Mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa.

Demographic and Health Survey Stunting Sub-Saharan Africa Undernutrition Underweight Wasting

Journal

Journal of health, population, and nutrition
ISSN: 2072-1315
Titre abrégé: J Health Popul Nutr
Pays: Bangladesh
ID NLM: 100959228

Informations de publication

Date de publication:
02 Jan 2024
Historique:
received: 20 07 2023
accepted: 24 11 2023
medline: 4 1 2024
pubmed: 4 1 2024
entrez: 3 1 2024
Statut: epublish

Résumé

Malnutrition remains one of the major public health concerns globally. To achieve the Sustainable Development Goal 2 which seeks to ensure that hunger and malnutrition are reduced by 2030, it is imperative to ascertain the factors influencing their occurrence. This study examined the prevalence and factors associated with mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa. Demographic and Health Survey data from 25 sub-Saharan African countries were used for the study. The sample was made up of 125,280 mother-child dyads. Descriptive analysis was performed to determine the prevalence of overweight or obese mother (OWOBM) with a stunted child (OWOBM-SC), OWOBM with an underweight child (OWOBM-UC), OWOBM with a wasted child (OWOBM-WC), and OWOBM with any form of child's undernutrition indicators (OWOBM-SUWC). Multilevel regression models were developed to examine the factors associated with these indicators. The results were presented using an adjusted odds ratio (AOR) with their respective 95% confidence interval (CI). Higher likelihood of OWOBM-SUWC was found among women aged 45-49 [AOR 2.20, 95% CI 1.70, 2.85], those with primary [AOR 1.32, 95% CI 1.21, 1.44] or secondary education [AOR 1.21, 95% CI 1.09, 1.35], and divorced women [AOR 1.32, 95% CI 1.02, 1.73]. However, lower odds of OWOBM-SUWC were observed among women who were working [AOR 0.82, 95% CI 0.76, 0.89] and those breastfeeding [AOR 0.75, 95% CI 0.70, 0.82]. The odds of OWOBM-SUWC was lower among females compared to male children [AOR 0.85, 95% CI 0.80, 0.90]. Compared to children aged <1 year, children of all other age groups were more likely to have OWOBM-SUWC. Other child characteristics significantly associated with OWOBM-SUWC were low birth weight [AOR 1.50, 95% CI 1.32, 1.71], having diarrhea [AOR 1.13, 95% CI 1.04, 1.24], and higher birth order [AOR 1.37, 95% CI 1.13, 1.66]. Children whose mothers used unimproved toilet facilities [AOR 0.90, 95% CI 0.83, 0.98], those who lived in rural areas [AOR 0.79, 95% CI 0.71, 0.87], and children from the Central [AOR 0.55, 95% CI 0.46, 0.65], Eastern [AOR 0.44, 95% CI 0.38, 0.52] and Western [AOR 0.76, 95% CI 0.65, 0.89] sub-Saharan Africa were less likely to have OWOBM-SUWC. Combination of child, maternal, and contextual factors could explain mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa. Addressing this situation requires multidimensional policies and interventions that empower women through education and economic engagement. The observed sub-regional differences in policies and commitments related to addressing malnutrition suggest the need for comprehensive and coordinated efforts to implement and strengthen multisectoral comprehensive nutrition plans across sub-Saharan Africa. Sharing best practices and lessons learned can help improve the effectiveness and comprehensiveness of nutrition interventions and contribute to reducing the prevalence of malnutrition.

Sections du résumé

BACKGROUND BACKGROUND
Malnutrition remains one of the major public health concerns globally. To achieve the Sustainable Development Goal 2 which seeks to ensure that hunger and malnutrition are reduced by 2030, it is imperative to ascertain the factors influencing their occurrence. This study examined the prevalence and factors associated with mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa.
METHODS METHODS
Demographic and Health Survey data from 25 sub-Saharan African countries were used for the study. The sample was made up of 125,280 mother-child dyads. Descriptive analysis was performed to determine the prevalence of overweight or obese mother (OWOBM) with a stunted child (OWOBM-SC), OWOBM with an underweight child (OWOBM-UC), OWOBM with a wasted child (OWOBM-WC), and OWOBM with any form of child's undernutrition indicators (OWOBM-SUWC). Multilevel regression models were developed to examine the factors associated with these indicators. The results were presented using an adjusted odds ratio (AOR) with their respective 95% confidence interval (CI).
RESULTS RESULTS
Higher likelihood of OWOBM-SUWC was found among women aged 45-49 [AOR 2.20, 95% CI 1.70, 2.85], those with primary [AOR 1.32, 95% CI 1.21, 1.44] or secondary education [AOR 1.21, 95% CI 1.09, 1.35], and divorced women [AOR 1.32, 95% CI 1.02, 1.73]. However, lower odds of OWOBM-SUWC were observed among women who were working [AOR 0.82, 95% CI 0.76, 0.89] and those breastfeeding [AOR 0.75, 95% CI 0.70, 0.82]. The odds of OWOBM-SUWC was lower among females compared to male children [AOR 0.85, 95% CI 0.80, 0.90]. Compared to children aged <1 year, children of all other age groups were more likely to have OWOBM-SUWC. Other child characteristics significantly associated with OWOBM-SUWC were low birth weight [AOR 1.50, 95% CI 1.32, 1.71], having diarrhea [AOR 1.13, 95% CI 1.04, 1.24], and higher birth order [AOR 1.37, 95% CI 1.13, 1.66]. Children whose mothers used unimproved toilet facilities [AOR 0.90, 95% CI 0.83, 0.98], those who lived in rural areas [AOR 0.79, 95% CI 0.71, 0.87], and children from the Central [AOR 0.55, 95% CI 0.46, 0.65], Eastern [AOR 0.44, 95% CI 0.38, 0.52] and Western [AOR 0.76, 95% CI 0.65, 0.89] sub-Saharan Africa were less likely to have OWOBM-SUWC.
CONCLUSION CONCLUSIONS
Combination of child, maternal, and contextual factors could explain mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa. Addressing this situation requires multidimensional policies and interventions that empower women through education and economic engagement. The observed sub-regional differences in policies and commitments related to addressing malnutrition suggest the need for comprehensive and coordinated efforts to implement and strengthen multisectoral comprehensive nutrition plans across sub-Saharan Africa. Sharing best practices and lessons learned can help improve the effectiveness and comprehensiveness of nutrition interventions and contribute to reducing the prevalence of malnutrition.

Identifiants

pubmed: 38167549
doi: 10.1186/s41043-023-00479-y
pii: 10.1186/s41043-023-00479-y
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1

Informations de copyright

© 2023. The Author(s).

Références

African Union Commission. Africa regional overview of food security and nutrition 2020: Transforming food systems for affordable healthy diets. Food & Agriculture Org.; 2021.
World Health Organization. Malnutrition. 2021. https://www.who.int/news-room/fact-sheets/detail/malnutrition . Accessed 20 July 2023.
Popkin BM, Corvalan C, Grummer-Strawn LM. Dynamics of the double burden of malnutrition and the changing nutrition reality. Lancet. 2020;395(10217):65–74.
pubmed: 31852602 doi: 10.1016/S0140-6736(19)32497-3
Christian AK, Dake FA. Profiling household double and triple burden of malnutrition in sub-Saharan Africa: prevalence and influencing household factors. Public Health Nutr. 2022;25(6):1563–76.
pubmed: 33896443 doi: 10.1017/S1368980021001750
Pomati M, Mendoza-Quispe D, Anza-Ramirez C, Hernández-Vásquez A, Carrillo Larco RM, Fernandez G, Nandy S, Miranda JJ, Bernabé-Ortiz A. Trends and patterns of the double burden of malnutrition (DBM) in Peru: a pooled analysis of 129,159 mother–child dyads. Int J Obes. 2021;45(3):609–18.
doi: 10.1038/s41366-020-00725-x
Sarker AR, Hossain Z, Morton A. Drivers and distribution of the household-level double burden of malnutrition in Bangladesh: analysis of mother–child dyads from a national household survey. Public Health Nutr. 2022;25(11):3158–71.
pubmed: 36111605 doi: 10.1017/S1368980022002075
Jones-Antwi RE, Cunningham SA. Weight patterns among mother-child pairs in the Middle East and North African Region. Ann Epidemiol. 2023;77:67–74.
pubmed: 36519722 doi: 10.1016/j.annepidem.2022.11.005
Blankenship JL, Gwavuya S, Palaniappan U, Alfred J, deBrum F, Erasmus W. High double burden of child stunting and maternal overweight in the Republic of the Marshall Islands. Matern Child Nutr. 2020;16:e12832.
pubmed: 32835441 pmcid: 7706834 doi: 10.1111/mcn.12832
Sunuwar DR, Singh DR, Pradhan PM. Factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal demographic and health survey.
Sunuwar DR, Singh DR, Pradhan PM. Prevalence and factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal demographic and health survey. BMC Public Health. 2020;20(1):1–1.
doi: 10.1186/s12889-020-8356-y
Luke N, Munshi K, Oommen A, Singh S. Economic development, the nutrition trap and metabolic disease. Cambridge: National Bureau of Economic Research; 2021.
doi: 10.3386/w29132
World Health Organization. The double burden of malnutrition: policy brief. London: World Health Organization; 2016.
Dobbs R, Sawers C, Thompson F, Manyika J, Woetzel JR, Child P, McKenna S, Spatharou A. Overcoming obesity: an initial economic analysis. London: McKinsey Global Institute; 2014.
Crozier P. The Double Burden of Intra-Household Malnutrition Among Mother–Child Dyads in South Africa (Doctoral dissertation, Walden University).
Were JM, Stranges S, Wilk P, Ali S, Sharma I, Vargas-Gonzalez JC, Campbell MK. The double burden of malnutrition among women of reproductive age and preschool children in low-and middle-income countries: a scoping review and thematic analysis of literature. Nutrition. 2023:112053.
Masibo PK, Humwa F, Macharia TN. The double burden of overnutrition and undernutrition in mother–child dyads in Kenya: demographic and health survey data, 2014. J Nutr Sci. 2020;9:e5.
pubmed: 32042413 pmcid: 6984123 doi: 10.1017/jns.2019.39
Demaio AR, Branca F. Decade of action on nutrition: our window to act on the double burden of malnutrition. BMJ Glob Health. 2018;3(Suppl 1):e000492.
pubmed: 29379647 doi: 10.1136/bmjgh-2017-000492
Croft TN, Marshall AMJ, Allen CK. Guide to DHS Statistics, DHS-7 [Internet]. Rockville, Maryland, USA: ICF, 2018. https://dhsprogram.com/pubs/pdf/DHSG1/Guide_to_DHS_Statistics_DHS-7.pdf
Corsi DJ, Neuman M, Finlay JE, Subramanian SV. Demographic and health surveys: a profile. Int J Epidemiol. 2012;41(6):1602–13.
pubmed: 23148108 doi: 10.1093/ije/dys184
ICF International. Demographic and Health Survey Sampling and Household Listing Manual. MEASURE DHS, Calverton, Maryland, U.S.A.: ICF International. 2012.
World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. London: World Health Organization; 2006.
Aboagye RG, Ahinkorah BO, Seidu AA, Frimpong JB, Archer AG, Adu C, Hagan JE Jr, Amu H, Yaya S. Birth weight and nutritional status of children under five in sub-Saharan Africa. PLoS ONE. 2022;17(6):e0269279.
pubmed: 35679306 pmcid: 9182265 doi: 10.1371/journal.pone.0269279
Amadu I, Seidu AA, Duku E, Frimpong JB, Jnr JE, Aboagye RG, Ampah B, Adu C, Ahinkorah BO. Risk factors associated with the coexistence of stunting, underweight, and wasting in children under 5 from 31 sub-Saharan African countries. BMJ Open. 2021;11(12):e052267.
pubmed: 34930735 pmcid: 8689177 doi: 10.1136/bmjopen-2021-052267
Kumar M, Mohanty P. Does maternal overnutrition carry child undernutrition in India? PLoS ONE. 2022;17(6):e0265788.
pubmed: 35714070 pmcid: 9205528 doi: 10.1371/journal.pone.0265788
Seidu AA, Ahinkorah BO, Agbaglo E, Nyaaba AA. Overweight and obesity among women of reproductive age in Mali: what are the determinants? Int Health. 2021;13(5):428–35.
pubmed: 33210112 doi: 10.1093/inthealth/ihaa094
Yaya S, Ghose B. Trend in overweight and obesity among women of reproductive age in Uganda: 1995–2016. Obes Sci Pract. 2019;5(4):312–23.
pubmed: 31452916 pmcid: 6700515 doi: 10.1002/osp4.351
Ahmed KY, Rwabilimbo AG, Abrha S, Page A, Arora A, Tadese F, Beyene TY, Seiko A, Endris AA, Agho KE, Ogbo FA. Factors associated with underweight, overweight, and obesity in reproductive age Tanzanian women. PLoS ONE. 2020;15(8):e0237720.
pubmed: 32834011 pmcid: 7444815 doi: 10.1371/journal.pone.0237720
Sahiledengle B, Mwanri L, Agho KE. Association between maternal stature and household-level double burden of malnutrition: findings from a comprehensive analysis of Ethiopian Demographic and Health Survey. J Health Popul Nutr. 2023;42(1):1–16.
doi: 10.1186/s41043-023-00347-9
Patel R, Srivastava S, Kumar P, Chauhan S. Factors associated with double burden of malnutrition among mother-child pairs in India: A study based on National Family Health Survey 2015–16. Child Youth Serv Rev. 2020;116:105256.
doi: 10.1016/j.childyouth.2020.105256
Hatt LE, Waters HR. Determinants of child morbidity in Latin America: a pooled analysis of interactions between parental education and economic status. Soc Sci Med. 2006;62(2):375–86.
pubmed: 16040175 doi: 10.1016/j.socscimed.2005.06.007
Peng YK, Hight-Laukaran V, Peterson AE, Perez-Escamilla R. Maternal nutritional status is inversely associated with lactational amenorrhea in Sub-Saharan Africa: results from demographic and health surveys II and III. J Nutr. 1998;128(10):1672–80.
pubmed: 9772135 doi: 10.1093/jn/128.10.1672
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Strobe Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9.
doi: 10.1016/j.ijsu.2014.07.013
Verschuur J, Li S, Wolski P, Otto FE. Climate change as a driver of food insecurity in the 2007 Lesotho-South Africa drought. Sci Rep. 2021;11(1):3852.
pubmed: 33594112 pmcid: 7887215 doi: 10.1038/s41598-021-83375-x
Keats EC, Das JK, Salam RA, Lassi ZS, Imdad A, Black RE, Bhutta ZA. Effective interventions to address maternal and child malnutrition: an update of the evidence. Lancet Child Adolescent Health. 2021;5(5):367–84.
pubmed: 33691083 doi: 10.1016/S2352-4642(20)30274-1
Mahmudiono T, Segalita C, Rosenkranz RR. Socio-ecological model of correlates of double burden of malnutrition in developing countries: a narrative review. Int J Environ Res Public Health. 2019;16(19):3730.
pubmed: 31623366 pmcid: 6801412 doi: 10.3390/ijerph16193730
Manggala AK, Kenwa KW, Kenwa MM, Jaya AA, Sawitri AA. Risk factors of stunting in children aged 24–59 months. Paediatr Indones. 2018;58(5):205–12.
doi: 10.14238/pi58.5.2018.205-12
Özaltin E, Hill K, Subramanian SV. Association of maternal stature with offspring mortality, underweight, and stunting in low-to middle-income countries. JAMA. 2010;303(15):1507–16.
pubmed: 20407060 pmcid: 3100588 doi: 10.1001/jama.2010.450
Weerasekara PC, Withanachchi CR, Ginigaddara GA, Ploeger A. Food and nutrition-related knowledge, attitudes, and practices among reproductive-age women in marginalized areas in Sri Lanka. Int J Environ Res Public Health. 2020;17(11):3985.
pubmed: 32512750 pmcid: 7312908 doi: 10.3390/ijerph17113985
Bintabara D, Nakamura K, Seino K. Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey. BMJ Open. 2018;8(9):e023013.
pubmed: 30209158 pmcid: 6144413 doi: 10.1136/bmjopen-2018-023013
Cornwall A. Women’s empowerment: what works? J Int Dev. 2016;28(3):342–59.
doi: 10.1002/jid.3210
Mardani RA, Wu WR, Nhi VT, Huang HC. Association of breastfeeding with undernutrition among children under 5 years of age in developing countries: a systematic review and meta-analysis. J Nurs Scholarsh. 2022;54(6):692–703.
pubmed: 35844158 doi: 10.1111/jnu.12799
Cook SM, Cameron ST. Social issues of teenage pregnancy. Obstet Gynaecol Reprod Med. 2015;25(9):243–8.
doi: 10.1016/j.ogrm.2015.06.001
SmithBattle LI. Reducing the stigmatization of teen mothers. MCN Am J Maternal/Child Nurs. 2013;38(4):235–41.
doi: 10.1097/NMC.0b013e3182836bd4
Anik AI, Rahman MM, Rahman MM, Tareque MI, Khan MN, Alam MM. Double burden of malnutrition at household level: a comparative study among Bangladesh, Nepal, Pakistan, and Myanmar. PLoS ONE. 2019;14(8):e0221274.
pubmed: 31419251 pmcid: 6697370 doi: 10.1371/journal.pone.0221274
Zhang N, Becares L, Chandola T. Patterns and determinants of double-burden of malnutrition among rural children: evidence from China. PLoS ONE. 2016;11(7):e0158119.
pubmed: 27391448 pmcid: 4938417 doi: 10.1371/journal.pone.0158119
Ahinkorah BO, Amadu I, Seidu AA, Okyere J, Duku E, Hagan JE Jr, Budu E, Archer AG, Yaya S. Prevalence and factors associated with the triple burden of malnutrition among mother-child pairs in Sub-Saharan Africa. Nutrients. 2021;13(6):2050.
pubmed: 34203986 pmcid: 8232587 doi: 10.3390/nu13062050
Trivers RL, Willard DE. Natural selection of parental ability to vary the sex ratio of offspring. Science. 1973;179(4068):90–2.
pubmed: 4682135 doi: 10.1126/science.179.4068.90
Kumar P, Chauhan S, Patel R, Srivastava S, Bansod DW. Prevalence and factors associated with triple burden of malnutrition among mother-child pairs in India: a study based on National Family Health Survey 2015–16. BMC Public Health. 2021;21:1–2.
doi: 10.1186/s12889-021-10411-w
Behera S, Bulliyya G. Magnitude of anemia and hematological predictors among children under 12 years in Odisha, India. Anemia. 2016;2016.
Development Initiatives Poverty Research Ltd. Country Nutrition Profiles. 2020. Available online: https://globalnutritionreport.org/resources/nutrition-profiles/africa/ . Accessed on 6 May 2023.

Auteurs

Joshua Okyere (J)

Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Irene Esi Donkoh (IE)

Department of Medical Laboratory Science, University of Cape Coast, Cape Coast, Ghana.

Abdul-Aziz Seidu (AA)

Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana.
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia.

Bright Opoku Ahinkorah (BO)

School of Clinical Medicine, University of New South Wales Sydney, Sydney, Australia.
School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.

Richard Gyan Aboagye (RG)

Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.

Sanni Yaya (S)

School of International Development and Global Studies, University of Ottawa, Ottawa, Canada. sanni.yaya@uOttawa.ca.
The George Institute for Global Health, Imperial College London, London, UK. sanni.yaya@uOttawa.ca.

Classifications MeSH