Prevalence and Predictors of Overweight and Obesity Among Kenyan Women

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.

Multilevel factors associated with overweight and obesity in East Africa: Comparative analysis in five countries from 2003 to 2016

Rising rates of overweight/obesity in sub-Saharan Africa (SSA) are a growing concern. Regional analysis of sociodemographic factors associated with overweight/obesity, as is common, may mask nationally specific associations. We examine the spatiotemporal trends of overweight/obesity in women (15-49 years) using 13 years of data (2003-2016) from Demographic and Health Surveys in five East African countries. Multivariable logistic regression reveals that urbanization and individual education, wealth, employment, marital status, and age are linked to overweight/obesity in the region, but their influence varied between nations. Variations in sociodemographic risk factors across nations underscore the need for tailored surveillance and interventions to address the increasing burden of overweight/obesity in East Africa.

The Association between Marital Status and Obesity: A Systematic Review and Meta-Analysis

BACKGROUND

Obesity was included in the International Classification of Diseases in 1990 as a chronic disease characterized by the excessive accumulation of body fat and a body mass index (BMI) greater than 30 kg/m2.

AIM

This systematic review was aimed to examine the role of marital status in determining body mass index and the risk of obesity.

METHODS

We performed a systematic literature search using three databases (PubMed (Medline), Embase, and Google Scholar) with the search query.

RESULTS

Of the 105 studies included in the systematic review, 76 studies (72%) reported a greater risk of obesity in married individuals compared to unmarried individuals. A meta-analysis of 24 studies included a total population of 369,499 participants: 257,257 married individuals (40,896 of whom had obesity) and 112,242 comparison subjects (single, divorced, or widowed individuals, 15,084 of whom had obesity). Odds ratios for obesity found a significant pooled odds ratio for obesity in married individuals compared with controls (OR 1.70; 95% CI 1.38-2.10). The socioeconomic environment was not the same throughout the period of studies analyzed. The odds of obesity in married individuals during economic crises was greater than during the period between crises: OR 2.56 (95% CI 2.09-3.13) during crises vs. OR 1.55 (95% CI 1.24-1.95) between crises.

CONCLUSION

The results of this review confirm the importance of considering marital status in determining the risk of obesity.

Rural-Urban Differences in Prevalence and Associated Factors of Underweight and Overweight/Obesity among Bangladeshi Adults: Evidence from Bangladesh Demographic and Health Survey 2017-2018

The aim of this study was to identify the differences in prevalence and associated factors of underweight and overweight/obesity among Bangladeshi adults (≥18 years) by analyzing the cross-sectional Bangladesh Demographic and Health Survey 2017-2018 data. Multilevel multivariable logistic regression was applied to identify the factors associated with underweight and overweight/obesity in urban and rural areas. The prevalence of underweight was 12.24% and 19.34% in urban and rural areas, respectively. The prevalence of overweight/obesity was 50.23% and 35.96%, respectively, in urban and rural areas. In the final multivariable analysis in both urban and rural areas, 30-49 years of age, female sex, being educated up to college or higher level, living in the wealthiest household, and being currently married or being separated/divorced/widowed had higher odds of being overweight/obese compared to other categories. Residence in the Mymensingh and Sylhet region was associated with decreased odds of overweight/obesity in urban and rural areas. On the other hand, being educated up to college or higher level, living in the wealthiest household, and being married were associated with reduced odds of being underweight in both areas. These high-risk groups should be brought under targeted health promotion programs to curb malnutrition.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Sensitivity of a preanaesthesia screening and triage tool in identifying high-risk patients attending the preanaesthesia assessment clinic in a tertiary referral hospital in Sub-Saharan Africa: a diagnostic accuracy study

OBJECTIVES

The use of preoperative triage questionnaires is an innovative way to mitigate the shortage of anaesthesiologists and to identify and refer high-risk patients early for evaluation. This study evaluates the diagnostic accuracy of one such questionnaire in identifying high-risk patients in a Sub-Saharan population.

DESIGN

Diagnostic accuracy study SETTING: The study was conducted in a preanaesthesia assessment clinic in a tertiary referral hospital in Sub-Saharan Africa.

PARTICIPANTS

The study had a sample size of 128, including all patients above the age of 18 scheduled for elective surgery under any modality of anaesthesia other than local anaesthesia presenting to the preanaesthesia clinic. Patients scheduled for cardiac and major non-cardiac surgery and those non-literate in English were excluded.

OUTCOME MEASURES

The sensitivity of the preanaesthesia risk assessment tool (PRAT) was the primary outcome measure. Other outcome measures were specificity, positive predictive value and negative predictive value.

RESULTS

Majority of patients were young and women with a mean age of 36 referred for obstetric and gynaecological procedures. The sensitivity of the PRAT in identifying high-risk patients was at 90.6% with 95% CI (76.9 to 98.2) in this current study while the specificity, negative predictive value (NPV) and positive predictive value (PPV) were 37.5% with 95% CI (24.0 to 43.7), 92.3% with 95% CI (77.7 to 97.0) and 32.6% with 95% CI (29.6 to 37.3) respectively.

CONCLUSION

The PRAT has a high sensitivity and may be used as a screening tool in identifying high risk patients to refer to the anaesthesiologist early before surgery. Adjusting the high risk criteria to fit the anaesthesiologists' assessments may improve the specificity of the tool.

Fasting blood glucose, blood pressure and body mass index among combined oral contraceptive users in Chencha town Southern Ethiopia, 2019

Background

The use of contraceptives has become prevalent among women in Ethiopia. Oral contraceptive use has been suggested to trigger changes in glucose metabolism, energy expenditure, blood pressure, and body weight, among various populations and ethnic groups.

Objective

To elucidate the pattern of fasting blood glucose, blood pressure, and body mass index among combined oral contraceptive pills users compared to controls.

Methods

An institution-based cross-sectional study design was employed. A total of 110 healthy women using combined oral contraceptive pills were recruited as cases. Another 110 healthy age and sex-matched women not using any hormonal contraceptives were recruited as controls. A study was conducted between October 2018 and January 2019. Data obtained was entered and analyzed using IBM SPSS version 23 software packages. One-way ANOVA was used to identify the variation of variables in relation to the duration of use of the drug. The P-value of < 0.05 at the 95% confidence level was statistically significant.

Results

Fasting blood glucose level among oral contraceptive users (88.55 ± 7.89 mg/dl) was higher than fasting blood glucose level among oral contraceptive non-users (86.00 ± 9.85 mg/dl) with a p-value of 0.025. The mean arterial pressure of oral contraceptive users (88.2 ± 8.48 mmHg) was relatively higher than their counterparts (86.0 ± 6.74 mmHg), with a p-value of 0.04. Comparatively the body weight and body mass index among oral contraceptive users were 2.5% and 3.9% higher than non-users with a p-value of 0.03 and 0.003, respectively(5). Utilization of oral contraceptive pills for prolonged period of time seemed to be a significant predictive factor for higher mean arterial pressure and body mass index with p < 0.001and p < 0.05 respectively.

Conclusions

Use of combined oral contraceptives was associated with higher fasting blood glucose (+2.9%), mean arterial pressure (+2.5%), and body mass index (3.9%) compared to controls.

Prevalence and characteristics associated with diabetes mellitus and impaired fasting glucose among people aged 15 to 64 years in rural and urban Rwanda: secondary data analysis of World Health Organization surveillance data

Introduction

diabetes mellitus is an increasing public health burden in developing countries. The magnitude of diabetes association with traditional risk factors for diabetes have been given less attention in rural population. This study aims to determine the prevalence of diabetes and impaired fasting glucose and to assess associated characteristics to hyperglycemia in rural and urban Rwanda.

Methods

this is a secondary analysis of data from a population-based cross-sectional study of 7240 people describing risk factors for non-communicable diseases using the WHO stepwise methods (STEPS). Relative frequencies of variables of interest were compared in rural and urban residence using Pearson chi-square tests. Diabetes and impaired fasting glucose were combined in a single hyperglycemia variable and odds ratios with 95% confidence intervals were used to explore associations between hyperglycemia, socio-demographic and health factors in urban and rural populations.

Results

the prevalence in rural and urban areas was 7.5% and 9.7% (p.005) for diabetes and 5.0% and 6.2% for impaired fasting glucose (p.079) respectively. Obesity (AOR 2.57: CI: 0.86-7.9), high total cholesterol (AOR 3.83: CI: 2.03-7.208), hypertension (AOR 1.18: CI: 0.69-2.00), increasing age were associated with hyperglycemia in urban participants but only high total cholesterol and low high density lipoproteins (HDL) cholesterol were risk factors for hyperglycemia in rural participants.

Conclusion

approximately one in six people in Rwanda have hyperglycemia. The magnitude of the association with traditional risk factors for diabetes differ in rural and urban settings. Different approaches to primary and secondary prevention of diabetes may be needed in rural populations.

Nutritional status and body image perception in a group of moroccan adolescents

BACKGROUND: Adolescent obesity has become a pressing public health issue in Morocco. Along with the increased prevalence of obesity, body weight misperceptions have also increased among adolescents, which may reduce the effectiveness of intervention programs. The main study objective was to establish the relationship between body image perception, anthropometric status and their associated factors among a sample of Moroccan adolescents. METHODS: A cross-sectional school-based survey was conducted during 2018, involving 250 adolescents from Morocco. Data on sociodemographic information, anthropometric characteristics, and weight perception were collected and reported as the means and proportions. Statistical analysis was carried out using Statistical Package for Social Sciences version 19.0 software. RESULTS: The prevalence of overweight and obesity in our study reached 12.8% and 4.8%, respectively. Misperception of body weight compared to body mass index (BMI) was found in 50.4% of young adolescents (χ2 = 54.05; p <  0.001), and dissatisfaction computed by the Feel minus Ideal Discrepancy (FID) index reached 46% with no difference between the sexes (χ2 = 2.55; p >  0.05). The Feel weight status minus Actual weight status Inconsistency (FAI) index was used to determine whether the subjects’ perception of their weight was realistic. The results showed that both sexes tended to underestimate their weight. Only 68.2% of overweight/obese participants reported trying to lose weight (χ2 = 39.74; p <  0.001), while this number increased to 94.7% when the intention to lose weight was related to perceived body image (χ2 = 86.09; p <  0.001). CONCLUSIONS: The results of this study reveal that a mismatch exists between the perception of body weight and actual BMI in adolescents, with a tendency toward underestimation, affirming the early effect of social norms and the vulnerability to sociocultural influences of individuals in this age category. Future interventions and educational programs are thus required to prevent overweight and obesity and to address the mismatch between adolescents’ weight status and their perceived weight.

What is a "high" prevalence of obesity? Two rapid reviews and a proposed set of thresholds for classifying prevalence levels

Categories such as "low" and "high" have been used for several decades to describe the prevalence of stunting and wasting in populations of children aged under 5 years. They provide support for public health risk assessment and policy-making, including alerting health departments and aid agencies to national trends and local needs. In the light of the need for monitoring progress to meet globally agreed targets for overweight and obesity, the classification of their prevalence will be a valuable to aid in policy development, to target resources, and to promote public health interventions. This paper reviews the current use of categories to describe obesity prevalence in policy, advocacy, and research literature. Where prevalence categories have been formally proposed, this paper compares their application on large-scale datasets. The paper then develops a set of recommended threshold values to classify prevalence levels for overweight and obesity among children under age 5 years, children aged 5-19 years, and adults.

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.

Changes in prevalence and risk factors of hypertension among adults in Bangladesh: An analysis of two waves of nationally representative surveys

Introduction

Bangladesh is one of the countries where the prevalence of non-communicable diseases (NCDs) such as hypertension is rising due to rising living standards, sedentary lifestyles, and epidemiological transition. Among the NCDs, hypertension is a major risk factor for CVD, accounting for half of all coronary heart disease worldwide. However, detailed research in this area has been limited in Bangladesh. The objective of the study was to estimate changes in the prevalence and risk factors of hypertension among Bangladeshi adult population. The study also sought to identify socioeconomic status-related inequality of hypertension prevalence in Bangladesh.

Methods

Cross-sectional analysis was conducted using nationally representative two waves of the Bangladesh Demographic and Health Survey (BDHS) in 2011 and 2017–18. Survey participants were adults 18 years or older- which included detailed biomarker and anthropometric measurements of 23539 participants. The change in prevalence of hypertension was estimated, and adjusted odds ratios were obtained using multivariable survey logistic regression models. Further, Wagstaff decomposition method was also used to analyze the relative contributions of factors to hypertension.

Results

From 2011 to 2018, the hypertension prevalence among adults aged ≥35 years increased from 25.84% to 39.40% (p<0.001), with the largest relative increase (97%) among obese individuals. The prevalence among women remained higher than men whereas the relative increase among men and women were 75% and 39%, respectively. Regression analysis identified age and BMI as the independent risk factors of hypertension. Other risk factors of hypertension were sex, marital status, education, geographic region, wealth index, and diabetes status in both survey years. Female adults had significantly higher hypertension risk in both survey years in the overall analysis in, however, in the subgroup analysis, the gender difference in hypertension risk was not significant in rural 2011 and urban 2018 samples. Decomposition analysis revealed that the contributions of socio-economic status related inequality of hypertension in 2011 were46.58% and 20.85% for wealth index and BMI, respectively. However, the contributions of wealth index and BMI have shifted to 12.60% and 55.29%, respectively in 2018.

Conclusion

The prevalence of hypertension among Bangladeshi adults has increased significantly, and there is no subgroup where it is decreasing. Population-level approaches directed at high-risk groups (overweight, obese) should be implemented thoroughly. We underscore prevention strategies by following strong collaboration with stakeholders in the health system of the country to adopt healthy lifestyle choices.

Socioeconomic Determinants of Diet Quality on Overweight and Obesity in Adults Aged 40-59 Years in Inner Mongolia: A Cross-Sectional Study

Objectives: This study investigated the relationship of socioeconomic status (SES), diet quality and overweight and obesity in adults aged 40-59 years in Inner Mongolia. Methods: This cross-sectional study was based on the survey of Chronic Disease and Nutrition Monitoring in Adults in Inner Mongolia in 2015. Diet quality was evaluated by the Alternate Mediterranean Diet score (aMeds). SES was measured by household annual income. Generalized estimating equations and path analysis were performed to determine the association of SES, diet quality and overweight and obesity. Results: Among participants, 63.0% had overweight and obesity. In high SES group, 66.4% had overweight and obesity. Higher SES was associated with a higher risk of overweight and obesity (OR = 1.352, 95%CI: 1.020-1.793). And higher aMeds was associated with a lower risk of overweight and obesity (OR = 0.597, 95%CI: 0.419-0.851). There was a positive correlation between SES and the intake of red and processed meat (r = 0.132, p < 0.05). Higher intake of red and processed meat was associated with lower diet quality (β = -0.34). And lower diet quality was associated with a higher risk of overweight and obesity (β = -0.10). Conclusion: In Inner Mongolia, during the period of economic transition, people aged 40-59 years in high SES had poor diet quality, which was related to a higher risk of overweight and obesity.

Identifying individuals with multiple non-communicable disease risk factors in Kenya: a latent class analysis

OBJECTIVES

Non-communicable diseases (NCDs) are the leading causes of death globally. In Kenya, the number of deaths resulting from NCDs is projected to surpass malaria and tuberculosis by 2030. Studies in Kenya show increasing NCDs; the aim of the present study is to examine the clustering of NCDs and risk factors in Kenya.

STUDY DESIGN

This is a cross-sectional study using data from the 2015 Kenya STEPwise Survey.

METHODS

This study examined relationships between NCDs (e.g. obesity, hypertension and diabetes) and health behaviours (e.g. sedentary activity, and fruit and vegetable consumption). Survey probability weights, which estimated the sampling design effect, were applied to consider the sampling units, and stratifications were used during sampling so that the results could be generalisable to the national adult Kenyan population. In total, 4350 adults were included in the study sample.

RESULTS

Overall, 24.43% of participants were classified as having hypertension, 1.88% as having type 2 diabetes, and 27.94% were classified as being overweight or obese. The best-fit model was a four-class solution. Class 1 is best described as 'young with high NCD risk' and had the highest sedentary activity. Class 2 is best described as 'poor rural with lower NCD risk' with a high chance of smoking and alcohol consumption. Class 3 is best described as 'rural with high NCD risk' and had the highest fruit and vegetable consumption. Class 4 is best described as 'wealthy young urban dwellers with high NCD risk' with a high chance of alcohol consumption and smoking. Individuals in Class 4 had the highest chance (40%) of being overweight/obese, a 2% chance of type 2 diabetes and a 23% chance of having hypertension.

CONCLUSIONS

NCDs are clustered in groups with high-risk behaviours. The group with the highest chance of having NCDs also had the highest chance of engaging in high-risk behaviours. The findings of this study suggest that smoking and alcohol consumption increase NCD risk in rural areas. Tailored and targeted interventions are needed to curb the increasing NCD prevalence in Kenya.

Underweight and overweight/obesity among adults in Afghanistan: prevalence and correlates from a national survey in 2018

BACKGROUND

The study aimed to estimate the prevalence and correlates of underweight and overweight/obesity among adults in Afghanistan.

METHODS

National cross-sectional survey data of 3779 persons aged 18-69 years were analysed. Multinomial logistic regression was used to estimate factors associated with underweight and overweight/obesity relative to normal weight.

RESULTS

In all, 7.8% of the study sample was underweight (BMI < 18.5 kg/m²), 49.5% had normal weight (BMI 18.5-24.9 kg/m²), 25.5% overweight (25.0-29.9 kg/m²), and 17.2% obesity. In adjusted multinomial logistic regression, factors negatively associated with underweight were male sex (adjusted relative risk ratio (ARRR): 0.30, 95% confidence interval (CI): 0.15-0.58) and hypertension (ARRR: 0.51, 95% CI: 0.27-0.95) and factors positively associated with underweight were sedentary behaviour (ARRR: 1.85, 95% CI: 1.11-3.10) and current tobacco use (ARRR: 2.58, 95% CI: 1.08-6.16). Factors positively associated with overweight/obesity were aged 30-44 years (ARRR: 2.00, CI: 1.51-2.66) and aged 45-69 years (ARRR: 1.58, CI: 1.09-2.31) (compared to 18-29 years) (ARRR: 1.28, CI: 1.14-2.18), hypertension (ARRR: 2.74, CI: 1.89-3.96), and type 2 diabetes (ARRR: 1.82, CI: 1.13-2.94), and high physical activity (ARRR: 0.70, CI: 0.50-0.98) was negatively associated with overweight/obesity.

CONCLUSION

Almost one in ten adult respondents were underweight and more than two in five were overweight/obese, confirming a dual burden of malnutrition in Afghanistan.

Wealth index and other behavioral and sociodemographic characteristics associated with body mass index in Ethiopia

BACKGROUND

Nowadays, the burden of non-communicable diseases including obesity has been an increasing public health concern. This menace can be monitored using indexing method like body mass index. Studies indicate that socioeconomic indicators such as income, biology, behavior, and demographic factors associated with body mass index. In Ethiopia, few studies associate wealth index with body mass index in people of ages between 15 and 49. This study was aimed to assess the association of body mass index with wealth index, and behavioral and sociodemographic population characteristics.

METHODS

A cross-sectional population-based study was conducted using the 2016 Ethiopian Demographic and Health Survey population of ages 15-49. A total of 10,245 individuals were considered to detect the effect of socioeconomic, biological, behavioral, and demographic factors on body mass index using logistic regression.

RESULTS

The prevalence of underweight, overweight, and obesity among men are 23.8%, 6.6%, and 2.0%, respectively, which is lower than that of women (underweight 25.3%, overweight 9.1%, and obesity 2.9%). The poorest men had higher odds of being underweight (adjusted odds ratio = 2.395%; 95% confidence interval = 2.020-3.544) as compared to the richest men. Merchants and government employees have lower odds (adjusted odds ratio = 0.744; 95% confidence interval = 0.588-0.899) compared to men whose occupation is farming and labor, indicating that merchants and government employees are more likely to become overweight and obese compared to men who are farmers and laborers.

CONCLUSION

It is concluded that wealth index is an important socioeconomic determinant of body mass index among men and women of age 15-49 in Ethiopia. A high prevalence of underweight, and overweight, and obesity is observed, which increases instances of non-communicable diseases. Effects of socioeconomic, biological, behavioral, and demographic indicators on body mass index differed according to sex.

Monitoring Information-Seeking Patterns and Obesity Prevalence in Africa With Internet Search Data: Observational Study

BACKGROUND

The prevalence of chronic conditions such as obesity, hypertension, and diabetes is increasing in African countries. Many chronic diseases have been linked to risk factors such as poor diet and physical inactivity. Data for these behavioral risk factors are usually obtained from surveys, which can be delayed by years. Behavioral data from digital sources, including social media and search engines, could be used for timely monitoring of behavioral risk factors.

OBJECTIVE

The objective of our study was to propose the use of digital data from internet sources for monitoring changes in behavioral risk factors in Africa.

METHODS

We obtained the adjusted volume of search queries submitted to Google for 108 terms related to diet, exercise, and disease from 2010 to 2016. We also obtained the obesity and overweight prevalence for 52 African countries from the World Health Organization (WHO) for the same period. Machine learning algorithms (ie, random forest, support vector machine, Bayes generalized linear model, gradient boosting, and an ensemble of the individual methods) were used to identify search terms and patterns that correlate with changes in obesity and overweight prevalence across Africa. Out-of-sample predictions were used to assess and validate the model performance.

RESULTS

The study included 52 African countries. In 2016, the WHO reported an overweight prevalence ranging from 20.9% (95% credible interval [CI] 17.1%-25.0%) to 66.8% (95% CI 62.4%-71.0%) and an obesity prevalence ranging from 4.5% (95% CI 2.9%-6.5%) to 32.5% (95% CI 27.2%-38.1%) in Africa. The highest obesity and overweight prevalence were noted in the northern and southern regions. Google searches for diet-, exercise-, and obesity-related terms explained 97.3% (root-mean-square error [RMSE] 1.15) of the variation in obesity prevalence across all 52 countries. Similarly, the search data explained 96.6% (RMSE 2.26) of the variation in the overweight prevalence. The search terms yoga, exercise, and gym were most correlated with changes in obesity and overweight prevalence in countries with the highest prevalence.

CONCLUSIONS

Information-seeking patterns for diet- and exercise-related terms could indicate changes in attitudes toward and engagement in risk factors or healthy behaviors. These trends could capture population changes in risk factor prevalence, inform digital and physical interventions, and supplement official data from surveys.

Overweight and Obesity among Adults in Iraq: Prevalence and Correlates from a National Survey in 2015

This study aimed to estimate the prevalence and correlates of overweight and obesity among adults in Iraq. Data from a 2015 nationally representative cross-sectional survey of 3916 persons 18 years or older (M (median) age = 40 years, IQR (interquartile range) age = 29–52 years; men: M = 41 years, IQR = 29–54 years; women: M = 40 years, IQR = 30–51 years) who responded to a questionnaire, and physical and biochemical measures were analysed. Multinomial logistic regression was utilised to predict the determinants of overweight and obesity relative to under or normal weight. The results indicate that 3.6% of the participants were underweight (body mass index (BMI) <18.5 kg/m²), 30.8% had normal weight (BMI 18.5–24.9 kg/m²), 31.8% were overweight (25.0–29.9 kg/m²), and 33.9% had obesity (BMI ≥30.0 kg/m²). In the adjusted multinomial logistic regression, being aged 40–49 years (compared to 18–39 years old) (adjusted relative risk ratio (ARRR): 4.47, confidence interval (CI): 3.39–5.91), living in an urban residence (ARRR: 1.28, CI: 1.14–2.18), and having hypertension (ARRR: 3.13, CI: 2.36–4.17) were positively associated with obesity. Being male (ARRR: 0.47, CI: 0.33–0.68), having more than primary education (ARRR: 0.69, CI: 0.50–0.94), and having a larger household size (five members or more) (ARRR: 0.45, CI: 0.33–0.60) were negatively associated with obesity. Approximately two in three adult participants were overweight/obese, and sociodemographic and health risk factors were found that can be utilised in targeting interventions.

Prevalence and factors associated with overweight and obesity in Kenya

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Almost one third of the sample had overweight/obese.

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Women were 4 times more likely to have overweight/obesity.

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Middle and high income individuals were 2 times more likely to have overweight/obesity.

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The odds of having overweight/obesity increased with increasing age.

Overweight and obesity rates continue to rise globally and are associated with increased chronic disease morbidity and mortality. There is evidence of high overweight and obesity prevalence in Kenya, however; a gap exists in the knowledge of national prevalence and predictors of overweight and obesity.

This cross-sectional study examined data from the 2015 World Health Organization (WHO) Kenya STEPwise Survey—the first nationally representative survey to objectively measure body mass index (BMI) among Kenyan men and women. Descriptive and logistic regression analysis of 4,340 adults aged 18–69 years examined the prevalence, sociodemographic, and behavioral risk factors associated with having overweight or obesity (overweight/obesity) defined by WHO

The mean BMI was 23.51 with 31.13% having overweight/obese. The likelihood of having overweight/obesity was significantly higher among married individuals [odds ratio (OR) = 1.78, 95% confidence interval (CI) 1.19, 2.66], women (OR = 4.08, 95% CI 3.02, 5.51), urban dwellers (OR = 1.70, 95% CI 1.28, 2.25) and middle wealth or higher (OR = 2.45, 95% CI 1.91, 3.14). The likelihood of having overweight/obesity increased by age, compared to 18–29-year olds; (30–44 years (OR = 2.05 95% CI 1.50, 2.80), 45–59-year olds (OR = 2.67, 95% CI 1.97, 3.63), 60–69-year olds (OR = 3.00, 95% CI 1.99, 4.51). Adults with completed primary education or more had higher odd of having overweight/obesity (OR = 2.15, 95% CI 1.72, 2.70). compared to adults with less than primary education.

Likelihood of having Overweight/obesity was highest among women, urban residents, and individuals with high education and wealth. Future studies should ascertain drivers of overweight/obesity to inform Targeted and tailored interventions and policies amongst high-risk groups.

Long-term effects of regular exercise during pregnancy on overweight and obese gravidas: A protocol of randomized controlled trial

BACKGROUND

Overweight before pregnancy is independent risk factor for diabetes mellitus. This randomized controlled trial was to investigate the long-term effects of regular exercise during pregnancy on overweight and obese gravidas.

METHODS AND ANALYSIS

This single-center, prospective, randomized controlled test will be conducted in Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology. Overweight and obese pregnant women will be included in our study and randomized into 2 groups: regular exercise and control groups. The informed consent will be acquired in each patient. Body weight, body fat, fasting and 2 h glucose level in 75 g oral glucose tolerance test (OGTT), insulin resistance index, and lipid profiles were compared. We also evaluated their physical activities with International Physical Activity Questionnaire (IPAQ), their dietary habits with modified Adult Dietary Behavior Assessment Scale, and depression condition with Postpartum Depression Screen Scale (PDSS). The significance level was defaulted as P < .05.

RESULTS

Results will be published in relevant peer-reviewed journals.

CONCLUSION

Our study aims to systematically assess the effects of regular exercise for overweight and obese gravidas, which will be provided clinical guidance for overweight and obese gravidas.

The association between combined oral contraceptive use and overweight/obesity: a secondary data analysis of the 2016 Ethiopia Demographic and Health Survey

OBJECTIVES

In this study, we aimed to assess the association between combined oral contraceptive (OC) use and overweight/obesity among Ethiopian adult women of reproductive age.

DESIGN, SETTING AND PARTICIPANTS

The data were extracted from the 2016 Ethiopia Demographic and Health Survey; these data were collected from nine regions and two city administrations. We analysed the data from a total of 11 018 women aged 18-49 years who met eligibility criteria.

MAIN OUTCOME MEASURES

We employed WHO criteria to classify the body mass index of women. Specifically we tested the association between combined OC utilisation with overweight/obesity after controlling for confounding variables.

RESULT

The prevalence of combined OC utilisation was 1.7% and the prevalence of overweight/obesity was 8.6% among adult women of reproductive age. Use of combined OC increases the odds of overweight/obesity by two times among adult women of reproductive age after controlling for potential confounders (adjusted OR=1.902 (1.064-3.399)).

CONCLUSION

In conclusion there is significant association between combined OC use and overweight/obesity. The findings have important implications for policymakers to design evidence based policy approachs to obesity prevention for women and at large for government to recognise the negative consequences of combined OC on women health.

Impacts of a New Supermarket on Dietary Behavior and the Local Foodscape in Kisumu, Kenya: Protocol for a Mixed Methods, Natural Experimental Study

Background

Access to healthy food is considered a key determinant of dietary behavior, and there is mixed evidence that living near a supermarket is associated with a healthier diet. In Africa, supermarkets may contribute to the nutrition transition by offering both healthy and unhealthy foods and by replacing traditional food sellers. In Kisumu, Kenya, a planned hypermarket (ie, a supermarket combined with a department store) will form the basis for a natural experimental evaluation.

Objective

The aim of this study is to explore the impacts of a new hypermarket on food shopping practices, dietary behaviors, physical activity patterns, and body composition among local residents and to identify concurrent changes in the local foodscape. We also aim to explore how impacts and associations vary by socioeconomic status.

Methods

We employ a mixed methods, longitudinal study design. Two study areas were defined: the hypermarket intervention area (ie, Kisumu) and a comparison area with no hypermarket (ie, Homabay). The study is comprised of 4 pieces of primary data collection: a quantitative household survey with local residents, a qualitative study consisting of focus group discussions with local residents and semistructured interviews with government and private sector stakeholders, an audit of the local foodscape using on-the-ground data collection, and an intercept survey of shoppers in the hypermarket. Assessments will be undertaken at baseline and approximately 1 year after the hypermarket opens.

Results

Baseline assessments were conducted from March 2019 to June 2019. From a total sampling frame of 400 households, we recruited 376 of these households, giving an overall response rate of 94.0%. The household survey was completed by 516 individuals within these households. Across the two study areas, 8 focus groups and 44 stakeholder interviews were conducted, and 1920 food outlets were geocoded.

Conclusions

This study aims to further the understanding of the relationship between food retail and dietary behaviors in Kenya. Baseline assessments for the study have been completed.

International Registered Report Identifier (IRRID)

DERR1-10.2196/17814

Overweight and obesity among women of reproductive age in Mali: what are the determinants?

Background

Existing evidence suggests that there has been a surge of overweight and obesity in low- and middle-income countries around the world. In this study we investigated the prevalence and factors associated with overweight and obesity among women in Mali.

Methods

We conducted the study among 5198 women using the 2018 Mali Demographic and Health Survey data. We used binary logistic regression for the analysis and pegged statistical significance at p<0.05.

Results

The prevalence of overweight and obesity was 26.9%. The likelihood of overweight and obesity was high among women 40–44 y of age (adjusted odds ratio [AOR] 5.94 [confidence interval {CI} 4.10 to 8.60]), those who were widowed/divorced/separated (AOR 1.59 [CI 1.04 to 2.43]), those with secondary education (AOR 1.41 [CI 1.13 to 1.75]), richest women (AOR 3.61 [CI 2.63 to 4.95]), those who watched television at least once a week (AOR 1.28 [CI 1.07 to 1.52]) and those who lived in the Kidal region (AOR 10.71 [CI 7.05 to 16.25]). Conversely, the likelihood of overweight and obesity was low among women who belonged to other religions compared with Muslims (AOR 0.63 [CI 0.43 to 0.92]).

Conclusions

This study found a predominance of overweight and obesity among women in Mali. The study showed that age, marital status, education, religion, region of residence, wealth status and frequency of watching television are associated with overweight and obesity among women in Mali. It is therefore critical for public health promotion programs in Mali to sensitize people to the negative effects associated with overweight and obesity. This implies that policies aimed at controlling overweight and obesity in Mali must take these factors into consideration.

Urban rural differences in prevalence and risk factors of self-reported hypertension among Kenyan women: a population-based study

This study investigated rural-urban variation in the prevalence of self-reported hypertension and its risk factors among reproductive-age women in Kenya. The 2014 nationally representative Kenya Demographic and Health Survey (KDHS) data were used in this analysis. The survey adopted a multistage, geographically clustered, and probability-based sampling approach. Multivariable logistic regression was performed to assess the association between risk factors and self-reported hypertension. Overall, 9.38% of the women were hypertensive with higher prevalence among urban 11.61%, compared to rural women, 7.86%. Older age, obesity, having diabetes, and increased the odds of hypertension in both rural and urban areas. We also observed that the odds of hypertension differed by ethnic group. High wealth status was a significant correlate only among urban women with women from rich and richest wealth groups had 2-2.3 times higher odds of hypertension compared to the poor and poorest wealth groups. Women with diabetes had 22 times higher odds of hypertension in both in rural and urban areas compared to women without diabetes. In conclusion, our study found that an estimated 1 out of 10 Kenyan women have hypertension. We believe that this study contributes to better understanding of regional variation of hypertension prevalence and risk factors for reproductive women in Kenya. Future studies should seek to develop evidence-based hypertension prevention and management interventions that are targeted and tailored for urban and rural women in Kenya.

Overweight and obesity among urban women with iron deficiency anaemia in Bangladesh

In this study, we aimed to determine the prevalence and factors associated with overweight and obesity among nonpregnant and nonlactating (NPNL) women of reproductive age with iron deficiency anaemia (IDA) in urban Bangladesh. We obtained data from the baseline assessment of a randomized control trial conducted among 525 women of reproductive age (18–49 years) with IDA (Hb < 12 gdl⁻¹ and serum ferritin <30 μg L⁻¹). The study was carried out in Mirpur, Dhaka, Bangladesh, between December 2017 and January 2019. We collected information on women's socio‐demographic characteristics and anthropometry. Body mass index (BMI) was calculated using the following formula: weight in kilograms per height in square metres. BMI ≥ 25–29.9 kg m⁻² was considered as overweight, whereas BMI ≥ 30 kg m⁻² as obese. A multivariable logistic regression model was used to ascertain the risk factors of overweight and obesity. The prevalence of overweight and obesity was 29.9% (95% CI: 26.0–34.0) and 13.1% (95% CI: 10.4–16.3), respectively. The combined prevalence of overweight and obesity was 43.0% (95% CI: 38.7–47.4). The multivariable analysis showed married women (aOR: 4.4; CI: 1.8–11.1), women aged 30–49 years (aOR: 7.6; CI: 2.4–24.1), unemployed women (aOR 1.5; CI: 1.0–2.4) and women from the wealthier households (aOR 3.9; CI: 2.3–6.8) had the highest risk of being overweight and obese compared with their counterparts. Both age and household wealth statuses showed dose–response relationships. Combination of overweight and obesity with IDA poses a particular challenge for public health interventions. The policymakers should consider what new interventions and policy initiatives are needed to address this combination of overweight and obesity with IDA.

Gender-specific temporal trends in overweight prevalence among Chinese adults: a hierarchical age-period-cohort analysis from 2008 to 2015

Background

As a key health risk, the prevalence of overweight has been strikingly increasing worldwide. This study aimed to disentangle the net age, period, and cohort effects on overweight among Chinese adults by gender.

Methods

Data came from the Chinese General Social Survey from 2008 to 2015, which was a repeated cross-sectional survey (n = 55,726, aged 18 and older). χ² or t tests were used to estimate the gender disparities in overweight and socioeconomic status (SES). A series of hierarchical age-period-cohort cross-classified random-effects models were performed using SAS version 9.4 to estimate the overall and gender-specific temporal trends of overweight, as well as the association between SES and overweight. Further, a series of line charts were used to present the age and cohort variations in overweight.

Results

After controlling for covariates, significant age and cohort effects were observed among adults in China (b = 0.0205, p < 0.001; b = 0.0122, p < 0.05; respectively). Specifically, inverted U-shaped age effects were identified for both genders, with a high probability of overweight occurring in middle age (b = -0.0012, p < 0.001). Overweight was more prevalent among men than women before 60 years old, and this trend reversed thereafter (b = -0.0253, p < 0.001). Moreover, men born during the war (before 1950) and reform cohorts (after the 1975s) demonstrated a substantial decline in overweight, while men born in 1950-1975 showed an increasing trend in overweight prevalence (b = 0.0378, p < 0.05). However, the cohort effect on women was not statistically significant. Additionally, a higher SES was related to an elevated probability of overweight.

Conclusion

Gender-specific age and cohort effects on the prevalence of overweight were observed among Chinese adults. Both China and other developing countries need to pay attention to the coming obesity challenge and related health inequality. Full life-cycle overweight prevention interventions should focus on middle-aged adults, men born in the war and reform eras, and adults with a higher SES.

The prevalence and associated factors of underweight and overweight/obesity among adults in Kenya: evidence from a national cross-sectional community survey

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.

Maternal obesity and its determinants: A neglected issue?

Maternal obesity is a global public health concern that affects every aspect of maternity care. It affects the short-term and long-term health of the mother and her offspring. Obese pregnant mothers are at an increased risk of developing complications during antenatal, intrapartum, and postnatal periods. Maternal complications include gestational diabetes mellitus, hypertensive disorder in pregnancy, pre-eclampsia and eclampsia, increased rate of cesarean delivery, pulmonary embolism, and maternal mortality; fetal complications include congenital malformation, stillbirth, and macrosomia. Moreover, both mother and infant are at an increased risk of developing subsequent non-communicable diseases and cardiovascular problems later in life. Several factors are associated with the likelihood of maternal obesity, including sociodemographic characteristics, obstetric characteristics, knowledge, and perception of health-promoting behavior. Gaining a sound understanding of these factors is vital to reaching the targets of Sustainable Developmental Goal 3-to reduce global maternal mortality and end preventable deaths of children under 5 years of age-by 2030. It is essential to identify pregnant women who are at risk of maternal obesity in order to plan and implement effective and timely interventions for optimal pregnancy outcomes. Importantly, maternal obesity as a significant pregnancy risk factor is largely modifiable.

Determinants of overweight/obesity among reproductive age group women in Ethiopia: multilevel analysis of Ethiopian demographic and health survey

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.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Country-Level Analysis of the Association between Maternal Obesity and Neonatal Mortality in 34 Sub-Saharan African Countries

Background

Prior work examining the association of maternal obesity and neonatal mortality indicate the presence of a positive relationship. However, regional evidence to provide insight on country-level heterogeneities within sub-Saharan Africa (SSA) with nationally representative datasets are non-existent.

Objective

We aimed to determine the relationship between maternal obesity and neonatal mortality at the country level in SSA countries. Moreover, we also estimate regional measures of association to complement previous findings.

Methods

Demographic and Health Survey (DHS) data from 34 SSA countries conducted from 2006-2016 were used for this study. After missing data (36.9% of cases) were addressed with multiple imputations, we identified a total of 175,860 women for the analysis. Complete case and multiply imputed datasets were analyzed individually with multilevel logistic regression models. Potential confounders adjusted for in the regression model included maternal age, level of educational attainment, area of residence, access to prenatal care, birth order and multiple birth (singleton vs twin birth). Regional and country-specific associations were computed, and unadjusted and adjusted odds ratios (ORs), along with the confidence intervals (CIs) were reported.

Findings

Of the total study population, 8,451 (7.6%) were obese. In the regional level analyses, maternal obesity was associated with 40% increased odds of neonatal deaths. This finding was consistent in subgroup analyses by urban and rural residence, and geographic region of residence in SSA. Additionally, obese women were more likely to report neonatal death in the first week of life (OR, days 0-1: 1.39, 95% CI 1.15-1.69; OR, days 2-6: 1.35, 95% CI 1.02-1.79). In the individual country analyses, majority of the countries studied had central estimates supporting elevated odds of neonatal mortality, but the confidence intervals were imprecise.

Conclusion

This study highlights the potential burden of neonatal mortality borne by obese women in SSA. There is, however, a need for longitudinal studies to confirm the results.

Non-Communicable Diseases on the Rise in Sub-Saharan Africa, the Underappreciated Threat of a Dual Disease Burden

In sub-Saharan Africa, the burden of non-communicable diseases (NCDs) remains under appreciated, but emerging evidence suggests it to be substantial. NCDs such as arterial hypertension, heart diseases, diabetes mellitus and chronic kidney diseases are especially relevant, and put additional strain on the already challenged health systems in this region. Moreover, NCDs appear to be associated with higher mortality and morbidity rates and are more common in younger population groups, in people from sub-Saharan Africa when compared to more developed countries. In this review, we summarize the current literature on the burden of NCDs in sub-Saharan Africa, and highlight the clinical implications of the most relevant etiologies, i.e. arterial hypertension, heart diseases, diabetes mellitus and chronic kidney diseases.

Magnitude and predictors of normal-weight central obesity- the AWI-Gen study findings

Background: Normal-weight central obesity is associated with higher mortality than general obesity as defined by body mass index, particularly in the absence of central fat distribution.Objective: The aim of this study was to examine the magnitude and predictors of normal-weight central obesity in an urban informal settlement setting in Kenya.Methods: We used data from the AWI-Gen study, a cross-sectional survey targeting randomly selected consenting adults between the ages of 40-60 in two urban informal settlements of Nairobi between 2014 and 2016. Central obesity was determined using waist circumference, waist to hip ratio, visceral fat thickness, and subcutaneous fat thickness. General obesity was determined using body mass index (BMI).Results: About 20.0% of participants in the study had general obesity. The prevalence of central obesity as measured by waist circumference was 52.0%, by waist-to-hip ratio was 53.5%, by visceral fat thickness was 32.4% and by subcutaneous fat thickness was 49.2%. The prevalence of normal-weight central obesity in the study population was highest when measured by waist to hip ratio (38.1%) and lowest when measured by visceral fat thickness (18.1%). Factors associated with normal-weight central obesity as assesses by waist circumference were being female, of older age, and in full-time employment. Older age was associated with normal-weight central obesity as assessed by waist to hip ratio.Conclusion: The findings highlight a significant prevalence of normal-weight central obesity among adults in a poor urban setting in Kenya, pointing to women as a key target group for focused interventions. Longitudinal studies are needed to establish whether there is a link between normal-weight central obesity and mortality in such settings as has been found in other settings.

Differentials in prevalence and correlates of metabolic risk factors of non-communicable diseases among women in sub-Saharan Africa: evidence from 33 countries

BACKGROUND

Even with the widespread recognition of non- communicable diseases (NCDs) in sub-Saharan Africa region, yet, sufficient evidence-based surveillance systems to confirm the prevalence and correlates of these diseases is lacking. In an attempt to understand the problem of NCDs in resource-constrained settings, this study was conducted to establish the pattern of the risk factors of NCDs in sub-Sahara Africa region.

METHODS

The current Demographic and Health Survey (DHS) data sets from 33 countries in sub-Sahara Africa region were used in this study. The individual woman component of DHS 2008-2016 was used. The outcome variables include anemia, hypertension and body mass index (underweight, overweight and obesity). BMI was categorized into; underweight (BMI < 18.5 kg/m2), normal (BMI 18.5-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2) and obesity (BMI ≥30 kg/m2). Hemoglobin level: anemic < 12.0 g/dL (< 120 g/L) for women. Hypertension was defined as systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg. Binary and multinomial logistic regression models were used to investigate the correlates of the variables.

RESULTS

The percentage of hypertension was highest among women in Lesotho with about 17.3% and lowest among women in Burundi (1.0%). Anemia was prevalent among sub-Saharan Africa women; where more than half of the women from several countries were anemic with Gabon (60.6%) reporting the highest prevalence. The percentage of obesity in sub-Saharan Africa showed that Lesotho (19.9%), Gabon (18.9%) and Ghana (15.6%) were the prominent countries with obese women, while Madagascar (1.1%) had the minimum obese women. Body mass index was significantly associated with hypertension and anemia. The behavioural or modifiable factors of hypertension and body mass index were; smoking, fruits, vegetables and alcohol consumption. While the non-modifiable significant factors include; age, residence, religion, education, wealth index, marital status, employment and number of children ever born. However, anemia shared similar factors except that smoking and vegetable consumption were not statistically significant. In addition, involvement in exercise was associated with anemia and hypertension.

CONCLUSION

The problem of NCDs and associated factors remains high among women of reproductive age in sub-Sahara region. The findings of this study suggest that promotion of regular positive health care-seeking behaviour, screening and early treatment are essential to mitigate the burden of NCDs. Furthermore, preventive interventions of NCDs risk factors should be strengthened among key population through behavior change communication with support from government and stakeholders in health care.

Trends, prevalence and risk factors of overweight and obesity among women of reproductive age in Bangladesh: a pooled analysis of five national cross-sectional surveys

OBJECTIVE

To determine the trends, prevalence and risk factors of overweight and obesity among Bangladeshi women of reproductive age from 1999 to 2014.

DESIGN

We analysed nationally representative data from the 1999, 2004, 2007, 2011 and 2014 cross-sectional Bangladesh Demographic and Health Surveys.

SETTING

Bangladesh.

PARTICIPANTS

Women aged 15-49 years.

PRIMARY OUTCOME

Overweight/obesity.

RESULTS

A total of 58 192 women were included in the analysis. The prevalence of overweight and obesity among women of reproductive age increased significantly from 7.53% (95% CI 6.83 to 8.29) and 1.82% (95% CI 1.48 to 2.24) in 1999 to 28.37% (95% CI 27.49 to 29.28) and 10.77% (95% CI 10.22 to 11.35) in 2014, respectively. Age, education, wealth index, watching television and contraceptive use were associated with overweight and obesity in both urban and rural areas.

CONCLUSIONS

Overweight and obesity prevalence increased significantly among Bangladeshi women of reproductive age between 1999 and 2014. Development of effective low-cost strategies to address the increasing burden of obesity should be a high priority.