Physical and socioeconomic environments are associated with concurrent malnutrition in neighborhoods, households and individuals in Sub‐Saharan Africa (378.3)

Abstract

This study aims to determine the extent to which physical and socioeconomic environments are associated with the “dual burden” of malnutrition and its component conditions in Sub‐Saharan Africa (SSA). We used Demographic and Health Survey (DHS) data from 29 countries in SSA from 2005‐2011 (n=155,238 households), and geocoded DHS cluster data with LandScan population density data to examine spatial determinants and clustering of concurrent forms of malnutrition at neighborhood scales. We identified the co‐occurrence of maternal overweight (MO) (body mass index 蠅 25 kg/m2) and anemia (MA) (hemoglobin < 120 g/L) among non‐pregnant mothers, and, in the same households, co‐existing MO and child stunting (CS) (height‐for‐age Z‐score < ‐2) in the oldest child aged 6‐59 months. The prevalence of CS was 37%, MO and MA were 20% and 40%, respectively, 5.8% of households had concurrent MO and CS, and concurrent MO and MA was 7.7%. Rural location was negatively associated with dual burden households (OR: 0.79; 95% CI: 0.64‐0.97) and with concurrent MO and MA (OR: 0.68; 95% CI: 0.61‐0.75). Maternal employment in agriculture was independently negatively associated with both MA and MO (OR: 0.93; 95% CI: 0.87‐0.99; OR: 0.73; 95% CI: 0.69‐0.78, respectively). Household wealth was positively associated with both dual burden manifestations while years of maternal education were negatively associated with the household dual burden (OR: 0.97; 95% CI: 0.95‐0.99). We further examined heterogeneity in spatial clustering of MO, MA and CS across urbanicity gradients. Undernutrition and overweight coexist throughout SSA at regional, household and individuals scales.