Abstract
BackgroundPrevious studies show a positive association between household wealth and overweight in sub-Saharan African (SSA) countries; however, the manner in which this relationship differs in the presence of educational attainment has not been well-established. This study examined the multiplicative effect modification of educational attainment on the association between middle-income and rich household wealth and overweight status among adult females in 22 SSA countries. We hypothesized that household wealth was associated with a greater likelihood of being overweight among middle income and rich women with lower levels of educational attainment compared to those with higher levels of educational attainment.MethodsDemographic and Health Survey (DHS) data from 2006 to 2016 for women aged 18–49 years in SSA countries were used for the study. Overweight was defined as a body mass index (BMI) ≥ 25 kg/m2. Household wealth index tertile was the exposure and educational attainment, the effect modifier. Potential confounders included age, ethnicity, place of residence, and parity. Descriptive analysis was conducted, and separate logistic regression models were fitted for each of the 22 SSA countries to compute measures of effect modification and 95% confidence intervals. Analysis of credibility (AnCred) methods were applied to assess the intrinsic credibility of the study findings and guide statistical inference.ResultsThe prevalence of overweight ranged from 12.6% in Chad to 56.6% in Swaziland. Eighteen of the 22 SSA countries had measures of effect modification below one in at least one wealth tertile. This included eight of the 12 low-income countries and all 10 middle income countries. This implied that the odds of overweight were greater among middle-income and rich women with lower levels of educational attainment than those with higher educational attainment. On the basis of the AnCred analysis, it was found that the majority of the study findings across the region provided some support for the study hypothesis.ConclusionsWomen in higher wealth strata and with lower levels of educational attainment appear to be more vulnerable to overweight compared to those in the same wealth strata but with higher levels of educational attainment in most low- and middle- income SSA countries.
Highlights
Previous studies show a positive association between household wealth and overweight in subSaharan African (SSA) countries; the manner in which this relationship differs in the presence of educational attainment has not been well-established
The prevalence of overweight ranged from 12.6% in Chad to 56.6% in Swaziland
Eighteen of the 22 SSA countries had measures of effect modification below one in at least one wealth tertile. This included eight of the 12 low-income countries and all 10 middle income countries. This implied that the odds of overweight were greater among middle-income and rich women with lower levels of educational attainment than those with higher educational attainment
Summary
Previous studies show a positive association between household wealth and overweight in subSaharan African (SSA) countries; the manner in which this relationship differs in the presence of educational attainment has not been well-established. Evidence from multiple country studies indicate that women of higher socioeconomic status (SES), as defined by household wealth are more likely to be overweight or obese in sub-Saharan African countries. High affluent groups in African countries have been found to have lower levels of physical activity and to consume more processed food, which may explain their elevated adiposity risk [2] Sociocultural factors such as the association of larger bodies with higher social status in African culture, coupled with other global factors - unregulated marketing of obesogenic foods and greater levels of mechanization – and the abundance of resources conferred by high income status may result in increased consumption of unhealthy foods and sedentarism [3, 4]. Studies investigating how different combinations of household wealth status and educational attainment relate to adult female overweight and obesity, in most low- and middle-income countries (LMICs) in sub-Saharan African countries are nonexistent, which provides the rationale for this study
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