Risk factors and morbidities associated with childhood obesity in sub-Saharan Africa: a systematic scoping review

Consumption frequency of ultra-processed foods and beverages among 6- to 36-month-olds in Kampala, Uganda

The nutrition transition in sub-Saharan Africa has led to increased consumption of ultra-processed foods in infancy, especially sweet foods. This has heightened the risk for nutrition-related non-communicable diseases, including dental caries and overweight/obesity, and promotes poor food choices later in life. The present study used a cross-sectional design to investigate the consumption frequency of ultra-processed foods and beverages among urban 6- to 36-month-olds attending four selected health facilities in Kampala using a standardised questionnaire and 24-h diet recall record. The primary outcome was the consumption of at least one ultra-processed food or beverage (UPFB) the previous day, and frequency of UPFB consumption of the week before was the secondary outcome. Four hundred and ten caregiver-child pairs were randomly recruited, 94% of caregivers being mothers with a mean age of 30.7 (±5.3) years. Fifty-nine per cent of mothers and 73% of fathers had attained a college education. The median age of children was 18 months and 51% were female. Most children (57%) consumed at least one UPFB the previous day. In the week before, 69% had consumed UPFB frequently (4-7 days) which was significantly positively associated with maternal education (odds ratio [OR] = 2.85, 95% confidence interval [CI]: 1.02-7.96, p = 0.045) and child's age ([OR = 2.87, 95% CI: 1.62-5.08, p < 0.001], [OR = 3.68, 95% CI: 1.88-7.20, p < 0.001]). In conclusion, the dietary habits of the surveyed Ugandan population were unhealthy, characterised by the frequent consumption of UPFB with added sugar. There is an urgent need to re-enforce existing Ugandan food regulation guidelines and policies and to build strong nutritional education programmes to enhance health-promoting environments in early childhood.

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

BACKGROUND

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

OBJECTIVE

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

ELIGIBILITY CRITERIA

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

SOURCES OF EVIDENCE

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

CHARTING METHODS

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

RESULTS

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

CONCLUSION

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

PROTOCOL REGISTRATION

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

Predictors of obesity among school-age children in Debre Berhan City, Ethiopia

BACKGROUND

Obesity causes a serious diet-related chronic disease, including type-2 diabetes, cardiovascular disease, hypertension, osteoarthritis, and certain forms of cancer. In Sub- Saharan Africa including Ethiopia, most nutritional interventions mainly focused on a child undernutrition and ignored the impacts of obesity among children. In Ethiopia, the magnitude and associated factors of obesity among school-age children were not clearly described. Therefore this study assesses the predictors of obesity among school- age children in Debre Berhan City, Ethiopia, 2022.

METHODS

A cross-sectional study design was conducted from June to July, 2022. Participants were selected by using multistage sampling method. Data were collected using pre-tested and structured questions. Data were coded and entered in Epi-data version 4.6 and exported and analyzed using SPSS version 25.

RESULT

A total of 600 children were participating in the study. The prevalence of obesity was 10.7% (95% CI: 8.3, 13.2). In this study, attending at private school (AOR = 4.24, 95% CI: 1.58, 11.32), children aged between 10-12years (AOR = 2.67, 95% CI: 1.30, 5.48), soft drink available in home (AOR = 2.27, 95% CI: 1.25,18.13), Loneliness (AOR = 1.67 95% CI: 1.12, 3.15) and mothers with occupational status of daily labour (AOR = 8.54 95% CI: 1.12, 65.39) were significantly associated with childhood obesity.

CONCLUSION

In this study, the overall magnitude of childhood obesity was (10.7%) which means one in eleven children and relatively high as compare to the EDHS survey. Therefore, more attention should be given to strengthening physical activities, providing nutritional education, and creating community awareness about healthy diets as well as other preventive measures.

Burden and contributing factors to overweight and obesity in young adolescents in Addis Ababa, Ethiopia

The prevalence of overweight/obesity in adolescents has increased globally, including in low- and middle-income countries. Early adolescence provides an opportunity to develop and encourage positive health and behavioural practices, yet it is an understudied age group with limited information to guide and inform appropriate interventions. This study aims to determine the prevalence of overweight/obesity in young adolescents, aged between 10 and 14 years attending public schools in Addis Ababa, Ethiopia, and to explore the contributing factors. A cross-sectional school-based study was conducted. Adolescents completed individual questionnaires. Weight (kg) and height (m) measurements were converted to BMI-for-age and gender z-scores. Multivariate regression analysis was conducted to determine the associated factors. The overall prevalence of overweight/obesity was 8% among adolescents aged 10-14 years and it was significantly higher in females (13%) than males (2%). The diet quality for the majority of the adolescents was inadequate, putting them at risk for poor health outcomes. The contributors to overweight/obesity were different between males and females. Age and no access to a flush toilet were negatively associated with overweight/obesity in males and access to a computer, laptop or tablet was positively associated. In females, menarche was positively associated with overweight/obesity. Living with only their mother or another female adult and an increase in physical activity were negatively associated with overweight/obesity. There is a need to improve the diet quality of young adolescents in Ethiopia and understand the reasons why females are less physically active to limit the risk of poor diet-related health outcomes.

Evaluating continuum of maternal and newborn healthcare in Rwanda: evidence from the 2019-2020 Rwanda demographic health survey

BACKGROUND

Access to a complete continuum of maternal and child health care has been recommended globally for better pregnancy outcomes. Hence this study determined the level (pooled prevalence) and predictors of successfully completing continuum of care (CoC) in Rwanda.

METHODS

We analyzed weighted secondary data from the 2019-2020 Rwanda Demographic and Health Survey (RDHS) that included 6,302 women aged 15 to 49 years who were selected using multistage stratified sampling. We analyzed complete continuum of care as a composite variable of three maternal care services: at least four ANC contacts, SBA, maternal and neonatal post-natal care. We used the SPSS version 25 complex samples package to conduct multivariable logistic regression.

RESULTS

Of the 6,302 women, 2,131 (33.8%) (95% CI: 32.8-35.1) had complete continuum of care. The odds of having complete continuum of care were higher among women who had exposure to newspapers (adjusted odds ratio (AOR): 1.30, 95% CI: 1.11-1.52), those belonging to the eastern region (AOR): 1.24, 95% CI: 1.01-1.52), southern region (AOR): 1.26, 95% CI: 1.04-1.53), those with health insurance (AOR): 1.55, 95% CI: 1.30-1.85), those who had been visited by a field health worker (AOR: 1.31, 95% CI: 1.15-1.49), those with no big problems with distance to health facility (AOR): 1.25, 95% CI: 1.07-1.46), those who were married (AOR): 1.35, 95% CI: 1.11-1.64), those with tertiary level of education (AOR): 1.61, 95% CI: 1.05-2.49), those belonging to richer households (AOR): 1.33, 95% CI: 1.07-1.65) and those whose parity was less than 2 (AOR): 1.52, 95% CI: 1.18-1.95).

CONCLUSION

We have identified modifiable factors (exposure to mass media, having been visited by a field health worker, having health insurance, having no big problems with distance to the nearest health facility, belonging to richer households, being married and educated), that can be targeted to improve utilization of the entire continuum of care. Promoting maternity services through mass media, strengthening the community health programmes, increasing access to health insurance and promoting girl child education to tertiary level may improve the level of utilization of maternity services.

The Current Prevalence of Underweight, Overweight, and Obesity Associated with Demographic Factors among Pakistan School-Aged Children and Adolescents-An Empirical Cross-Sectional Study

Purpose: This study investigated the most recent estimates of underweight, overweight, and obesity prevalence in Pakistani school-aged children and adolescents. Methods: A cross-sectional study was conducted using a convenience random clustered sampling approach with 3,551 Pakistani school children aged 9 to 17 years from 52 schools throughout seven districts in central Punjab province. The CDC US 2000 was used to define underweight (BMI < 5th percentile), overweight (85th ≤ BMI < 95th percentile), and obesity (95th percentile ≤ BMI) for different school grade cohorts (primary, middle, secondary, and higher secondary schools). As a trend test, the Chi-square test was used. A Spearman correlation analysis (r) was used to determine the correlations between demographic variables and weight status. A regression analysis was conducted to explore the predictive power of demographic factors in relation to body weight. Results: In Pakistani school-aged children and adolescents, the prevalence of underweight, normal weight, overweight, and obesity was 21.9%, 66.9%, 5.8%, and 5.4%, respectively. Significant correlations with body weight status were shown for individual demographic parameters (age, gender, school type, and school grade). Children in urban areas were more likely to be underweight, overweight, or obese than those in rural areas. Boys were found to have a lower BMI than girls. Accordingly, more boys than girls were underweight (odds ratio (OR) = 1.57, 95% CI: 1.33-1.85) and more girls had a higher risk of obesity than boys (OR = 1.39, 95% CI: 1.03-1.86). Lower grades showed more underweight (OR = 1.66, 95% CI: 1.39-1.99) whereas higher grades showed a higher risk of obesity (OR = 1.91, 95% CI: 1.41-2.57). Conclusions: In Pakistani school-aged children and adolescents, underweight, overweight, and obesity were prevalent. Compared with studies from 2011, the risk of overweight and obesity in Pakistan has decreased. However, this may also be due to the fact that students in Pakistan have a lower BMI compared to other countries. This issue has also been seen in the present study and is confirmed here by the high number of cases of underweight students. Future research studies should look into additional weight status correlates and factors. To evaluate the association between weight status and behavioral and other health variables, future research should use longitudinal or interventional designs.

Differences in nutritional status between rural and urban Yucatec Maya children: The importance of early life conditions

Early‐life conditions shape childhood growth and are affected by urbanization and the nutritional transition. To investigate how early‐life conditions (across the “first” and “second” 1000 days) are associated with rural and urban children's nutritional status, we analyzed anthropometric data from Maya children in Yucatan, Mexico. We collected weight, height and triceps skinfold measures, then computed body mass and fat mass indices (BMI/FMI), in a cross‐sectional sample of 6‐year‐olds (urban n = 72, rural n = 66). Demographic, socioeconomic and early‐life variables (birthweight/mode, rural/urban residence, household crowding) were collected by maternal interview. We statistically analyzed rural‐urban differences in demographic, socioeconomic, early‐life, and anthropometric variables, then created linear mixed models to evaluate associations between early‐life variables and child anthropometric outcomes. Two‐way interactions were tested between early‐life variables and child sex, and between early‐life variables and rural‐urban residence. Results showed that rural children were shorter‐statured, with lower overweight/obesity and cesarean delivery rates, compared to urban children. Household crowding was a negative predictor of anthropometric outcomes; the strongest effect was in boys and in urban children. Birthweight positively predicted anthropometric outcomes, especially weight/BMI. Birth mode was positively (not statistically) associated with any anthropometric outcome. Cesarean delivery was more common in boys than in girls, and predicted increased height in urban boys. In conclusion, urbanization and household crowding were the most powerful predictors of Maya 6‐year‐old anthropometry. The negative effects of crowding may disproportionately affect Maya boys versus girls and urban versus rural children. Early‐life conditions shape Maya children's nutritional status both in the “first” and “second” 1000 days.

Cancer in sub-Saharan Africa: a Lancet Oncology Commission

In sub-Saharan Africa (SSA), urgent action is needed to curb a growing crisis in cancer incidence and mortality. Without rapid interventions, data estimates show a major increase in cancer mortality from 520 348 in 2020 to about 1 million deaths per year by 2030. Here, we detail the state of cancer in SSA, recommend key actions on the basis of analysis, and highlight case studies and successful models that can be emulated, adapted, or improved across the region to reduce the growing cancer crises. Recommended actions begin with the need to develop or update national cancer control plans in each country. Plans must include childhood cancer plans, managing comorbidities such as HIV and malnutrition, a reliable and predictable supply of medication, and the provision of psychosocial, supportive, and palliative care. Plans should also engage traditional, complementary, and alternative medical practices employed by more than 80% of SSA populations and pathways to reduce missed diagnoses and late referrals. More substantial investment is needed in developing cancer registries and cancer diagnostics for core cancer tests. We show that investments in, and increased adoption of, some approaches used during the COVID-19 pandemic, such as hypofractionated radiotherapy and telehealth, can substantially increase access to cancer care in Africa, accelerate cancer prevention and control efforts, increase survival, and save billions of US dollars over the next decade. The involvement of African First Ladies in cancer prevention efforts represents one practical approach that should be amplified across SSA. Moreover, investments in workforce training are crucial to prevent millions of avoidable deaths by 2030. We present a framework that can be used to strategically plan cancer research enhancement in SSA, with investments in research that can produce a return on investment and help drive policy and effective collaborations. Expansion of universal health coverage to incorporate cancer into essential benefits packages is also vital. Implementation of the recommended actions in this Commission will be crucial for reducing the growing cancer crises in SSA and achieving political commitments to the UN Sustainable Development Goals to reduce premature mortality from non-communicable diseases by a third by 2030.

Mapping the national evidence on double burden of malnutrition in Ethiopia: a protocol of scoping review

INTRODUCTION

Currently, the double burden of malnutrition (DBM) is an emerging public health problem due to the inevitable consequences of nutritional transition. An increasing number of studies have reported the DBM in Ethiopian populations. However, organised and summarised national evidence is not yet available. Therefore, the main aim and research question of this scoping review is to map the national evidence on the DBM in the last decades in Ethiopia.

METHODS

This scoping review will be mapping the national evidence on the DBM in different population groups of Ethiopia including all ages and both sexes from 1 January 2021 to 30 September 2021. The Joanna Briggs Institute Reviewer's Manual will be used as the methodology of review for this review. The search strategy will be conducted using electronic databases such as PubMed, ScienceDirect, Cochrane Library, Wiley Online Library, Google Scholar, and grey literature sources and reference lists of key studies to identify studies appropriate for inclusion in the review. Two independent reviewers will be screened independently with all abstracts and full-text studies for inclusion. Data will be abstracted into tables and logically organised according to the items addressed in the specific research questions.

ETHICS AND DISSEMINATION

The data will be used from publicly available secondary sources. Therefore, no ethical review and approval will be required for this review. Dissemination of results will be sought through peer-reviewed publications, conference presentations and stakeholder meetings. Regarding registration, this review protocol is registered on the figshare website on 28 February 2021, with the DOI number https://doiorg/106084/m9figshare14131874.

Continuum of maternity care in Zambia: a national representative survey

Background

Globally, over half of maternal deaths are related to pregnancy-related complications. Provision of a continuum of care during pregnancy, childbirth and the postnatal period results in reduced maternal and neonatal morbidity and mortality. Hence this study determined the prevalence of the continuum of care and its determinants among women in Zambia.

Methods

We used weighted data from the Zambian Demographic and Health Survey (ZDHS) of 2018 for 7325 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants. Complete continuum of care was considered when a woman had; at least four antenatal care (ANC) contacts, utilized a health facility for childbirth and had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression to explore continuum of care in Zambia. All our analyses were done using SPSS version 25.

Results

Of the 7,325 women, 38.0% (2787/7325) (95% confidence interval (CI): 36.9-39.1) had complete continuum of maternal healthcare. Women who had attained tertiary level of education (adjusted odds ratio (AOR): 1.93, 95% CI: 1.09-3.42) and whose partners had also attained tertiary level of education (AOR: 2.58, 95% CI: 1.54-4.32) were more likely to utilize the whole continuum of care compared to those who had no education. Women who initiated ANC after the first trimester (AOR: 0.46, 95% CI: 0.39-0.53) were less likely to utilize the whole continuum of care compared to those who initiated in the first semester. Women with exposure to radio (AOR: 1.58, 95% CI: 1.27-1.96) were more likely to utilize the whole continuum of care compared to those who were not exposed to radio. Women residing in the Western province were less likely to utilize the entire continuum of care compared to those in the other nine provinces.

Conclusion

Level of education of the women and of their partners, early timing of ANC initiation, residing in other provinces other than the Western province, and exposure to information through radio were positively associated with utilization of the entire continuum of care. Improving literacy levels and promoting maternity services through radio may improve the level of utilization of maternity services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04080-1.

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

Background

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

Methods

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

Results

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

Conclusion

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

Subcutaneous Adipose Tissue Measured by B-Mode Ultrasound to Assess and Monitor Obesity and Cardio-Metabolic Risk in Children and Adolescents

Simple Summary

The prevention and treatment of childhood and adolescent overweight and obesity raises the need for accurate body fat assessment. Precise methods are at high technical expense, require exposure to ionizing radiation and are limited to institutional investigations, while common body indicators fail to identify excess body fat. Subcutaneous adipose tissue measured by ultrasound is an alternative approach, which was evaluated in relation to commonly applied body indicators to assess cardio–metabolic risk and its applicability in the field. Subcutaneous adipose tissue measured by ultrasound indicated a clear advantage over commonly applied body indicators and implies that severe body fat assessment errors are to be expected when BMI is used as a measure for body fatness in children. Children or adolescents with identical BMIs may have large differences (>200%) in their amount of subcutaneous adipose tissue. Ultrasound provides an easily applicable, reliable and safe method for accurate assessment of obesity and monitoring treatment responses in children and adolescents at cardio–metabolic risk.

Abstract

Monitoring of children at heightened risk of cardio–metabolic diseases raises the need for accurate assessment of obesity. A standardized approach for measuring subcutaneous adipose tissue (SAT) by bright-mode ultrasound was evaluated in relation to body indices and anthropometry in a cross-sectional sample of 76 South African children (7–10 years) and 86 adolescents (13–17 years) to assess cardio–metabolic risk. SAT was higher in girls as compared to boys (children: 50.0 ± 21.7 mm > 34.42 ± 15.8 mm, adolescents: 140.9 ± 59.4 mm > 79.5 ± 75.6 mm, p < 0.001) and up to four times higher in adolescents than in children. In children, measures of relative body weight showed only a poor correlation to SAT (BMI: r = 0.607, p < 0.001), while in adolescents, BMI correlated high with SAT (r = 0.906, p < 0.001) based on high rates of overweight and obesity (41.8%). Children with identical BMIs may have large differences (>2–3-fold) in their amount of SAT. The moderate association to systolic (r = 0.534, r = 0.550, p < 0.001) and diastolic blood pressure (r = 0.402, r = 0.262, p < 0.001) further substantiates that SAT measured by ultrasound provides an accurate, safe and easy applicable approach for monitoring in children and adolescents at cardio–metabolic risk.

Parents' perception of their children's weight status in an urban area of Western Greece

Context:

A lot of parents whose children are overweight or even obese are in no position to accurately acknowledge the real weight of their children. Parents' perception of their children's weight plays a significant role in the prevention and treatment of childhood obesity.

Aims:

This paper describes parents' opinions on the real weight status of their children and the sufficiency of quality nutrients in their diet.

Settings and Design:

The research methodology used in the particular study was based on survey research in preschool settings in West Greece.

Methods and Material:

The research methodology used in the particular study was based on survey research. Data were collected through questionnaires answered by parents of children attending preschool settings aged between two and five. One hundred and seventy-eight children and their parents participated. All parents had been informed of the aim of the study beforehand and gave their consent on condition that they could withdraw at any stage they wished.

Statistical Analysis Used:

Data were analyzed using SPSS (Statistical Package for the Social Sciences).

Results:

Comparing the Body Mass Index of children with the parents' opinion of their children's weight, we noticed 85,71% and 78,13% of the parents whose children were obese and overweight respectively, regarded their weight as normal. The majority of the overweight and obese children's parents were of the opinion that their children's diet was proper and healthy.

Conclusions:

Most parents whose children were obese or overweight underestimated the real weight of their children and considered their nutrition healthy.

Global Trends in Child Obesity: Are Figures Converging?

Childhood obesity has become one of the most serious global health challenges of our time. The combined prevalence of overweight and obesity has rapidly increased worldwide during the last two decades, especially in some developing countries where obesity is reaching levels on a par with some industrialized countries, or even higher. This fast growth has occurred especially in countries in the midst of rapid social-economic transitions. Most international comparisons focus on the adult population while analyses focusing on the child population are more limited. Using the methodology developed by Phillips and Sul, this paper studies the worldwide evolution of children’s body mass index (BMI), overweight and obesity prevalence for a large sample of countries during the period 1975–2016. Our results indicate that the figures for BMI or the prevalence of obesity in different countries do not converge, while the opposite is the case for overweight prevalence in children. Furthermore, there is a non-linear relationship between obesity and income or human capital, indicating that low and middle-income countries require a strong initiative for health policies targeting obesity prevention.