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The double burden household in sub-Saharan Africa: maternal overweight and obesity and childhood undernutrition from the year 2000: results from World Health Organization Data (WHO) and Demographic Health Surveys (DHS).

Wojcicki JM - BMC Public Health (2014)

Bottom Line: These associations were not significant in a smaller sample size using urban-only surveys.Restricting the analysis to urban only populations did not increase the frequencies of double burden households significantly.Countries that have a high prevalence of child undernutrition correspondingly have a high prevalence of adult underweight and low prevalence of adult overweight and obesity.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, University of California, 500 Parnassus Avenue MU4E, San Francisco, CA 94134-0136, USA. wojcickij@peds.ucsf.edu.

ABSTRACT

Background: Previous studies have characterized an increasing trend of double burden households, or households with individuals experiencing both undernutrition and obesity, in countries undergoing a nutrition transition. Although most prior studies indicate the prevalence of double burden households is highest in middle-income countries, there is some support for an increase in double burden households in sub-Saharan African countries as well.

Method: Using data from the Demographic Health Surveys (DHS) and the World Health Organization (WHO), the prevalence of double burden households in sub-Saharan African countries was calculated and the associations between prevalence of overweight/obese adults and underweight, stunted and wasted children were evaluated at the country and household (DHS only) levels. Restricted analyses and frequencies were calculated using urban-only datasets. Surveys from 28 African countries were available using WHO data and 26 from the DHS surveys. Only surveys that were conducted after 2000 were included in analyses.

Results: Using the WHO datasets, there were inverse associations between the prevalence of overweight and obesity in adults and underweight, stunting and wasting in children. Correspondingly, there were positive associations between adult underweight and child underweight, stunting and wasting. These associations were not significant in a smaller sample size using urban-only surveys. The prevalence of double burden households in DHS datasets was low: under 5 percent for obese mothers and underweight, stunted or wasted child pairs with a slightly higher percentage for overweight mothers and children with undernutrition. Restricting the analysis to urban only populations did not increase the frequencies of double burden households significantly.

Conclusion: There was a low prevalence of double burden households in recent data from sub-Saharan Africa. Countries that have a high prevalence of child undernutrition correspondingly have a high prevalence of adult underweight and low prevalence of adult overweight and obesity.

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Maternal overweight and obesity in relation to child stunting by country. DHS data defining childhood stunting as height-for-age Z score <-2. Maternal overweight and obesity defined as BMI ≥25.
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Fig7: Maternal overweight and obesity in relation to child stunting by country. DHS data defining childhood stunting as height-for-age Z score <-2. Maternal overweight and obesity defined as BMI ≥25.

Mentions: The overall prevalence of maternal overweight and obesity in the 27 DHS countries surveyed was 16.5% (95% CI 16.1-17.0%), maternal obesity was 5.1% (95% CI 4.8-5.3%) and maternal underweight was 10.4% (95% CI 10.1-10.7%). The prevalence of maternal overweight and obesity was higher than 20% in the following countries and years: Congo 2005, Ghana 2008, Namibia 2007, Nigeria 2003, Nigeria 2008, Sao Tome 2009, Sierra Leone 2006, Swaziland 2006 and Zimbabwe 2005 (Figure 4). The overall prevalence was higher in urban areas for maternal overweight and obesity (30.3% (95% CI 29.5-31.2%) and obesity10.5% (95% CI 10.0-11.0%)) but lower for maternal underweight (7.6%, 95% CI 7.1-8.0%) in comparison with the national prevalence. The overall prevalence of child stunting (<-2SD) was 37.8%, (95% CI 37.4-38.3%) and severe stunting (<-3SD) was 17.4% (95% CI 17.1-17.8%), wasting (<-2SD) was 8.4% (<-3SD was 1.8% (95% CI 1.75-1.94%) and underweight (<-2SD) was 25.5%, (95% CI, 25.1-26.0%) and severe underweight (<-3SD) 7.3% (95% CI 7.1-7.5%). The child undernutrition prevalence was lower in the urban areas (27.2% (95% CI 26.5-28.0%) for stunting, 7.1% (95% CI 6.7-7.5%) for wasting and 17.4% (95% CI 16.8-18.1%) for underweight) in comparison with national prevalence. There was no observable association at the country level between maternal overweight and obesity and child undernutrition although the percentage of maternal overweight and obesity appeared to decrease with higher levels of child undernutriiton (Figures 5, 6 and 7).Figure 4


The double burden household in sub-Saharan Africa: maternal overweight and obesity and childhood undernutrition from the year 2000: results from World Health Organization Data (WHO) and Demographic Health Surveys (DHS).

Wojcicki JM - BMC Public Health (2014)

Maternal overweight and obesity in relation to child stunting by country. DHS data defining childhood stunting as height-for-age Z score <-2. Maternal overweight and obesity defined as BMI ≥25.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4233103&req=5

Fig7: Maternal overweight and obesity in relation to child stunting by country. DHS data defining childhood stunting as height-for-age Z score <-2. Maternal overweight and obesity defined as BMI ≥25.
Mentions: The overall prevalence of maternal overweight and obesity in the 27 DHS countries surveyed was 16.5% (95% CI 16.1-17.0%), maternal obesity was 5.1% (95% CI 4.8-5.3%) and maternal underweight was 10.4% (95% CI 10.1-10.7%). The prevalence of maternal overweight and obesity was higher than 20% in the following countries and years: Congo 2005, Ghana 2008, Namibia 2007, Nigeria 2003, Nigeria 2008, Sao Tome 2009, Sierra Leone 2006, Swaziland 2006 and Zimbabwe 2005 (Figure 4). The overall prevalence was higher in urban areas for maternal overweight and obesity (30.3% (95% CI 29.5-31.2%) and obesity10.5% (95% CI 10.0-11.0%)) but lower for maternal underweight (7.6%, 95% CI 7.1-8.0%) in comparison with the national prevalence. The overall prevalence of child stunting (<-2SD) was 37.8%, (95% CI 37.4-38.3%) and severe stunting (<-3SD) was 17.4% (95% CI 17.1-17.8%), wasting (<-2SD) was 8.4% (<-3SD was 1.8% (95% CI 1.75-1.94%) and underweight (<-2SD) was 25.5%, (95% CI, 25.1-26.0%) and severe underweight (<-3SD) 7.3% (95% CI 7.1-7.5%). The child undernutrition prevalence was lower in the urban areas (27.2% (95% CI 26.5-28.0%) for stunting, 7.1% (95% CI 6.7-7.5%) for wasting and 17.4% (95% CI 16.8-18.1%) for underweight) in comparison with national prevalence. There was no observable association at the country level between maternal overweight and obesity and child undernutrition although the percentage of maternal overweight and obesity appeared to decrease with higher levels of child undernutriiton (Figures 5, 6 and 7).Figure 4

Bottom Line: These associations were not significant in a smaller sample size using urban-only surveys.Restricting the analysis to urban only populations did not increase the frequencies of double burden households significantly.Countries that have a high prevalence of child undernutrition correspondingly have a high prevalence of adult underweight and low prevalence of adult overweight and obesity.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, University of California, 500 Parnassus Avenue MU4E, San Francisco, CA 94134-0136, USA. wojcickij@peds.ucsf.edu.

ABSTRACT

Background: Previous studies have characterized an increasing trend of double burden households, or households with individuals experiencing both undernutrition and obesity, in countries undergoing a nutrition transition. Although most prior studies indicate the prevalence of double burden households is highest in middle-income countries, there is some support for an increase in double burden households in sub-Saharan African countries as well.

Method: Using data from the Demographic Health Surveys (DHS) and the World Health Organization (WHO), the prevalence of double burden households in sub-Saharan African countries was calculated and the associations between prevalence of overweight/obese adults and underweight, stunted and wasted children were evaluated at the country and household (DHS only) levels. Restricted analyses and frequencies were calculated using urban-only datasets. Surveys from 28 African countries were available using WHO data and 26 from the DHS surveys. Only surveys that were conducted after 2000 were included in analyses.

Results: Using the WHO datasets, there were inverse associations between the prevalence of overweight and obesity in adults and underweight, stunting and wasting in children. Correspondingly, there were positive associations between adult underweight and child underweight, stunting and wasting. These associations were not significant in a smaller sample size using urban-only surveys. The prevalence of double burden households in DHS datasets was low: under 5 percent for obese mothers and underweight, stunted or wasted child pairs with a slightly higher percentage for overweight mothers and children with undernutrition. Restricting the analysis to urban only populations did not increase the frequencies of double burden households significantly.

Conclusion: There was a low prevalence of double burden households in recent data from sub-Saharan Africa. Countries that have a high prevalence of child undernutrition correspondingly have a high prevalence of adult underweight and low prevalence of adult overweight and obesity.

Show MeSH
Related in: MedlinePlus