similarly, including the recent survey (D = -2.80, 95% CI:-4.15, - 1.45, R = 0.37, 95% CI: 0.23, 0.50) absolute (in 1996 & 2014 survey) and relative (in all three surveys) educational status inequality with constant pattern were observed. Substantial absolute (PAR = -2.2, 95% CI: - 3.21, - 1.34) and relative (PAF = - 91.9, 95% CI: - 129.58, - 54.29) regional inequality was observed with increasing and constant pattern by simple (D) and complex (PAR, PAF) measures.

CONCLUSION

The study showed socioeconomic and area-based obesity inequalities that disfavored women in higher socioeconomic status and residing in urban areas. Prevention of obesity prevalence should be government and stakeholders' priority through organizing the evidence, health promotion and prevention interventions for at risk population and general population.

Risk factors for overweight and obesity among women of reproductive age in Dar es Salaam, Tanzania

Background

Overweight and obesity have increased considerably in low- and middle-income countries over the past few decades, particularly among women of reproductive age. This study assessed the role of physical activity, nutrient intake and risk factors for overweight and obesity among women in Dar es Salaam, Tanzania.

Methods

We conducted a cross-sectional survey among 1004 women aged 15–49 years in the Dar es Salaam Urban Cohort Study (DUCS) from September 2018 to January 2019. Dietary intake was assessed using a food frequency questionnaire (FFQ). Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) using metabolic equivalent tasks (MET). Modified poison regression models were used to evaluate associations between physical activity and nutrient intake with overweight/obesity in women, controlling for energy and other factors.

Results

The mean (±SD) age of study women was 30.2 (±8.1) years. Prevalence of overweight and obesity was high (50.4%), and underweight was 8.6%. The risk of overweight/obesity was higher among older women (35–49 vs 15–24 years: PR 1.59; 95% CI: 1.30–1.95); women of higher wealth status (PR 1.24; 95% CI: 1.07–1.43); and informally employed and married women. Attaining moderate to high physical activity (≥600 MET) was inversely associated with overweight/obesity (PR 0.79; 95% CI: 0.63–0.99). Dietary sugar intake (PR 1.27; 95% CI: 1.03–1.58) was associated with increased risk, and fish and poultry consumption (PR 0.78; 95% CI: 0.61–0.99) with lower risk of overweight/obesity.

Conclusion

Lifestyle (low physical activity and high sugar intake), age, wealth status, informal employment and marital status were associated with increased risk of overweight/obesity, while consumption of fish and poultry protein was associated with lower risk. The study findings underscore the need to design feasible and high-impact interventions to address physical activity and healthy diets among women in Tanzania.

Individual and community-level determinants of Iron-Folic Acid Intake for the recommended period among pregnant women in Ethiopia: A multilevel analysis

Background

Iron-folic acid (IFA) intake for the recommended period during pregnancy reduces the risk of anemia and congenital anomalies. However, IFA intake for the recommended period is still very low in low-income countries including Ethiopia. Thus, the aim of this study was to assess both individual-and community-level determinants of IFA intake for the recommended period among pregnant women in Ethiopia.

Methods

Data were retrieved from the Demographic and Health Survey program's official database website (http://dhsprogram.com). A two-stage stratified cluster sampling technique was employed to conduct the 2016 Ethiopian Demographic and Health Survey. A sample of 3088 pregnant women who had received at least one dose of IFA in Ethiopia were included in this study. A multivariable multilevel logistic regression analysis model was fitted to identify the determinants of IFA intake below the recommended period [< 90 days] during pregnancy. Akaike's Information Criterion (AIC) was used during the model selection procedure.

Results

This study revealed that 87.6% [95% CI; 86.3%, 88.6%] of the women took IFA below the recommended period during the index pregnancy. After adjusting for the covariates: living in rural areas [AOR = 1.74: 95% CI 1.37, 2.50], and women's illiterate proportion [AOR = 1.43: 95% CI 1.06, 1.70] were community level factors. Whereas, primary education level [AOR = 0.63: 95% CI 0.40, 0.78], poorer wealth index [AOR = 1.53: 95% CI 1.08, 3.09], 4 + antenatal care visits [AOR = 0.43: 95% CI 0.31, 0.69], and receive nutritional counseling during pregnancy [AOR = 0.63: 95% CI 0.37, 0.84] were the individual-level factors of IFA intake below the recommended period during pregnancy.

Conclusions

In this study, nearly nine out of ten pregnant women did not take IFA for the recommended period. Thus, promoting recommended ANC visits, enhancing the quality of nutritional counseling, strengthening the expansion of media, and educate rural women towards the importance of optimal intake of IFA during pregnancy. Besides, the policymakers should design essential strategies based on identified barriers to improve the IFA intake for the recommended period.