Profiling Household Double and Triple Burden of Malnutrition in sub-Saharan Africa: Prevalence and Influencing Household Factors

Abstract Objective: Undernutrition and anaemia - the commonest micronutrient deficiency, continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. This study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA. Setting: The study involved twenty-three countries across SSA who conducted demographic and health surveys between 2008 and 2017. Participants: The analytical sample includes 145,020 households with valid data on the nutritional status of women and children pairs (i.e. women of reproductive age; 15-49 years and children under-five years). Design: Logistic regression analyses were used to determine household correlates of household burden of malnutrition. Results: Anaemia was the most common form of household burden of malnutrition, affecting about 7 out of 10 households. Double and Triple burden of malnutrition though less common, was also found to be present in 8 and 5 percent of the households respectively. The age of the household head, location of the household, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition. Conclusions: The findings of this study reveal that, both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only, but also address overweight/obesity and anaemia.

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Correlates of the double burden of malnutrition among women: an analysis of cross sectional survey data from sub-Saharan Africa

BMJ Open ◽

10.1136/bmjopen-2019-029545 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029545 ◽

Cited By ~ 5

Author(s):

Dickson Abanimi Amugsi ◽

Zacharie Tsala Dimbuene ◽

Catherine Kyobutungi

Keyword(s):

Household Wealth ◽

Normal Weight ◽

Overweight And Obesity ◽

Sub Saharan Africa ◽

Outcome Variable ◽

Demographic And Health Surveys ◽

African Countries ◽

Double Burden ◽

Double Burden Of Malnutrition ◽

Sub Saharan

ObjectiveTo investigate the correlates of the double burden of malnutrition (DBM) among women in five sub-Saharan African countries.DesignSecondary analysis of Demographic and Health Surveys (DHS). The outcome variable was body mass index (BMI), a measure of DBM. The BMI was classified into underweight (BMI <18.50 kg/m2), normal weight (18.50–24.99 kg/m2), overweight (25.0–29.9 kg/m2) and obesity (≥30.0 kg/m2).SettingsGhana, Nigeria, Kenya, Mozambique and Democratic Republic of Congo (DRC).SubjectsWomen aged 15–49 years (n=64698).ResultsCompared with normal weight women, number of years of formal education was associated with the likelihood of being overweight and obese in Ghana, Mozambique and Nigeria, while associated with the likelihood of being underweight in Kenya and Nigeria. Older age was associated with the likelihood of being underweight, overweight and obese in all countries. Positive associations were also observed between living in better-off households and overweight and obesity, while a negative association was observed for underweight. Breastfeeding was associated with less likelihood of underweight in DRC and Nigeria, obesity in DRC and Ghana, overweight in Kenya and overweight and obesity in Mozambique and Nigeria relative to normal weight.ConclusionsOur analysis reveals that in all the countries, women who are breastfeeding are less likely to be underweight, overweight and obese. Education, age and household wealth index tend to associate with a higher likelihood of DBM among women. Interventions to address DBM should take into account the variations in the effects of these correlates.

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Safer sex negotiation and parity among women in sub-Saharan Africa

Journal of Biosocial Science ◽

10.1017/s0021932021000651 ◽

2022 ◽

pp. 1-13

Author(s):

Collins Adu ◽

James Boadu Frimpong ◽

Aliu Mohammed ◽

Justice Kanor Tetteh ◽

Eugene Budu ◽

...

Keyword(s):

Safer Sex ◽

Household Head ◽

Wealth Quintile ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

African Countries ◽

High Parity ◽

Significance Level ◽

Sub Saharan

Abstract Women’s ability to negotiate for safer sex has effects on their sexual and reproductive health. This study investigated the association between safer sex negotiation and parity among women in sub-Saharan Africa. The data were sourced from the Demographic and Health Surveys of 28 sub-Saharan African countries conducted from 2010 to 2019. A total of 215,397 women aged 15–49 were included in the study. Multilevel logistic analysis was conducted to examine the association between safer sex negotiation and parity among women in sub-Saharan Africa. The results were presented as adjusted odds ratios (aOR) and the significance level set at p<0.05. The overall prevalences of safer sex negotiation and high parity among women in sub-Saharan Africa were 82.7% and 52.1%, respectively. The prevalence of high parity ranged from 32.3% in Chad to 72.1% in Lesotho. The lowest prevalence of safer sex negotiation was in Chad (16.8%) while the highest prevalence was recorded in Rwanda (99.7%). Women who had the capacity to negotiate for safer sex were less likely to have high parity compared with those who had no capacity to negotiate for safer sex (aOR = 0.78, CI: 0.75–0.81). Other factors that were associated with high parity were age, educational level, marital status, exposure to media, contraceptive use, religion, wealth quintile, sex of household head, and place of residence. The study identified significant association between safer sex negotiation and high parity among women of reproductive age in sub-Saharan Africa. It is worth noting that women’s ability to negotiate for safer sex could reduce high parity among women in sub-Saharan Africa. Therefore, policies and programmes aimed at birth control or reducing high parity among women could be targeted at improving their capacity to negotiate for safer sex through education.

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Impact of Orphanhood on Underweight Prevalence in Sub-Saharan Africa

Food and Nutrition Bulletin ◽

10.1177/156482650802900104 ◽

2008 ◽

Vol 29 (1) ◽

pp. 32-42 ◽

Cited By ~ 10

Author(s):

Jonathan Rivers ◽

John Mason ◽

Eva Silvestre ◽

Stuart Gillespie ◽

Mary Mahy ◽

...

Keyword(s):

Household Wealth ◽

Household Structure ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Wealth Status ◽

Orphan Status ◽

Confounding Variables ◽

Multiple Indicator ◽

Sub Saharan ◽

Child Nutritional Status

Background In Africa, approximately 25 million people live with HIV/AIDS and 12 million children are orphaned. Although evidence indicates that orphans risk losing opportunities for adequate education, health care, and future employment, the immediate effects of orphanhood on child nutritional status remain poorly understood. Objective This paper assesses the nutritional impact of orphanhood, with particular emphasis on taking account of various factors potentially confounding or masking these impacts. Methods Child anthropometry and orphan status were examined in 23 Multiple Indicator Cluster Surveys and Demographic and Health Surveys throughout sub-Saharan Africa, which were subsequently merged into larger, region-specific datasets (East, West, and Southern Africa). To compare orphans and nonorphans, linear regression and probit models were developed, taking account of orphan status and type, presence of a surviving parent in the household, household structure, child age and sex, urban versus rural residence, and current wealth status. Results Few differences emerged between orphans and nonorphans in controlled and uncontrolled comparisons, regardless of orphan type, presence of surviving parent, or household structure. Age differentials did confound nutritional comparisons, although in the counterintuitive direction, with orphans (who were 8 months older on average) becoming less malnourished when age differences were taken into account. Wealth did appear to be associated with orphanhood status, although it did not significantly confound nutritional comparisons. Conclusions Orphans were not consistently more malnourished than nonorphans, even when potential confounding variables were examined. Since household wealth status is likely to change after becoming affected by HIV, ruling out wealth as a potential confounder would require more detailed, prospective studies.

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Socioeconomic determinants of cumulative fertility in Ghana

PLoS ONE ◽

10.1371/journal.pone.0252519 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252519

Author(s):

Samuel H. Nyarko

Keyword(s):

Negative Binomial ◽

Sexual Debut ◽

Negative Binomial Regression ◽

Household Wealth ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Socioeconomic Disparities ◽

Demographic And Health Surveys ◽

Cumulative Fertility ◽

Sub Saharan

The pace of decline in fertility rates in sub-Saharan Africa appears to have slowed or stalled in the last few decades. This study examines the socioeconomic associated with cumulative fertility in Ghana. Negative binomial regression models were used to estimate determinants of cumulative fertility using data from the Ghana Demographic and Health Surveys of 2003, 2008, and 2014. The composition of children ever born by women did not change considerably over the study periods. Socioeconomic disparities in educational attainment, household wealth, employment, and employer status are significantly associated with cumulative fertility risks in Ghana. The current age of women, age at sexual debut, and marital status, among others, are also linked to cumulative fertility levels. Place and region of residence are also linked to fertility in Ghana. Cumulative fertility levels in Ghana are underscored by considerable socioeconomic disparities among women of reproductive age. Fertility regulation policies should hinge on improving the socio-economic wellbeing of women in Ghana.

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Decomposing the rural–urban gap in factors associated with childhood immunisation in sub-Saharan Africa: evidence from surveys in 23 countries

BMJ Global Health ◽

10.1136/bmjgh-2020-003773 ◽

2021 ◽

Vol 6 (1) ◽

pp. e003773

Author(s):

Edward Kwabena Ameyaw ◽

Yusuf Olushola Kareem ◽

Bright Opoku Ahinkorah ◽

Abdul-Aziz Seidu ◽

Sanni Yaya

Keyword(s):

Decomposition Analysis ◽

Household Wealth ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Childhood Immunisation ◽

Urban Settings ◽

Factors Associated ◽

Rural And Urban ◽

Full Immunisation ◽

Sub Saharan

BackgroundAbout 31 million children in sub-Saharan Africa (SSA) suffer from immunisation preventable diseases yearly and more than half a million children die because of lack of access to immunisation. Immunisation coverage has stagnated at 72% in SSA over the past 6 years. Due to evidence that full immunisation of children may be determined by place of residence, this study aimed at investigating the rural–urban differential in full childhood immunisation in SSA.MethodsThe data used for this study consisted of 26 241 children pooled from 23 Demographic and Health Surveys conducted between 2010 and 2018 in SSA. We performed a Poisson regression analysis with robust Standard Errors (SEs) to determine the factors associated with full immunisation status for rural and urban children. Likewise, a multivariate decomposition analysis for non-linear response model was used to examine the contribution of the covariates to the observed rural and urban differential in full childhood immunisation. All analyses were performed using Stata software V.15.0 and associations with a p<0.05 were considered statistically significant.ResultsMore than half of children in urban settings were fully immunised (52.8%) while 59.3% of rural residents were not fully immunised. In all, 76.5% of rural–urban variation in full immunisation was attributable to differences in child and maternal characteristics. Household wealth was an important component contributing to the rural–urban gap. Specifically, richest wealth status substantially accounted for immunisation disparity (35.7%). First and sixth birth orders contributed 7.3% and 14.9%, respectively, towards the disparity while 7.9% of the disparity was attributable to distance to health facility.ConclusionThis study has emphasised the rural–urban disparity in childhood immunisation, with children in the urban settings more likely to complete immunisation. Subregional, national and community-level interventions to obviate this disparity should target children in rural settings, those from poor households and women who have difficulties in accessing healthcare facilities due to distance.

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Trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa since 2000: a cross-sectional series study

BMJ Global Health ◽

10.1136/bmjgh-2020-002948 ◽

2020 ◽

Vol 5 (10) ◽

pp. e002948

Author(s):

Safia S Jiwani ◽

Giovanna Gatica-Domínguez ◽

Inacio Crochemore-Silva ◽

Abdoulaye Maïga ◽

Shelley Walton ◽

...

Keyword(s):

Nutritional Status ◽

Adolescent Girls ◽

Overweight And Obesity ◽

Rate Of Change ◽

Capital City ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Adult Women ◽

Cross Sectional ◽

Sub Saharan

IntroductionEvidence on the rate at which the double burden of malnutrition unfolds is limited. We quantified trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa.MethodsWe analysed 102 Demographic and Health Surveys between 1993 and 2017 from 35 countries. We assessed regional trends through cross-sectional series analyses and ran multilevel linear regression models to estimate the average annual rate of change (AARC) in the prevalence of underweight, anaemia, anaemia during pregnancy, overweight and obesity among women by their age, residence, wealth and education levels. We quantified current absolute inequalities in these indicators and wealth-inequality trends.ResultsThere was a modest decline in underweight prevalence (AARC=−0.14 percentage points (pp), 95% CI −0.17 to -0.11). Anaemia declined fastest among adult women and the richest pregnant women with an AARC of −0.67 pp (95% CI −1.06 to -0.28) and −0.97 pp (95% CI −1.60 to -0.34), respectively, although it affects all women with no marked disparities. Overweight is increasing rapidly among adult women and women with no education. Capital city residents had a threefold more rapid rise in obesity (AARC=0.47 pp, 95% CI 0.39, 0.55), compared with their rural counterparts. Absolute inequalities suggest that Ethiopia and South Africa have the largest gap in underweight (15.4 pp) and obesity (28.5 pp) respectively, between adult and adolescent women. Regional wealth inequalities in obesity are widening by 0.34 pp annually.ConclusionUnderweight persists, while overweight and obesity are rising among adult women, the rich and capital city residents. Adolescent girls do not present adverse nutritional outcomes except anaemia, remaining high among all women. Multifaceted responses with an equity lens are needed to ensure no woman is left behind.

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Geographic variation and risk factors for teenage pregnancy in Uganda

African Health Sciences ◽

10.4314/ahs.v20i4.48 ◽

2020 ◽

Vol 20 (4) ◽

pp. 1898-907

Author(s):

Joseph Byonanebye ◽

Ruta Brazauskas ◽

Nazarius Tumwesigye ◽

Staci Young ◽

Thomas May ◽

...

Keyword(s):

Risk Factors ◽

Teenage Pregnancy ◽

Sub Saharan Africa ◽

Health Issue ◽

Bivariate Analysis ◽

Demographic And Health Surveys ◽

Wealth Status ◽

Pregnancy Risk ◽

Global Health Issue ◽

Sub Saharan

Background: Teenage pregnancy is a global health issue with high rates in sub-Saharan Africa. In Uganda, teenage pregnan- cy is a public and community health issue. Objectives: This study hypothesized that there would be regional variations in rates, risk factors and trends of teenage pregnancy in Uganda. Methods: Data were analyzed from the Uganda Demographic and Health Surveys (UDHS) in 2006 and 2011. The outcome of interest was current pregnancy for females 15 to 19 years of age at the time of the survey. Bivariate analysis was per- formed for each year to examine the rate and trends of pregnancy by various demographic characteristics. Logistic regres- sion was conducted to assess the association between teenage pregnancy and sociodemographic variables. Results: Uganda’s rate of teenage pregnancy increased from 7.3/1000 in 2006 to 8.1/1000 in 2011. The East Central region consistently had the highest rates than other regions. In 2006, teenage pregnancy was significantly associated with being mar- ried, living with a partner or separated, as compared to those who were single. Marital and wealth status were also significant predictors of teenage pregnancy based on the 2011 survey. Conclusion: The rate of teenage pregnancy in Uganda is high and the trend demonstrated regional variation. Future inter- ventions could focus on regions with high poverty and low education. Keywords: Teenage pregnancy; risk factors; Uganda demographic; health survey.

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Sociodemographic Inequalities in Health Insurance Ownership among Women in Selected Francophone Countries in Sub-Saharan Africa

BioMed Research International ◽

10.1155/2021/6516202 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Yiting Wang ◽

Xuhui Wang ◽

Lu Ji ◽

Rui Huang

Keyword(s):

Health Insurance ◽

Rural Women ◽

Rural Areas ◽

Household Wealth ◽

Access To Healthcare ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Universal Healthcare ◽

Explanatory Factors ◽

Sub Saharan

In sub-Saharan Africa, improving equitable access to healthcare remains a major challenge for public health systems. Health policymakers encourage the adoption of health insurance schemes to promote universal healthcare. Nonetheless, progress towards this goal remains suboptimal due to inequalities health insurance ownership especially among women. In this study, we aimed to explore the sociodemographic factors contributing to health insurance ownership among women in selected francophone countries in sub-Saharan Africa. Methods. This study is based on cross-sectional data obtained from Demographic and Health Surveys on five countries including Benin ( n = 13,407 ), Madagascar ( n = 12,448 ), Mali ( n = 10,326 ), Niger ( n = 12,558 ), and Togo ( n = 6,979 ). The explanatory factors included participant age, marital status, type of residency, education, household wealth quantile, employment stats, and access to electronic media. Associations between health insurance ownership and the explanatory factors were analyzed using multivariate regression analysis, and effect sizes were reported in terms in average marginal effects (AMEs). Results. The highest percentage of insurance ownership was observed for Togo (3.31%), followed by Madagascar (2.23%) and Mali (2.2%). After stratifying by place of residency, the percentages were found to be significantly lower in the rural areas for all countries, with the most noticeable difference observed for Niger (7.73% in urban vs. 0.54% in rural women). Higher levels of education and wealth quantile were positively associated with insurance ownership in all five countries. In the pooled sample, women in the higher education category had higher likelihood of having an insurance: Benin ( AME = 1.18 ; 95% CI = 1.10 , 1.27), Madagascar ( AME = 1.10 ; 95% CI = 1.05 , 1.15), Mali ( AME = 1.14 ; 95% CI = 1.04 , 1.24), Niger ( AME = 1.13 ; 95% CI = 1.07 , 1.21), and Togo ( AME = 1.17 ; 95% CI = 1.09 , 1.26). Regarding wealth status, women from the households in the highest wealth quantile had 4% higher likelihood of having insurance in Benin and Mali and 6% higher likelihood in Madagascar and Togo. Conclusions. Percentage of women who reported having health insurance was noticeably low in all five countries. As indicated by the multivariate analyses, the actual situation is likely to be even worse due to significant socioeconomic inequalities in the distribution of women having an insurance plan. Increasing women’s access to healthcare is an urgent priority for population health promotion in these countries, and therefore, addressing the entrenched sociodemographic disparities should be given urgent policy attention in an effort to strengthen universal healthcare-related goals.

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Association between type of contraceptive use and haemoglobin status among women of reproductive age in 24 sub-Saharan Africa countries

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2018-200178 ◽

2018 ◽

Vol 45 (1) ◽

pp. 54-60 ◽

Cited By ~ 1

Author(s):

Samson Gebremedhin ◽

Anteneh Asefa

Keyword(s):

Contraceptive Use ◽

Secondary Data ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Hormonal Contraceptives ◽

Demographic And Health Surveys ◽

Barrier Methods ◽

Oral Contraceptive Pills ◽

Nationally Representative ◽

Sub Saharan

BackgroundLittle is known whether contraceptive methods differentially modify women’s risk of anaemia or not. We compared the haemoglobin status of women currently using different fertility regulation methods in sub-Saharan Africa (SSA) where anaemia is a major concern.MethodsWe conducted the study based on the secondary data of 24 nationally representative demographic and health surveys carried out recently in SSA. The data of 105 532 women were included in the analysis. In the original surveys, respondents were selected using multistage sampling techniques and haemoglobin was determined using the HemoCue analyser. The association between method of contraception and anaemia status was determined via a mixed-effects logistic regression model adjusted for potential confounders. The outputs are presented using adjusted odds ratio (AOR) with 95% CI.ResultsThe mean (±SD deviation) haemoglobin was 12.3 (±1.7) g/dl and 36.7% of the women had anaemia. Current use of modern contraceptives, as compared with non-use, was associated with a 25% reduction (AOR=0.75 (95% CI: 0.73 to 0.78)) in the odds of anaemia. Comparison among individual modern methods showed, as compared with current barrier methods users, use of injectables (AOR=0.62 (95% CI: 0.57 to 0.67)), oral contraceptive pills (OCP) (AOR=0.62 (95% CI: 0.57 to 0.66)) and implants (AOR=0.63 (95% CI: 0.58 to 0.70)) were significantly associated with reduced odds of anaemia. With reference to women with less than 12 months of use, the odds were significantly reduced by about a quarter among women with more than 12 months of OCP or injectables use.ConclusionThe use of hormonal contraceptives is associated with lower odds of anaemia.

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Cross-country Comparison of Dietary Patterns and Obesity Among Women of Reproductive Age in Urban Sub-Saharan Africa (P10-069-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.p10-069-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Lilia Bliznashka ◽

Günther Fink ◽

Valerie Flax ◽

Chrissie Thakwalakwa ◽

Lindsay Jaacks

Keyword(s):

Higher Education ◽

Dietary Patterns ◽

Overweight And Obesity ◽

Reproductive Age ◽

Leafy Vegetables ◽

Sub Saharan Africa ◽

Specific Information ◽

Women Of Reproductive Age ◽

High Intake ◽

Sub Saharan

Abstract Objectives Obesity is an increasing problem among women of reproductive age (WRA) in urban sub-Saharan Africa (SSA), yet population-specific information on dietary risk factors is limited. The objective of this study was to derive dietary patterns (DPs) among WRAs in urban SSA and to examine their association with overweight and obesity. Methods We used baseline data from two prospective studies conducted among WRAs in Accra, Ghana (n = 2307, year = 2008–9) and Lilongwe, Malawi (n = 103, year = 2017–18). Diet was assessed using locally adapted food frequency questionnaires. Overweight was defined as body mass index (BMI) ≥25 kg/m2 and BMI <30 kg/m2, and obesity as BMI ≥30 kg/m2. DPs were derived using principal components analysis, and their association with overweight and obesity was assessed using generalized linear models controlling for age, education and wealth. Socio-demographic characteristics were examined across ordered DP quartiles/quintiles using a non-parametric test for trends (significance: P < 0.05). Results Two DPs were identified in both Ghana and Malawi, explaining 34% and 42% of dietary variance, respectively. In both samples, a protein DP was identified characterized by high intake of cereals, pulses, eggs, meat and poultry in Ghana and dairy, eggs, poultry, fats and sugar-sweetened beverages in Malawi. In addition, a healthy DP in Ghana showed high intake of fruit, nuts and dark green leafy vegetables, and a modern DP in Malawi showed high intake of sweets, processed foods, tubers, nuts and fruit. In both countries, higher education and wealth were associated with higher protein, healthy and modern DPs. In Ghana, higher protein DP was also associated with lower age and lower prevalence of underweight. DPs were not significantly (all P > 0.05) associated with overweight or obesity in either Ghana or Malawi. Conclusions Healthy and protein DPs characterized diets of urban WRA in Ghana, and protein and modern DPs in Malawi. Higher education and wealth were associated with higher DP quartiles/quintiles in both samples. The healthy DP in Ghana may reflect an earlier stage of the nutrition transition compared to the modern DP in Malawi (data collected ten years apart), or different food cultures and food varieties in the two countries. Further research is needed to understand the lack of association between DPs and obesity among urban WRAs in SSA. Funding Sources None. Supporting Tables, Images and/or Graphs

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