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

Safia S Jiwani,Tome Ca,William K Bosu,Elizabeth Hazel,Vrinda Mehra,Cheikh Mbacké Faye,Abdoulaye Maïga,Agbessi Amouzou,Serge M A Somda,Richard Kumapley,Sujata Bose,Sujata Bose,Kofi Busia,Giovanna Gatica-Domínguez,Inacio Crochemore-Silva,Ferima Coulibaly-Zerbo,Barbara Baille,Shelley Walton,Roosmarijn Verstraeten

doi:10.1136/bmjgh-2020-002948

Abstract

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.

Highlights

Evidence on the rate at which the double burden of malnutrition unfolds is limited
What is already known? ►► The double burden of malnutrition is common to the poorest countries in low-income and middle-income countries where rapid changes in food systems, diets and physical activity have led to a rise in the prevalence of overweight and obesity. ►► little is known on the rate at which the double burden of malnutrition has unfolded and the subgroups that are most vulnerable. ►► In sub-S aharan Africa, the prevalence of overweight and obesity has increased over the past two decades among urban women, and higher wealth status has been associated with higher overweight and obesity, as well as lower underweight prevalence. ►► Anaemia continues to affect 50% of pregnant women in this region, acting as a ‘triple burden’ of malnutrition
What are the new findings? ►► Our study provides evidence for a situation of lower underweight, overweight and obesity prevalence among adolescent girls compared with adult women. ►► Over the past two decades, anaemia has declined the fastest among adult women and the richest pregnant women, it remains a threat to all women. ►► Overweight and obesity have been rising faster among adult women, as well as women living in the richest households. ►► Wealth inequalities in obesity have widened over time in sub-S aharan Africa

Summary

Introduction

Evidence 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-S aharan Africa. Obesity, which was believed to affect only the ‘elite’ in LMIC,[9] has doubled globally and tripled in the last two decades in LMIC.[10] In 2010, overweight and obesity were responsible for 3.4 million deaths globally.[11] By 2016, 44% of adults were overweight or obese, of which 70% lived in LMIC.[12] In SSA, rapid urbanisation and economic development have led to a nutrition transition[5 13] characterised by a progressive shift in eating patterns, diets and lifestyles, leading to up to 50% of urban women being classified as overweight or obese in some countries.14Although the rise has been witnessed among children, adolescents and adults,[11] the burden appears to be unevenly distributed across socioeconomic status and gender: research in this region has pointed to a higher obesity prevalence among women, the rich and urban residents.[15]

Methods

Results

Discussion

Conclusion