1
|
Quintana-Navarrete M. Extreme Violence and Weight-Related Outcomes in Mexican Adults. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:401-416. [PMID: 37052319 DOI: 10.1177/00221465231163906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Sociological research suggests that violent environments contribute to excess weight, a pressing health issue worldwide. However, this research has neglected extreme forms of violence, such as armed conflicts, a theoretically significant omission because armed conflict could reasonably lead to weight loss, not weight gain. I examine the weight-related, short-term consequences of the Mexican "War on Organized Crime." I combine body mass index (N = 3,341) and waist circumference (N = 3,509) measures from the Mexico Family Life Survey with a novel data set on aggressions, confrontations, and executions between 2009 and 2011 (CIDE-PPD database) and exploit variation in the timing of the outcome relative to violent events taking place in the same residential environment. I find a robust and large positive association between armed conflict events and weight gain in adults and suggestive evidence of the behavioral, emotional, and physiological/biochemical pathways connecting those variables.
Collapse
|
2
|
Hossain MI, Rahman A, Uddin MSG, Zinia FA. Double burden of malnutrition among women of reproductive age in Bangladesh: A comparative study of classical and Bayesian logistic regression approach. Food Sci Nutr 2023; 11:1785-1796. [PMID: 37051361 PMCID: PMC10084956 DOI: 10.1002/fsn3.3209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/04/2022] [Accepted: 12/19/2022] [Indexed: 01/08/2023] Open
Abstract
Although the prevalence of undernutrition among women of reproductive age has declined in Bangladesh, the increase in the prevalence of overnutrition remains a major challenge. To achieve Sustainable Development Goal 2.2, it is important to identify the drivers of the double burden of malnutrition on women in Bangladesh. The Bangladesh Demographic and Health Survey, 2017-2018 was used to model the relationship between the double burden of malnutrition among women and the risk factors using a logistic regression model under the classical and Bayesian frameworks and performed the comparison between the regression models based on the narrowest confidence interval. Regarding the Bayesian application, the Metropolis-Hastings algorithm with two types of prior information (historical and noninformative prior) was used to simulate parameter estimates from the posterior distributions. The Boruta algorithm was used to determine the significant predictors. Almost half of reproductive aged women experienced a form of malnutrition (12% were underweight, 26.1% were overweight, and 6.8% were obese). In terms of the narrowest interval estimate, it was found that Bayesian logistic regression with informative priors performs better than the noninformative priors and the classical logistic regression model. Women who were older, highly educated, from rich families, unemployed, and from urban residences were more likely to experience the double burden of malnutrition. This study recommended using the historical prior as the informative prior rather than the flat/noninformative prior to estimating the parameter uncertainty if historical data are available. The double burden of malnutrition among women is a major public health challenge in Bangladesh. This study was to determine the impact of effective risk factors on the double burden of malnutrition among women by applying the Bayesian framework. Using both informative and noninformative priors, "historical prior" was proposed as informative prior information. The main strength is that the proposed prior (historical prior) provided improved estimation as compared to the flat prior distribution.
Collapse
Affiliation(s)
| | - Azizur Rahman
- Department of StatisticsJahangirnagar UniversitySavar, DhakaBangladesh
| | | | | |
Collapse
|
3
|
Arero G. Undernutrition and associated factors among pregnant women in East Borena Zone, Liban District, Oromia regional state, Ethiopia. Front Nutr 2022; 9:1008701. [PMID: 36590217 PMCID: PMC9800510 DOI: 10.3389/fnut.2022.1008701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/20/2022] [Indexed: 12/23/2022] Open
Abstract
Background Undernutrition is cellular imbalance between supply of nutrients, energy and body's demand to ensure growth, maintenance, and specific function. However, there was no study conducted earlier on this topic in East Borena Zone. Objective To assess the prevalence of undernutrition and associated factors among pregnant women in East Borena Zone, Liban District. Method A community-based cross-sectional study was conducted on 420 study participants from November 20 to December 2021. The systematic sampling technique and simple random sampling methods were used to select study participants. Data were double entered into Epi-info software version 7 and SPSS version 21 software for analysis. Descriptive statistics were used to describe the characteristics of study participants. Bivariate and multivariable logistic regressions were carried out to identify the association between independent and dependent variables by measuring the adjusted odds ratio and 95% confidence interval. P-values less than 0.05 were considered statistically significant. Results Prevalence of undernutrition among pregnant women was about (44.9%) of family monthly income [AOR = 8.72 (4.80, 15.83)], women's decision-making autonomy [AOR = 0.40 (0.19, 0.82)], skipping meal [AOR = 2.62 (1.41, 4.89)], substance use [AOR = 2.01 (1.07, 3.77)], household food insecurity [AOR = 2.01 (1.06, 3.80)], lack of prenatal dietary advice [AOR = 2.73 (1.53, 4.89)], absence of household latrine [AOR = 9.23 (3.48, 24.46)], not participating health development army's meeting at village level [AOR = 3.01 (1.57, 5.72)] and hand washing habit [AOR = 6.55 (3.02, 14.20)] had shown statistically significant association with undernutrition. Conclusion The prevalence of undernutrition among pregnant women was high income. Women's decision-making autonomy, skipping meals, substances use, household food insecurity, lack of prenatal dietary advice, poor hand washing habit, lack household of latrine, and not participation in health development army's meeting were found to be predictors of the undernutrition.
Collapse
Affiliation(s)
- Godana Arero
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| |
Collapse
|
4
|
Resilience in maternal and child nutrition outcomes in a refugee-hosting community in Cameroon: A quasi-experimental study. Heliyon 2022; 8:e12096. [PMID: 36506401 PMCID: PMC9732403 DOI: 10.1016/j.heliyon.2022.e12096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/25/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
Refugees may be perceived as a burden to their host communities, and nutrition insecurity is a critical area of contention. We explored the relationship between refugee presence and a host community's resilience in nutrition outcomes in Cameroon. We also tested an analytical framework for evaluating community resilience during shocks. We used data from repeated cross-sectional Demographic and Health Surveys in Cameroon (2004 and 2011), data on refugee movement, and data on extreme climatic events, epidemics, and conflicts from multiple sources. Outcome variables were maternal underweight, maternal anaemia, and child underweight, anaemia, stunting and wasting. The exposure variable was residence within an area in which refugees settled. We used a genetic matching algorithm to select controls from the rest of the country after excluding areas experiencing concurrent shocks. We used a difference-in-differences analysis to compare outcomes between the exposed and control areas. The 2004 survey comprised 10,656 women and 8,125 children, while the 2011 survey comprised 15,426 women and 11,732 children. Apart from anaemia which showed a decreasing trend in both the refugee-hosting community and the rest of the country, all other indicators (wasting, underweight and stunting) showed increasing trends in the refugee-hosting community but decreasing trends in the rest of the country. The matched control group showed a similar trend of decreasing trend for all the indicators. Controlled comparisons showed no evidence of an association between changes in nutrition outcomes and the presence of refugees. These findings contest a common perception that refugees negatively impact hosting communities. The difference-in-differences analysis and an improved matching technique offer a method for exploring the resilience of communities to shocks.
Collapse
|
5
|
Inequities in childhood anaemia at provincial borders in Mozambique: cross-sectional study results from multilevel Bayesian analysis of 2018 National Malaria Indicator Survey. BMJ Open 2021. [PMCID: PMC8718414 DOI: 10.1136/bmjopen-2021-051395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives This study aims to identify the child-level, maternal-level, household-level and community-level determinants of anaemia among children aged 6–59 months, and determine the inequities of anaemia prevalence across communities in Mozambique. Design Cross-sectional study. Setting Mozambique. Participants This study used data of a weighted population of 3946 children, 6–59 months, delivered by women between 15 and 49 years of age, from the 2018 Mozambique Malaria Indicator Survey. Primary outcome measure Child’s anaemic status, measured as altitude-adjusted haemoglobin concentration (in g/L); the severity of anaemia was categorised based on predefined threshold values. Multilevel Bayesian linear regressions identified key determinants of childhood anaemia. Based on data availability and policy implications, spatial analysis was used to determine geographical variation of anaemia at the community level and areas with higher risks. Results The mean prevalence of childhood anaemia was 77.7% (SD: 5.5%). Provincially, Cabo Delgado province (86.2%) had the highest prevalence, Maputo province (70.2%) the lowest. Children with excess risk were mostly found in communities that had proximity to provincial borders: Niassa-Cabo Delgado-Nampula triprovincial border, Gaza-Inhambane border, Zambezia-Nampula border and provinces of Manica and Inhambane. Children with anaemia tended to be younger, males and at risk of having malaria because they were not sleeping under mosquito nets. In addition, children from poor families relative to children from wealthier households and those living in female-headed households were prone to anaemia. Conclusion Findings from this study provide evidence that spatial inequities in childhood anaemia exist in Mozambique, mostly concentrated in the communities living close to the provincial borders. Anaemia among children could be effectively reduced through malaria prevention, for example, bed netting. Interventions are needed that generate income for households, increase community support for households headed by women, improve malaria control, build capacity of healthcare workers to manage severely anaemic children and health education for mothers.
Collapse
|
6
|
Individual and community-level determinants of overweight and obesity among urban men: Further analysis of the Ethiopian demographic and health survey. PLoS One 2021; 16:e0259412. [PMID: 34735510 PMCID: PMC8568163 DOI: 10.1371/journal.pone.0259412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022] Open
Abstract
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.
Collapse
|
7
|
Multilevel analysis of unhealthy bodyweight among women in Malawi: Does urbanisation matter? PLoS One 2021; 16:e0249289. [PMID: 33780505 PMCID: PMC8006991 DOI: 10.1371/journal.pone.0249289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/15/2021] [Indexed: 01/22/2023] Open
Abstract
Background Underweight and overweight constitute unhealthy bodyweight and their coexistence is symptomatic of the dual burden of malnutrition (DBM) of high public health concern in many sub-Saharan Africa countries. Little is known about DBM and its correlates in Malawi, a country undergoing urbanisation. The study examined net effects of urban residence on unhealthy weights amidst individual- and community-level factors among women in Malawi. Methods Data on 7231 women aged 15–49 years nested within 850 communities extracted from 2015–16 Malawi Demographic and Health Survey were analysed. Women’s weight status measured by body mass index, operationally categorised as underweight, normal and overweight, was the outcome variable while urban-rural residence was the main explanatory variable. Multilevel multinomial logistic regression analysis was employed at 5% significant level; the relative-risk ratio (RR) and its 95% confidence interval (CI) were presented. Results Urban residents had a significantly higher prevalence of overweight than rural (36.4% vs. 17.2%; p< 0.001) but a -non-significant lower prevalence of underweight (6.2% vs. 7.4%; p = 0.423). Having adjusted for both individual- and community-level covariates, compared to rural, living in urban (aRR = 1.25; CI: 1.02–1.53) accounted for about 25% higher risk of being overweight relative to normal weight. Higher education attainment, being married and belonging to Chewa, Lomwe or Mang’anja ethnic group significantly reduced the risk of being underweight but heightened the risk of being overweight. Being older and living in wealthier households respectively accounted for about 3- and 2-times higher likelihood of being overweight, while breastfeeding (aRR = 0.65; CI: 0.55–0.76) was protective against overweight. Living in communities with higher poverty and higher education levels reduced and increased the risk of being overweight, respectively. Evidence of community’s variability in unhealthy weights was observed in that 11.1% and 3.0% respectively of the variance in the likelihood of being overweight and underweight occurred across communities. Conclusions The study demonstrated association between urban residence and women overweight. Other important associated factors of overweight included breastfeeding, community education- and poverty-level, while education attainment, marital status and ethnicity were associated with the dual unhealthy weight. Thus, both individual- and community-level characteristics are important considerations for policy makers in designing interventions to address DBM in Malawi.
Collapse
|
8
|
Dagnew GW, Asresie MB. Comparative assessment of overweight/obesity among rural and urban reproductive-age women in Ethiopia: Evidence from a cross-sectional 2016 national survey. Nutr Health 2021; 27:221-230. [PMID: 33594927 DOI: 10.1177/0260106020982346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Overweight/obesity has become a global health problem for both developed and developing regions. Nowadays, overweight/obesity among childrearing-age women has become rapidly increasing in both urban and rural areas. AIM This study aimed to assess the variation of overweight/obesity among urban and rural reproductive-age women in Ethiopia. METHODS For this study, the 2016 Ethiopia Demographic and Health Survey data were used. The survey was a community-based cross-sectional study, which used a two-stage stratified cluster sampling technique to select the participants. A total of 13,451 reproductive-age women were included in the analysis. Both descriptive and analytical analysis was performed. A p-value of less than 0.05 was used as the measure of statistical significance. RESULTS The prevalence of overweight/obesity among urban reproductive-age women was statistically higher (p = 21.5%; 95% confidence interval (CI): 18.2-25.1) than the rural women (p = 3.5%; 95% CI: 2.9%-4.2%). Women who attend secondary or above education, women in the age groups 25-34 and ≥ 35 years, and high wealth index (rich) had higher odds of overweight/obesity in both urban and rural women. Moreover, women who were married, who had a large family size, and who have a history of alcohol intake had higher odds of overweight/obesity among urban women. CONCLUSIONS Overweight/obesity among reproductive-age women is a public health problem in Ethiopia, especially for women who are living in urban settings. Therefore, it is important to establish targeted overweight reduction programs with particular emphasis on urban, older aged, educated, and married women. Additionally, encouraging the limitation of the number of family size and alcohol intake can reduce women's overweight/obesity.
Collapse
Affiliation(s)
- Gizachew Worku Dagnew
- Department of Reproductive Health, School of Public Health, 247589College of Medicine and Health Science, Bahir Dar University, Ethiopia
| | - Melash Belachew Asresie
- Department of Reproductive Health, School of Public Health, 247589College of Medicine and Health Science, Bahir Dar University, Ethiopia
| |
Collapse
|
9
|
Tekalegn Y. Determinants of Overweight or Obesity among Men Aged 20-59 Years: A Case-Control Study Based on the 2016 Ethiopian Demographic and Health Survey. J Obes 2021; 2021:6627328. [PMID: 33981456 PMCID: PMC8088365 DOI: 10.1155/2021/6627328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/28/2021] [Accepted: 04/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence shows that overweight or obesity has become a major public health problem in both developed and developing countries. However, there are limited studies conducted to identify the risk factors of overweight or obesity in Ethiopia. Therefore, this study aimed to assess the determinants of overweight or obesity among men aged 20-59 years in Ethiopia. METHODS This study used the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A case-control study was conducted based on the EDHS data; cases were men who were overweight or obese, depending on their body mass index, and controls were men with normal body mass index. Bivariate and multivariate binary logistic regression was performed to assess the determinants of overweight or obesity among the study participants. RESULTS A total of 610 cases and 2440 controls were included in this study. Men aged 30-39 years (adjusted odds ratio (AOR) = 2.2, 95% CI: 1.6-3.0) and ≥40 years (AOR = 3.4, 95% CI: 2.5-4.7) had higher odds of being overweight or obese compared to men aged 20-29 years old. The likelihood of overweight or obesity was significantly higher among married men (AOR = 1.5, 95% CI: 1.1-2.0), living in urban areas (AOR = 3.1, 95% CI: 2.1-4.4), those in the rich wealth quintile (AOR = 1.9, 95% CI: 1.2-2.9), and those with primary (AOR = 1.6, 95% CI: 1.1-2.3), secondary (AOR = 2.6, 95% CI: 1.7-3.9), and higher education (AOR = 3.6, 95% CI: 2.4-5.6). Additionally, men watching television at least once a week had higher odds (AOR = 1.5, 95% CI: 1.1-2.1) of being overweight or obese. CONCLUSION Men in the higher wealth quintile, older age, married, higher educational status, watching television at least once a week, urban dwellers, residents of big cities such as Addis Ababa and Harari, and residents of low land like Afar were more likely to be overweight or obese. Therefore, it is essential to design strategies and programs to reduce or prevent overweight or obesity with a special focus on the identified risk factors.
Collapse
Affiliation(s)
- Yohannes Tekalegn
- Madda Walabu University, Goba Referral Hospital, School of Health Science, Department of Public Health, Goba, Ethiopia
| |
Collapse
|
10
|
Pengpid S, Peltzer K. The prevalence and associated factors of underweight and overweight/obesity among adults in Kenya: evidence from a national cross-sectional community survey. Pan Afr Med J 2020; 36:338. [PMID: 33193991 PMCID: PMC7603835 DOI: 10.11604/pamj.2020.36.338.21215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 01/14/2020] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION the study aimed to investigate the prevalence and factors associated with underweight and overweight or obesity in an adult population in Kenya. METHODS data from a cross-sectional nationally representative community-based study in Kenya (N=4283, 18-69 years) conducted in 2015 was utilized. Assessments included anthropometric, interview, blood pressure and biochemistry mesures. Multinomial logistic regression was used to assess the determinants of underweight and overweight or obesity relative to normal weight. RESULTS in all, 11.9% of the study sample was underweight (BMI <18.5kg/m2), 60.1% had normal weight (BMI 18.5-24.9kg/m2), 18.9% overweight (25.0-29.9kg/m2) and 9.1% obesity (BMI ≥30.0kg/m2). In adjusted multinomial logistic regression, male sex (adjusted relative risk ratio-ARRR: 1.47, confidence interval-CI: 1.01, 2.13), lower education (ARRR: 0.63, CI: 0.46, 0.88), lower wealth status (ARRR: 0.47, CI: 0.29, 0.78), inadequate fruit and vegetable consumption (ARRR: 1.79, CI: 1.19, 2.70), adding daily sugar into beverages (ARRR: 1.49, CI: 1.01, 2.22) and having no hypertension (ARRR: 0.54, CI: 0.40, 0.74) were associated with underweight. Factors associated with overweight or obesity were middle and older age (ARRR: 2.15, CI: 1.46, 3.80), being female (ARRR: 0.30, CI: 0.22, 0.41), higher education (ARRR: 1.61, CI: 1.26, 2.24), greater wealth (ARRR: 2.38, CI: 1.41, 3.50), being a Kikuyu by ethnic group (ARRR: 1.68, CI: 1.19, 2.37), urban residence (ARRR: 1.45, CI: 1.06, 1.99), no current tobacco use (ARRR: 0.39, CI: 0.24, 0.54), low physical activity (ARRR: 1.49, CI: 1.02, 2.18) and having hypertension (ARRR: 1.96, CI: 1.54, 2.50). CONCLUSION more than one in ten were underweight and almost three in ten were overweight or obese among adults in Kenya. Several risk factors, including sociodemographic, lifestyle and health status risk variables, were identified for underweight and overweight or obesity, which can assist in developing intervention strategies targeting both these conditions.
Collapse
Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand
- Department of Research and Innovation, University of Limpopo, Turfloop, South Africa
| | - Karl Peltzer
- Department of Research and Innovation, University of Limpopo, Turfloop, South Africa
| |
Collapse
|
11
|
The prevalence of underweight and overweight/obesity and its correlates among adults in Laos: a cross-sectional national population-based survey, 2013. Eat Weight Disord 2020; 25:265-273. [PMID: 30225825 DOI: 10.1007/s40519-018-0571-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/22/2018] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The study aimed to assess the prevalence of underweight and overweight or obesity and their sociodemographic, lifestyle, and health factors in a national adult population in Lao People's Democratic Republic (PDR) (Laos). METHODS A national cross-sectional study based on a stratified cluster random sampling was conducted in 2013. The total sample included 2531 individuals 18-64 years, (females = 59.3%; mean age 38.7 years, SD = 12.8) from Laos. Questionnaire interview, blood pressure and anthropometric measurements, and biochemistry tests were conducted. Multinomial logistic regression was utilized to determine the association between sociodemographic, lifestyle and health status factors, and underweight and overweight or obesity relative to normal weight. RESULTS Using Asian criteria for body mass index (BMI) classification, 9.7% of the population was underweight (BMI < 18.5, kg/m2), 47.5% had normal weight (BMI 18.5-22.9 kg/m2), 17.5% overweight (23.0-24.9 kg/m2), 19.6% class I obesity (BMI 25.0-29.9 kg/m2), and 5.6% class II obesity (BMI ≥ 30.0 kg/m2) (or 42.8% overweight, class I or class II obesity). In adjusted multinomial logistic regression, female sex (adjusted relative risk ratio-ARRR 0.67, confidence interval-CI 0.45, 0.99), current tobacco use (ARRR 1.57, CI 1.02, 2.41), and having no hypertension (ARRR 0.50, CI 0.26, 0.97) were associated with underweight, and middle and older age (ARRR 1.79, CI 1.41, 2.25), being Lao-Tai (ARRR 1.37, CI 1.06, 1.76), urban residence (ARRR 1.62, CI 1.20, 2.17), having meals outside home (ARRR 1.36, CI 1.04, 1.77), no current tobacco use (ARRR 0.57, CI 0.34, 0.59), low physical activity (ARRR 1.39, CI 1.01, 1.92), having hypertension (ARRR 2.52, CI 1.94, 3.26), and dyslipidaemia (ARRR 1.56, CI 1.21, 2.00) were associated with overweight or obesity. CONCLUSION A dual burden of both adult underweight and overweight or obesity was found in Laos. Sociodemographic, lifestyle, and health status risk factors were identified for underweight and overweight or obesity, which can help in guiding public health programmes to address both these conditions. LEVEL OF EVIDENCE Level V, descriptive cross-sectional survey.
Collapse
|
12
|
Yeshaw Y, Kebede SA, Liyew AM, Tesema GA, Agegnehu CD, Teshale AB, Alem AZ. Determinants of overweight/obesity among reproductive age group women in Ethiopia: multilevel analysis of Ethiopian demographic and health survey. BMJ Open 2020; 10:e034963. [PMID: 32156768 PMCID: PMC7064084 DOI: 10.1136/bmjopen-2019-034963] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Overweight/obesity among women is associated with an increased risk of gestational diabetes, pre-eclampsia, postpartum haemorrhage, low birth weight, congenital malformation and neonatal deaths. Although the magnitude of overweight and obesity among the reproductive age group women is a common problem in Ethiopia, there are limited studies that determine the associated factors of overweight and obesity at the national level. Therefore, this study aimed to identify the determinant factors of overweight/obesity among reproductive age group women in Ethiopia. DESIGN Cross-sectional study design. SETTING Ethiopia. PARTICIPANTS Non-pregnant women aged 15-49 years. PRIMARY OUTCOME Overweight/obesity. METHODS The present study used the Ethiopia Demographic Health Survey (EDHS) data for 2016. A total of 10 938 non-pregnant reproductive age group women were included in the analysis. Both bivariable and multivariable multilevel logistic regression were performed to determine the determinants of overweight and obesity among women in Ethiopia. The OR with a 95% CI was estimated for potential determinants included in the final model. RESULTS Those women with secondary education (adjusted OR (AOR)=1.48, 1.01, 2.18), higher education (AOR=1.78, 1.13, 2.81), richer (AOR=1.85, 1.15, 2.98) and richest wealth index (AOR=3.23, 1.98, 5.29), urban residence (AOR=4.46, 2.89, 6.87), married (AOR=1.79, 1.21, 2.64), widowed (AOR=2.42, 1.41, 4.15), divorced (AOR=1.84, 1.13, 3.00), aged 25-34 years (AOR=2.04, 1.43, 2.89), 35-44 years (AOR=2.79, 1.99, 3.93) and 45-49 years (AOR=2.62, 1.54, 4.45) had higher odds of developing overweight and obesity. CONCLUSION Women with higher education level, high wealth status, older age, formerly married and those urban dwellers had higher odds of overweight and obesity. Therefore, regular physical activity, reducing consumption of fat/energy-dense food as well as modifying the mode of transportation is recommended.
Collapse
Affiliation(s)
- Yigizie Yeshaw
- Medical Physiology, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Sewnet Adem Kebede
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Chilot Desta Agegnehu
- School of Nursing, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| |
Collapse
|
13
|
Tareke AA, Abate MG. Nutritional paradox in Ethiopian women: Multilevel multinomial analysis. Clin Nutr ESPEN 2020; 36:60-68. [PMID: 32220370 DOI: 10.1016/j.clnesp.2020.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nutrition-related diseases have emerged at a faster rate in lower economic conditions before the battle against poverty and undernutrition has been won. In Ethiopia, the double burden of malnutrition seems to come sooner. The present study aims to determine the prevalence and identify the determinants of malnutrition among reproductive-age women using the 2016 Ethiopian Demographic and Health Survey dataset. METHODS Data from Ethiopian Demographic and Health Survey 2016 were used to identify individual and community-level associated factors of malnutrition among reproductive-age women. Nonpregnant, non-puerperal women aged 15-49 were included. Six hundred forty-two communities and 11,513 women were involved from this nationally representative data. The analysis was done using multi-level mixed-effects multinomial logistic regression to determine fixed effects of individual and community-level factors and random intercept of between characteristics. RESULTS Thirty-seven percent of the women had malnutrition generally. One-quarter of Ethiopian women were underweight and 11.8% were overweight/obese. Household wealth, women's age and contraceptive use were individual factors negatively associated with undernutrition. Region, place of residence and community-level wealth were cluster characteristics associated with undernutrition. On the other hand, the educational status of women, household wealth index, women's age, contraceptive use, breastfeeding, region and place of residence were the factors associated with overweight. Wealthier women had lowest of the odds for undernutrition OR = 0.84 (95% CI, 0.71, 0.98: P-value < 0.05). Middle-aged women had lower odds of being underweight, whereas reproductive-age extremities on both ends were prone to malnutrition. Modern contraceptive use had decreased the odds of being underweight OR = 0.71 (95% CI 0.63, 0.81 P-value <0.05). Women residing in rural areas had higher odds for undernutrition OR = 1.31 (95% CI 1.10, 1.56: p-value <0.001). In the same scenario, wealthier cluster had lower odds for undernutrition as rivalled with poorer clusters OR = 0.75 (95% CI 0.65, 0.87: P-value < 0.0001). CONCLUSION Nutritional paradox in the form of overweight/obesity and underweight exists in Ethiopian women. Underweight has a high prevalence and it is in a serious situation, whereas, the burden of overweight/obesity is rising. Both individual and community-level characteristics were significant predictors of malnutrition in Ethiopian women. Besides, the individual-level factors, interventions should also consider community-level associates in tackling malnutrition.
Collapse
Affiliation(s)
- Amare Abera Tareke
- Department of Biomedical Sciences, Institute of Health, Jimma University, Ethiopia.
| | - Masrie Getnet Abate
- Biostatistics Unit, Department of Epidemiology, Institute of Health, Jimma University, Ethiopia.
| |
Collapse
|
14
|
The Burden of Malnutrition among Adults Residing in Arba Minch Health and Demographic Surveillance Site (HDSS): A WHO STEPS Survey. J Nutr Metab 2020; 2020:6986830. [PMID: 32082623 PMCID: PMC7007928 DOI: 10.1155/2020/6986830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/17/2019] [Accepted: 01/08/2020] [Indexed: 01/26/2023] Open
Abstract
Background Malnutrition is one of the main underlying risk factors for the deaths due to different diseases. The aim of this study was to assess the prevalence and factors associated with underweight and overweight among adults residing in Arba Minch Health and Demographic Surveillance Site (HDSS), Southern Ethiopia. Methods A community-based cross-sectional survey was conducted from April to June 2017. The data collection procedures and 3,368 calculated sample size were based on the World Health Organization (WHO) STEPwise approach to Surveillance guideline. Using the surveillance data of Arba Minch HDSS, simple random sampling technique was implemented to identify individuals for the study. To assess the presence of association, the multinomial logistic regression model was used. Results The mean (SD) body mass index of the participants was 21.5 4.90 kg/m2. From 3,346 participants, 23.3% of the study participants were affected by malnutrition (10.8% and 12.5% were overweight and underweight, respectively). The prevalence of underweight was increased significantly among individuals aged 45–54 years and 55–64 years (adjusted odds ratio (AOR) 1.70 and 1.93, respectively) compared with those who were 25–34 years old. Belonging to households with higher wealth index quintile (2nd quintile AOR is 0.58 and 4th quintile AOR is 0.66) has decreased the chance of adult individual to be underweight compared with the poorest households. On the other hand, the prevalence of overweight was significantly higher among females (AOR 1.60), urban residents (AOR 1.72), those with formal education (primary AOR 1.89 and secondary and above AOR 1.94), and higher wealth index (5th quintile AOR 1.87). Conclusion One in five adult individuals was malnourished in the study area. The double burden of malnutrition at the population level is becoming a challenge for this community, as both underweight and overweight are becoming prevalent. Sex, age, residency, educational status, current tobacco use, occupation, and wealth index were identified as important determinates of under- and overweight.
Collapse
|
15
|
Jawad M, Vamos EP, Najim M, Roberts B, Millett C. Impact of armed conflict on cardiovascular disease risk: a systematic review. Heart 2019; 105:1388-1394. [PMID: 31138670 DOI: 10.1136/heartjnl-2018-314459] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Prolonged armed conflict may constrain efforts to address non-communicable disease in some settings. We assessed the impact of armed conflict on cardiovascular disease (CVD) risk among civilians in low/middle-income countries (LMICs). METHODS In February 2019, we performed a systematic review searching Medline, Embase, PsychINFO, Global Health and Web of Science without language or date restrictions. We included adult, civilian populations in LMICs. Outcomes included CVDs and diabetes, and eight clinical and behavioural factors (blood pressure, blood glucose, lipids, tobacco, alcohol, body mass index, nutrition, physical activity). We systematically reanalysed data from original papers and presented them descriptively. RESULTS Sixty-five studies analysed 23 conflicts, and 66% were of low quality. We found some evidence that armed conflict is associated with an increased coronary heart disease, cerebrovascular and endocrine diseases, in addition to increased blood pressure, lipids, alcohol and tobacco use. These associations were more consistent for mortality from chronic ischaemic heart disease or unspecified heart disease, systolic blood pressure and tobacco use. Associations between armed conflict and other outcomes showed no change, or had mixed or uncertain evidence. We found no clear patterning by conflict type, length of follow-up and study quality, nor strong evidence for publication bias. CONCLUSIONS Armed conflict may exacerbate CVDs and their risk factors, but the current literature is somewhat inconsistent. Postconflict reconstruction efforts should deliver low-resource preventative interventions through primary care to prevent excess CVD-related morbidity and mortality. PROSPERO REGISTRATION NUMBER CRD42017065722.
Collapse
Affiliation(s)
- Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
| | - Muhammad Najim
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
| |
Collapse
|
16
|
Pengpid S, Peltzer K. Prevalence and correlates of underweight and overweight/obesity among women in India: results from the National Family Health Survey 2015-2016. Diabetes Metab Syndr Obes 2019; 12:647-653. [PMID: 31118726 PMCID: PMC6506572 DOI: 10.2147/dmso.s206855] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/29/2019] [Indexed: 12/28/2022] Open
Abstract
Objective: The study aimed to assess the prevalence and correlates of underweight and overweight or obesity among women in India. Subjects and methods: In a population-based cross-sectional 2015-2016 National Family Health Survey, ever married non-pregnant women (18-49 years) were interviewed and assessed with anthropometric, blood pressure and biochemical measures. Results: The total sample included 5,82,320 non-pregnant women 18-49 years, median age 31 years, interquartile range =16 years, from India. Overall, 20.1% of the women were underweight [body mass index (BMI) <18.5 kg/m2] and 36.3% were overweight, or had class I or class II obesity (BMI ≥23.0 kg/m2). In adjusted multinomial logistic regression, younger age, lower education, lower wealth status, not eating daily fruits, vegetables, fried food, belonging to the scheduled tribe and tobacco use were associated with underweight, while older age, higher education, higher wealth, belonging to other backward class or other, urban residence, daily fruit consumption, daily fried food consumption, having hypertension, heart disease and high or very high blood glucose levels were associated with overweight or obesity. Belonging to the scheduled caste and tobacco use were negatively associated with overweight or obesity. Conclusions: A high dual burden of both underweight and overweight or obesity was observed among women in India. Sociodemographic and health variables were identified as risk factors for both underweight and overweight or obesity, which can be utilized in informing intervention strategies.
Collapse
Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Nakhonpathom, Thailand
- Deputy Vice Chancellor Research and Innovation Office, North West University, Potchefstroom, South Africa
| | - Karl Peltzer
- Deputy Vice Chancellor Research and Innovation Office, North West University, Potchefstroom, South Africa
- Correspondence: Karl PeltzerDeputy Vice Chancellor Research and Innovation Office, North-West University, Potchefstroom Campus, 11 Hoffman Street, Potchefstroom2531, South AfricaEmail
| |
Collapse
|
17
|
Pengpid S, Peltzer K. The Prevalence of Underweight, Overweight/Obesity and Their Related Lifestyle Factors in Indonesia, 2014-2015. AIMS Public Health 2017; 4:633-649. [PMID: 30155506 PMCID: PMC6111269 DOI: 10.3934/publichealth.2017.6.633] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 12/14/2017] [Indexed: 12/14/2022] Open
Abstract
Objective To quantify the prevalence of underweight and overweight or obesity and its related factors (socio-demographic, health behavior, health status) in a national adult population in Indonesia. Material and Methods In a national cross-sectional population-based survey in 2014–15 in Indonesia, 29509 adults (median age 41.0 years, Inter Quartile Range = 22.0, age range of 18–103 years) completed questionnaires and anthropometric measurements. Multinomial logistic regression modelling was used to determine the association between socio-demographic, health behavior and health status factors and underweight and overweight or obesity. Results Of total sample (n = 29509), 11.2% measured underweight (13.5% among men and 9.1% among women) (<18.5 kg/m2), 39.8% normal weight (48.1% among men and 32.0% among women) and 49.0% had overweight or obesity (≥23 kg/m2) (38.3% among men and 58.9% among women); 24.6% of the overall sample had class I obesity (25–29.9 kg/m2), and 8.5% had class II obesity (30 or more kg/m2). Among different age groups, underweight was the highest among 18–29 year-olds (20.0%) and those 70 years and older (29.8%), while overweight or obesity was the highest in the age group 30 to 59 years (more than 53%). In adjusted multinomial logistic regression, having less education, living in rural areas and not having chronic conditions were associated with underweight status. While better education, higher economic status, urban residency, dietary behavior (infrequent meals, frequent meat, fried snacks and fast food consumption), physical inactivity, not using tobacco, having chronic conditions (diabetes, hypertension, hypercholesterol), and better perceived health and happiness status were associated with overweight or obesity. Conclusions A dual burden of both adult underweight and having overweight or obesity was found in Indonesia. Sociodemographic, health risk behavior and health status risk factors were identified, which can guide public health interventions to address both these conditions.
Collapse
Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand.,Department of Research & Innovation, University of Limpopo, Turfloop, South Africa
| | - Karl Peltzer
- Department of Research & Innovation, University of Limpopo, Turfloop, South Africa.,HIV/AIDS/STIs and TB Research Programme, Human Sciences Research Council, Private Bag X41, Pretoria 0001, South Africa
| |
Collapse
|
18
|
Bruniera-Oliveira R, Horta MAP, Varan A, Montiel S, Carmo EH, Waterman SH, Verani JFDS. Epidemiological surveillance of land borders in North and South America: a case study. Rev Inst Med Trop Sao Paulo 2017; 59:e68. [PMID: 29116288 PMCID: PMC5679680 DOI: 10.1590/s1678-9946201759068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/10/2017] [Indexed: 11/22/2022] Open
Abstract
This study aims to analyze the different binational/multinational activities,
programs, and structures taking place on the borders of Brazil and the U.S. between
2013 and 2015. A descriptive exploratory study of two border epidemiological
surveillance (BES) systems has been performed. Two approaches were used to collect
data: i) technical visits to the facilities involved with border
surveillance and application of a questionnaire survey; ii)
application of an online questionnaire survey. It was identified that, for both
surveillance systems, more than 55% of the technicians had realized that the BES and
its activities have high priority. Eighty percent of North American and 71% of
Brazilian border jurisdictions reported an exchange of information between countries.
Less than half of the jurisdictions reported that the necessary tools to carry out
information exchange were available. Operational attributes of completeness,
feedback, reciprocity, and quality of information were identified as weak or of low
quality in both systems. Statements, guidelines, and protocols to develop
surveillance activities are available at the U.S.-Mexico border area. The continuous
systematic development of surveillance systems at these borders will create more
effective actions and responses.
Collapse
Affiliation(s)
| | - Marco Aurélio Pereira Horta
- Fundação Oswaldo Cruz, Vice-Presidência de Pesquisa e Laboratórios de Referência, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aiden Varan
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine San Diego, California, USA
| | - Sonia Montiel
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine San Diego, California, USA
| | - Eduardo Hage Carmo
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, Distrito Federal, Brazil
| | - Stephen H Waterman
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine San Diego, California, USA
| | - José Fernando de Souza Verani
- Fundação Oswaldo Cruz, Departamento de Epidemiologia e Métodos Quantitativos em Saúde da Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
19
|
Delbiso TD, Rodriguez-Llanes JM, Donneau AF, Speybroeck N, Guha-Sapir D. Drought, conflict and children's undernutrition in Ethiopia 2000-2013: a meta-analysis. Bull World Health Organ 2017; 95:94-102. [PMID: 28250509 PMCID: PMC5327931 DOI: 10.2471/blt.16.172700] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/15/2016] [Accepted: 07/04/2016] [Indexed: 11/30/2022] Open
Abstract
Objective To estimate the prevalence of childhood wasting and to investigate the effects of drought and conflict on wasting in crisis-affected areas within Ethiopia. Methods We searched the Complex Emergency Database for nutrition surveys carried out in Ethiopia over the period 2000–2013. We extracted data on the prevalence of wasting (weight-for-height z-scores below –2) among children aged 6–59 months for areas of Ethiopia that had sufficient data available. Data on any conflict events (irrespective of magnitude or impact) and episodes of seasonal drought affecting the survey areas were extracted from publicly available data sources. Random-effects Bayesian meta-analysis was used to synthesize the evidence from 231 small-scale surveys. Findings From the total sample of 175 607 children analysed, the pooled number of children wasted was 21 709. The posterior median prevalence of wasting was 11.0% (95% credible interval, CrI: 10.3–11.7) over the 14-year period. Compared with areas unaffected by drought, the estimated prevalence of wasting was higher in areas affected by moderate levels of drought (posterior odds ratio, OR: 1.34; 95% CrI: 1.05–1.72) but similar in severe drought-affected areas (OR: 0.96; 95% CrI: 0.68–1.35). Although the pooled prevalence of wasting was higher in conflict-affected than unaffected areas, the difference was not plausible (OR: 1.02; 95% CrI: 0.82–1.26). Conclusion Despite an overall declining trend, a wasting problem persists among children in Ethiopia. Conflict events did not have a major impact on childhood wasting. Nutrition interventions should go beyond severe drought-prone areas to incorporate areas where moderate droughts occur.
Collapse
Affiliation(s)
- Tefera Darge Delbiso
- Center for Research on the Epidemiology of Disasters, Institute of Health and Society, Université catholique de Louvain, Clos Chapelle-aux-Champs 30, 1200 Brussels, Belgium
| | - Jose Manuel Rodriguez-Llanes
- Center for Research on the Epidemiology of Disasters, Institute of Health and Society, Université catholique de Louvain, Clos Chapelle-aux-Champs 30, 1200 Brussels, Belgium
| | | | - Niko Speybroeck
- Institute of Health and Society, Université catholique de Louvain, Clos Chapelle-aux-Champs, Brussels, Belgium
| | - Debarati Guha-Sapir
- Center for Research on the Epidemiology of Disasters, Institute of Health and Society, Université catholique de Louvain, Clos Chapelle-aux-Champs 30, 1200 Brussels, Belgium
| |
Collapse
|
20
|
Tatah L, Delbiso TD, Rodriguez-Llanes JM, Gil Cuesta J, Guha-Sapir D. Impact of Refugees on Local Health Systems: A Difference-in-Differences Analysis in Cameroon. PLoS One 2016; 11:e0168820. [PMID: 27992563 PMCID: PMC5161383 DOI: 10.1371/journal.pone.0168820] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/06/2016] [Indexed: 11/19/2022] Open
Abstract
Hosting refugees may represent a drain on local resources, particularly since external aid is frequently insufficient. Between 2004 and 2011, over 100,000 refugees settled in the eastern border of Cameroon. With little known on how refugee influx affects health services of the hosting community, we investigated the impact of refugees on mother and child health (MCH) services in the host community in Cameroon. We used Cameroon's 2004 and 2011 Demographic and Health Surveys to evaluate changes in MCH indicators in the refugee hosting community. Our outcome variables were antenatal care (ANC) coverage, caesarean delivery rate, place of delivery and child vaccination coverage; whereas the exposure variable was residence in the refugee hosting community. We used a difference-in-differences analysis to compare indicators of the refugee hosting community to a control group selected through propensity score matching from the rest of the country. A total of 10,656 women were included in our 2004 analysis and 7.6% (n = 826) of them resided in the refugee hosting community. For 2011, 15,426 women were included and 5.8% (n = 902) of them resided in the hosting community. Between 2004 and 2011, both the proportion of women delivering outside health facilities and children not completing DPT3 vaccination in the refugee hosting community decreased by 9.0% (95% Confidence Interval (CI): 3.9-14.1%) and 9.6% (95% CI: 7.9-11.3%) respectively. However, ANC attendance and caesarean delivery did not show any significant change. Our findings demonstrate that none of the evaluated MCH service indicators deteriorated (in fact, two of them improved: delivery in health facilities and completing DPT3 vaccine) with the presence of refugees. This suggests evidence disproving the common belief that refugees always have a negative impact on their hosting community.
Collapse
Affiliation(s)
- Lambed Tatah
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Health and Human Development (2HD) Research Group, Douala, Cameroon
| | - Tefera Darge Delbiso
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Jose Manuel Rodriguez-Llanes
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Julita Gil Cuesta
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| |
Collapse
|