The Co-Occurrence of Overweight and Micronutrient Deficiencies or Anemia among Women of Reproductive Age in Malawi

ABSTRACT Background In low-resource settings, urbanization may contribute to the individual-level double burden of malnutrition (DBM), whereby under- and overnutrition co-occur within the same individuals. Objective We described DBM prevalence among Malawian women by urban-rural residence, examined whether urban residence was associated with DBM, and assessed whether DBM prevalence was greater than the prevalence expected by chance given population levels of under- and overnutrition, which would suggest DBM is a distinct phenomenon associated with specific factors. Methods We analyzed nationally representative data of 723 nonpregnant women aged 15–49 y from the 2015–2016 Malawi Micronutrient Survey. DBM was defined as co-occurring overweight or obesity (OWOB) and ≥1 micronutrient deficiency or anemia. We used Poisson regression models to examine the association between urban residence and DBM and its components. The Rao-Scott modified chi-square test compared the observed and expected DBM prevalence. Results Nationally, 10.8% (95% CI: 7.0, 14.5) of women had co-occurring OWOB and any micronutrient deficiency and 3.4% (95% CI: 1.3, 5.5) had co-occurring OWOB and anemia. The prevalence of co-occurring OWOB and any micronutrient deficiency was 2 times higher among urban women than rural women [urban 32.6 (24.1, 41.2) compared with rural 8.6 (5.2, 11.9), adjusted prevalence ratio: 2.0 (1.1, 3.5)]. Co-occurring OWOB and anemia prevalence did not significantly differ by residence [urban 6.9 (0.6, 13.2) compared with rural 3.0 (0.8, 5.3)]. There were no statistically significant differences in observed and expected prevalence estimates of DBM. Conclusions This analysis shows that co-occurring OWOB and any micronutrient deficiency was higher among women in urban Malawi compared with rural areas. However, our finding that co-occurring OWOB and any micronutrient deficiency or anemia may be due to chance suggests that there may not be common causes driving DBM in Malawian women. Thus, there may not be a need to design and target interventions specifically for women with DBM.

Download Full-text

Intraindividual double burden of overweight or obesity and micronutrient deficiencies or anemia among women of reproductive age in 17 population-based surveys

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa118 ◽

2020 ◽

Vol 112 (Supplement_1) ◽

pp. 468S-477S ◽

Cited By ~ 1

Author(s):

Anne M Williams ◽

Junjie Guo ◽

O Yaw Addo ◽

Sanober Ismaily ◽

Sorrel M L Namaste ◽

...

Keyword(s):

Population Based ◽

Micronutrient Deficiency ◽

High Income ◽

Reproductive Age ◽

Micronutrient Deficiencies ◽

Women Of Reproductive Age ◽

Chi Square ◽

Double Burden ◽

Middle Income ◽

The Individual

ABSTRACT Background Rising prevalence of overweight/obesity (OWOB) alongside persistent micronutrient deficiencies suggests many women face concomitant OWOB and undernutrition. Objectives We aimed to 1) describe the prevalence of the double burden of malnutrition (DBM) among nonpregnant women of reproductive age, defined as intraindividual OWOB and either ≥1 micronutrient deficiency [micronutrient deficiency index (MDI) > 0; DBM-MDI] or anemia (DBM-anemia); 2) test whether the components of the DBM were independent; and 3) identify factors associated with DBM-MDI and DBM-anemia. Methods With data from 17 national surveys spanning low- and middle-income countries (LMICs) and high-income countries from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project (n = 419 to n = 9029), we tested independence of over- and undernutrition using the Rao–Scott chi-square test and examined predictors of the DBM and its components using logistic regression for each survey. Results Median DBM-MDI was 21.9% (range: 1.6%–39.2%); median DBM-anemia was 8.6% (range: 1.0%–18.6%). OWOB and micronutrient deficiencies or anemia were independent in most surveys. Where associations existed, OWOB was negatively associated with micronutrient deficiencies and anemia in LMICs. In 1 high-income country, OWOB women were more likely to experience micronutrient deficiencies and anemia. Age was consistently positively associated with OWOB and the DBM, whereas the associations with other sociodemographic characteristics varied. Higher socioeconomic status tended to be positively associated with OWOB and the DBM in LMICs, whereas in higher-income countries the association was reversed. Conclusions The independence of OWOB and micronutrient deficiencies or anemia within individuals suggests that these forms of over- and undernutrition may have unique etiologies. Decision-makers should still consider the prevalence, consequences, and etiology of the individual components of the DBM as programs move towards double-duty interventions aimed at addressing OWOB and undernutrition simultaneously.

Download Full-text

Intraindividual double burden of overweight and micronutrient deficiencies or anemia among preschool children

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa101 ◽

2020 ◽

Vol 112 (Supplement_1) ◽

pp. 478S-487S

Author(s):

Reina Engle-Stone ◽

Junjie Guo ◽

Sanober Ismaily ◽

O Yaw Addo ◽

Tahmeed Ahmed ◽

...

Keyword(s):

Preschool Children ◽

Population Level ◽

Population Based ◽

Micronutrient Deficiency ◽

Micronutrient Deficiencies ◽

Chi Square ◽

Double Burden ◽

Caregiver Education ◽

Chi Square Test ◽

Household Socioeconomic Status

ABSTRACT Background Child overweight prevalence is increasing globally, but micronutrient deficiencies persist. Objectives We aimed to 1) describe the prevalence and distribution of intraindividual double burden of malnutrition (DBM), defined as coexistence of overweight or obesity (OWOB) and either micronutrient deficiencies or anemia, among preschool children; 2) assess the independence of DBM components, e.g., whether the prevalence of DBM is greater than what would be expected by chance; and 3) identify predictors of intraindividual DBM, to guide intervention targeting. Methods We analyzed data from 24 population-based surveys from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project (separately by survey; n = 226 to n = 7166). We defined intraindividual DBM as coexisting OWOB and ≥1 micronutrient deficiency [e.g., Micronutrient Deficiency Index (MDI) > 0; DBM-MDI] or anemia (DBM-Anemia). We assessed independence of DBM components with the Rao–Scott chi-square test and examined predictors of DBM and its components with logistic regression. Results DBM prevalence ranged from 0% to 9.7% (median: 2.5%, DBM-MDI; 1.4%, DBM-Anemia), reflecting a lower prevalence of OWOB (range: 0%–19.5%) than of micronutrient deficiencies and anemia, which exceeded 20% in most surveys. OWOB was generally not significantly associated with micronutrient deficiencies or anemia. In more than half of surveys, children 6–23 mo of age, compared with ≥24 mo, had greater adjusted odds of DBM-Anemia, anemia, and micronutrient deficiencies. Child sex and household socioeconomic status, urban location, and caregiver education did not consistently predict DBM or its components. Conclusions Intraindividual DBM among preschool children was low but might increase as child OWOB increases. The analysis does not support the hypothesis that DBM components cluster within individuals, suggesting that population-level DBM may be addressed by programs to reduce DBM components without targeting individuals with DBM.

Download Full-text

Prevalence and determinants of contraceptives use among rural young women (15-24 years) in Ghana

10.21203/rs.3.rs-25494/v1 ◽

2020 ◽

Author(s):

Mohammed Gazali Salifu ◽

Kamaldeen Mohammed ◽

Mac-Cauley Harrison ◽

Aaron Atimpe ◽

Rogers Wuniwumda Abukari ◽

...

Keyword(s):

Young Women ◽

Rural Women ◽

Rural Areas ◽

Educational Level ◽

Contraceptive Use ◽

Reproductive Age ◽

Categorical Variables ◽

Chi Square ◽

History Of ◽

Living Children

Abstract Background: Contraceptives use has significant effect on controlling fertility, preventing STIs, reducing unwanted pregnancies and induced abortions. The use of contraceptives among reproductive age women (15-49 years) has been largely reported. However, what is unclear is whether the reported prevalence of, and factors that influence the usage of contraceptives is comparable in the context of young adults (aged 15-24 years) in rural areas. The purpose of this study was therefore to report the prevalence and factors that influence contraceptives use among young women (15-24 years) in rural Ghana.Methods: Data (n = 3797) collected using a questionnaire through a mutli-stage probability sampling method in the 2017 Ghana Maternal Health Survey (GMHS) was analyzed by descriptive and inferential statistical methods. The chi-square test was used to identify significant associations between categorical variables at a significant level of p < 0.05. Univariate and multivariate logistic regression analyses was conducted to explore how well each independent variable predicted contraceptive use. Results: Out of the 3,797 women, only 21.49% (95% CI: 19.56, 23.55) used contraceptives. Number of living children, health insurance, knowledge of fertility period, history of abortion, ever given birth, educational level, age of participants and current union were found to influence contraceptives use. Strong significant predictors (at 95% CI, p<0.05) of contraceptives use were history of abortion, age of participants, educational level, number of living children, and knowledge of fertility period. Conclusion: Low usage of contraceptives has been identified among rural women and so there is the need for policymakers to intensify education and facilitate widespread access to modern contraceptives in rural areas and promote their effective use.

Download Full-text

Differences in prevalence and associated factors of underweight and overweight/obesity according to rural–urban residence strata among women of reproductive age in Bangladesh: evidence from a cross-sectional national survey

BMJ Open ◽

10.1136/bmjopen-2019-034321 ◽

2020 ◽

Vol 10 (2) ◽

pp. e034321 ◽

Cited By ~ 3

Author(s):

Mohammad Rashidul Hashan ◽

Rajat Das Gupta ◽

Brendan Day ◽

Gulam Muhammed Al Kibria

Keyword(s):

Rural Women ◽

Public Awareness ◽

Urban Women ◽

Reproductive Age ◽

Secondary Outcome ◽

Inverse Association ◽

Urban Residence ◽

Women Of Reproductive Age ◽

Double Burden ◽

Cross Sectional

ObjectivesThis study aimed to investigate the differences in prevalence and factors influencing underweight and overweight/obesity stratified by region of residence among women of reproductive age in Bangladesh.DesignSecondary analysis of cross-sectional nationwide data.SettingThis study used Bangladesh Demographic and Health Survey 2014 data.ParticipantsA weighted sample of 16 478 women of reproductive age (15–49 years) were included in the analysis.Primary and secondary outcome measuresUsing the Asian-specific cut-off for body mass index, the primary outcome of this study was categorised as: underweight (<18.5 kg/m2), normal weight (18.5 to <23.0) kg/m2and overweight/obese (≥23.0 kg/m2) stratified according to rural–urban residence.ResultsMore than half of urban women (53%, n=2493) and one-third of rural women (33%, n=3968) were found to be overweight/obese. Around one-fifth of rural women (21%, n=2490) and almost one in eight urban women (12%, n=571) were reported as underweight. In the final multivariable analyses, increasing age, higher educational status and higher order wealth quintile, each had a significant positive association with being overweight/obese and an inverse association with being underweight. Urban unmarried women had lower odds of being overweight/obese compared with their married counterparts. Rural women who used contraceptives had significantly decreased odds (adjusted OR (AOR) 0.8, 95% CI 0.7 to 0.9) of being underweight compared with contraceptive non-users; no such association was noted in urban women. Women from Sylhet division in both urban (AOR 1.7, 95% CI 1.2 to 2.5) and rural regions (AOR 1.5, 95% CI 1.2 to 1.8) had increased odds of being underweight compared with women in Barisal division.ConclusionsThis study found association of multiple factors with both overweight/obesity and underweight among Bangladeshi women of reproductive age. Public health programmes in Bangladesh aiming to prevent the double burden of malnutrition should focus these factors through comprehensive public awareness and cost-effective operational health interventions.

Download Full-text

Various forms of double burden of malnutrition problems exist in rural Kenya

BMC Public Health ◽

10.1186/s12889-019-7882-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 5

Author(s):

Andrea Fongar ◽

Theda Gödecke ◽

Matin Qaim

Keyword(s):

Developing Countries ◽

Rural Areas ◽

Micronutrient Deficiency ◽

Double Burden ◽

Household Level ◽

Individual Level ◽

Child Undernutrition ◽

Rural Kenya ◽

Double Burden Of Malnutrition ◽

The Individual

Abstract Background The coexistence of overweight/obesity and undernutrition is often referred to as the double burden of malnutrition (DB). DB was shown to exist in many developing countries, especially in urban areas. Much less is known about DB in rural areas of developing countries. Also, the exact definition of DB varies between studies, making comparison difficult. The objective of this study is to analyse DB problems in rural Kenya, using and comparing different DB definitions and measurement approaches. Methods Food intake and anthropometric data were collected from 874 male and female adults and 184 children (< 5 years) through a cross-section survey in rural areas of Western Kenya. DB at the individual level is defined as a person suffering simultaneously from overweight/obesity and micronutrient deficiency or stunting. DB at the household level is defined as an overweight/obese adult and an undernourished child living in the same household, using underweight, stunting, wasting, and micronutrient deficiency as indicators of child undernutrition. Results DB at the individual level is found in 19% of the adults, but only in 1% of the children. DB at the household level is relatively low (1–3%) when using wasting or underweight as indicators of child undernutrition, but much higher (13–17%) when using stunting or micronutrient deficiency as indicators. Conclusion Various forms of DB problems exist in rural Kenya at household and individual levels. Prevalence rates depend on how exactly DB is defined and measured. The rise of overweight and obesity, even in rural areas, and their coexistence with different forms of undernutrition are challenges for food and nutrition policies.

Download Full-text

Rural-urban variation in hypertension among women in Ghana: insights from a national survey

BMC Public Health ◽

10.1186/s12889-021-12204-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Francis Appiah ◽

Edward Kwabena Ameyaw ◽

Joseph Kojo Oduro ◽

Linus Baatiema ◽

Francis Sambah ◽

...

Keyword(s):

Logistic Regression ◽

Rural Women ◽

Rural Areas ◽

Statistical Significance ◽

Health Sector ◽

Binary Logistic Regression ◽

Reproductive Age ◽

Health Concern ◽

Odds Ratios ◽

Chi Square

Abstract Background Hypertension is one of the leading causes of cardiovascular morbidities in Ghana and represents a major public health concern. There is dearth of information on the rural-urban disparity in hypertension among women in Ghana. Therefore, this study aimed at examining the rural-urban variation in hypertension among women in Ghana. Methods We extracted data from the women’s file of the 2014 Ghana Demographic and Health Survey. The sample included 9333 women aged 15–49 with complete data on hypertension. The analysis was done using Pearson Chi-square and binary logistic regression at 95% confidence interval. The results of the binary logistic regression were presented as Odds Ratios (ORs) and Adjusted Odds Ratios (AORs). Statistical significance was set at p < 0.05. Results Hypertension prevalence among urban and rural residents were 9.5% and 5.1% respectively. Rural women had lower odds of hypertension [OR = 0.59; 95% CI = 0.52, 0.67] compared to urban women, however, this was insignificant in the adjusted model [aOR = 0.84; 95% CI = 0.70, 1.00]. The propensity to be hypertensive was lower for women aged 15–19 [aOR = 0.07; 95% CI = 0.05, 0.11]. The poorest were less likely to be hypertensive [aOR = 0.63; 95% CI = 0.45, 0.89]. Single women were also less probable to have hypertension [aOR = 0.66; 95% CI = 0.46, 0.97]. Conclusions Women from urban and rural areas shed similar chance to be hypertensive in Ghana. Therefore, the health sector needs to target women from both areas of residence (rural/urban) when designing their programmes that are intended to modify women’s lifestyle in order to reduce their risks of hypertension. Other categories of women that need to be prioritised to avert hypertension are those who are heading towards the end of their reproductive age, richest women and the divorced.

Download Full-text

Prevalence of anaemia, deficiencies of iron and vitamin A and their determinants in rural women and young children: a cross-sectional study in Kalalé district of northern Benin

Public Health Nutrition ◽

10.1017/s1368980016003608 ◽

2017 ◽

Vol 20 (7) ◽

pp. 1203-1213 ◽

Cited By ~ 14

Author(s):

Halimatou Alaofè ◽

Jennifer Burney ◽

Rosamond Naylor ◽

Douglas Taren

Keyword(s):

Vitamin A ◽

Rural Women ◽

Maternal Education ◽

Large Family ◽

Reproductive Age ◽

Micronutrient Deficiencies ◽

Nutrition Survey ◽

Anthropometric Parameters ◽

Cross Sectional ◽

Food Diversity

AbstractObjectiveTo identify the magnitude of anaemia and deficiencies of Fe (ID) and vitamin A (VAD) and their associated factors among rural women and children.DesignCross-sectional, comprising a household, health and nutrition survey and determination of Hb, biochemical (serum concentrations of ferritin, retinol, C-reactive protein and α1-acid glycoprotein) and anthropometric parameters. Multivariate logistic regression examined associations of various factors with anaemia and micronutrient deficiencies.SettingKalalé district, northern Benin.SubjectsMother–child pairs (n 767): non-pregnant women of reproductive age (15–49 years) and children 6–59 months old.ResultsIn women, the overall prevalence of anaemia, ID, Fe-deficiency anaemia (IDA) and VAD was 47·7, 18·3, 11·3 and 17·7 %, respectively. A similar pattern for anaemia (82·4 %), ID (23·6 %) and IDA (21·2 %) was observed among children, while VAD was greater at 33·6 %. Greater risk of anaemia, ID and VAD was found for low maternal education, maternal farming activity, maternal health status, low food diversity, lack of fruits and vegetables consumption, low protein foods consumption, high infection, anthropometric deficits, large family size, poor sanitary conditions and low socio-economic status. Strong differences were also observed by ethnicity, women’s group participation and source of information. Finally, age had a significant effect in children, with those aged 6–23 months having the highest risk for anaemia and those aged 12–23 months at risk for ID and IDA.ConclusionsAnaemia, ID and VAD were high among rural women and their children in northern Benin, although ID accounted for a small proportion of anaemia. Multicentre studies in various parts of the country are needed to substantiate the present results, so that appropriate and beneficial strategies for micronutrient supplementation and interventions to improve food diversity and quality can be planned.

Download Full-text

DETERMINANTS OF INDUCED ABORTION: AN ANALYSIS OF INDIVIDUAL, HOUSEHOLD AND CONTEXTUAL FACTORS IN RAJASTHAN, INDIA

Journal of Biosocial Science ◽

10.1017/s0021932010000490 ◽

2010 ◽

Vol 43 (1) ◽

pp. 1-17 ◽

Cited By ~ 6

Author(s):

BATYA ELUL

Keyword(s):

Rural Women ◽

Health Behaviours ◽

Induced Abortion ◽

Reproductive Age ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Individual Level ◽

Attitudes And Practices ◽

Individual Household ◽

Socio Demographic Factors

SummaryIn the developing world, little is known about the risk and precipitating factors for abortion, due to a dearth of community-based surveys. Most analyses of determinants of induced abortion consider only a small set of household and individual socio-demographic factors and treat abortion as an isolated outcome, which ignores its relationship with prior reproductive health behaviours and experiences. In this paper, data from a cross-sectional survey of abortion knowledge, attitudes and practices among 2571 currently married women of reproductive age in Rajasthan, India, were used to examine contextual-, household- and individual-level determinants of abortion. Bivariate probit models, which jointly determine the probability of pregnancy and the conditional probability of abortion, were used to reflect the probability of abortion as a result of interrelated and sequential events. Increased socioeconomic status and life-cycle factors were associated with both the probability of pregnancy and with the conditional likelihood of abortion. Women who reported personal networks were also more likely to terminate pregnancies, particularly if their network members purportedly had abortion experience. Community knowledge of sex-selective abortion also exerted a significant positive effect on the propensity to terminate a pregnancy. For rural women only, community beliefs regarding spousal consent requirements pre-abortion were also significantly associated with abortion.

Download Full-text

The prevalence and correlates of the double burden of malnutrition among women in Ghana

PLoS ONE ◽

10.1371/journal.pone.0244362 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244362

Author(s):

Sandra Boatemaa Kushitor ◽

Lily Owusu ◽

Mawuli Kobla Kushitor

Keyword(s):

Normal Weight ◽

Chi Square ◽

Double Burden ◽

Middle Income ◽

Individual Level ◽

Factors Associated ◽

Middle Income Countries ◽

Chi Square Test ◽

Double Burden Of Malnutrition ◽

The Individual

Anaemia and underweight or overweight/obesity are major public health problems driving maternal and child mortality in low- and middle-income countries. While the burden of these conditions is recognised, the evidence for the co-occurrence of these conditions is fragmented and mixed, especially at the individual level. Further, many studies have focused on families and communities. The different pathways for the occurrence of anaemia and BMI challenges indicate that an individual can potentially live with both conditions and suffer the complications. This study examined the prevalence and factors associated with the co-occurrence of anaemia and BMI challenges among a cohort of women in Ghana. Data from the 2014 Ghana Demographic and Health Survey were used. The sample size was 4 337 women aged 15–49 years who were not pregnant during the survey. Women who suffered simultaneously from underweight or overweight/obesity and anaemia were considered as having the double burden of malnutrition. The data were analysed using descriptive statistics, Chi-square test and logistic regression in STATA. One-fifth of the participants were overweight (21%), 4% were underweight and about one-tenth were obese (12%). The prevalence of anaemia was 41%. Only one in three women had normal weight and was not anaemic (34%). About 14% of the women experienced the double burden of malnutrition. Being overweight and anaemic (57%) was the most common form of this double burden. Age, marital status, parity, and wealth were t key risk factors associated with the double burden of malnutrition. The findings from this study show that women experience multiple nutritional challenges concurrently and that only a few women had healthy nutritional status. This information is particularly important and can be introduced into health education programmes to help address misconceptions about body weight and health.

Download Full-text

Spatial Distribution and Determinants of Nonautonomy on Decision Regarding Contraceptive Utilization among Married Reproductive-Age Women in Ethiopia: Spatial and Bayesian Multilevel Analysis

Nursing Research and Practice ◽

10.1155/2021/2160922 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Setognal Birara Aychiluhm ◽

Kusse Urmale Mare ◽

Mequannet Sharew Melaku ◽

Abay Woday Tadesse

Keyword(s):

Spatial Distribution ◽

Rural Areas ◽

Wealth Index ◽

Credible Interval ◽

Reproductive Age ◽

Metropolitan Regions ◽

Logistic Regression Models ◽

Individual Level ◽

Reproductive Age Women ◽

Contraceptive Utilization

Background. Studies conducted to date in Ethiopia did not explore the spatial distribution, individual-level, and community-level factors affecting women’s nonautonomy on decision to use contraceptives. Hence, this study aimed to assess the spatial distribution of women’s nonautonomy on decision regarding contraceptive utilization and its determinants in Ethiopia. Methods. Data were accessed from the Demographic Health Survey program official database website (https://dhsprogram.com). A weighted sample of 3,668 married reproductive-age women currently using contraceptives was included in this analysis. Bayesian multilevel logistic regression models were fitted to identify the determinants of women’s nonautonomy on contraceptive utilization. Adjusted odds ratio with 95% credible interval was used to select variables that have a significant effect on nonautonomy on contraceptive utilization. Results. A high proportion of women with nonautonomy on decision regarding contraceptive utilization was found in northern parts of Southern Nations, Nationalities, and People’s Region, Southern parts of Oromia, and Benishangul-Gumuz regions of the country. Overall, 2876 (78.40% (95% CI: 77.0%, 79.7%)) women were nonautonomous on decision regarding contraceptive utilization. In the final model, age from 35–49 (AOR (95% CI) = 0.63 (0.54, 0.72)), living in the richer households (AOR (95% CI) = 0.12 (0.03, 0.26)), being married at 18 years or above (AOR (95% CI) = 0.33 (0.19, 0.57)), and residing in an rural areas (AOR (95% CI) = 1.34 (1.01, 1.71)) and metropolitan regions (AOR (95% CI) = 0.71(0.54, 0.91)) were associated with women’s nonautonomy on decision regarding contraceptive utilization. Conclusions. In Ethiopia, the spatial distribution of women’s nonautonomy on decision about contraceptive utilization was nonrandom. More than three-fourths of married reproductive-age women in Ethiopia are nonautonomous on decision regarding contraceptive utilization. Region, residence, current age, age at marriage, and wealth index were statistically associated with women’s nonautonomy on decision regarding contraceptive utilization.

Download Full-text