Background The ongoing nutrition transition in sub-Saharan Africa (SSA) is exhibiting spatial heterogeneity and temporal variability leading to different forms of malnutrition burden across SSA, with some regions exhibiting the double burden of malnutrition. This study aimed to develop a predictive understanding of the malnutrition burden among women of child-bearing age. Methods Data from 34 SSA countries were acquired from the Demographic and Health Survey, World Bank, and Swiss Federal Institute of Technology. The SSA countries were classified into malnutrition classes based on their national prevalence of underweight, overweight, and obesity using a 10% threshold. Next, random forest analysis was used to examine the association between country-level demographic variables and the national prevalence of underweight, overweight and obesity. Finally, random forest analysis and multinomial logistic regression models were utilized to investigate the association between individual-level social and demographic variables and Body Mass Index (BMI) categories of underweight, normal weight, and combined overweight and obesity. Results Four malnutrition classes were identified: Class A had 5 countries with ≥10% of the women underweight; Class B had 11 countries with ≥10% each of underweight and overweight; Class C1 had 7 countries with ≥10% overweight; and Class C2 had 11 countries with ≥10% obesity. At the country-level, fertility rate predicted underweight, overweight and obesity prevalence, but economic indicators were also important, including the gross domestic product per capita – a measure of economic opportunity that predicted both overweight and obesity prevalence, and the GINI coefficient – a measure of economic inequality that predicted both underweight and overweight prevalence. At the individual-level, parity was a risk factor for underweight in underweight burdened countries and a risk factor for overweight/obesity in overweight/obesity burdened countries, whereas age and wealth were protective factors for underweight but risk factors for overweight/obesity. Conclusions Beyond the effect of economic indicators, this study revealed the important role of fertility rate and parity, which may represent risk factors for both underweight and combined overweight and obesity among women of child-bearing age. Health professionals should consider combining reproductive health services with nutritional programs when addressing the challenge of malnutrition in SSA.

IntroductionThe majority of the populations in low-income and middle-income countries (LMICs) are encountering the double burden of malnutrition (DBM): the coexistence of both undernutrition and overnutrition sequalae. With DBM being a new phenomenon in research, little is known about its aetiology, operational definitions and risk factors influencing its manifestation. The proposed scoping review is aimed at mapping literature with regard to the DBM phenomenon among preschool children and women of reproductive age in LMICs who are among the most high-risk groups to encounter DBM.MethodsA comprehensive literature search will be conducted in the following electronic databases: MEDLINE, EMBASE, Scopus, CINAHL, LILACS and ProQuest Dissertations and Thesis Global. Additionally, searches in other government and institutional sources (WHO website and university repositories) and forward and backward citation tracking of seminal articles will also be done. Two reviewers will independently conduct title and abstract screening and full-text screening. Similarly, data extraction and coding will independently be done by two reviewers. Information extracted from included literature will be analysed qualitatively using thematic analysis approach and reported as per the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines.Ethics and disseminationEthical approval is not required for this study because the review is based on literature from publicly available sources. The dissemination of our findings will be done through presentations in relevant conferences and publication in a peer-reviewed journal.

Even though several studies have examined various risk factors for hypertension, residential influence is poorly explored especially in the low-income countries. We aim to investigate the association between residential characteristics and hypertension in resource limited and transitional settings like Nepal. A total of 14,652 individuals aged 15 and above were selected from 2016-Nepal Demographic and Health Survey. Individuals with blood pressure ≥140/90 mmHg or a history of hypertension (as identified by physicians/health professionals) or under antihypertensive medication were defined as hypertensive. Residential characteristics were represented by area level deprivation index, with a higher score representing higher level of deprivation. Association was explored using a two-level logistic regression. We also assessed if residential area modifies the association between individual socio-economic status and hypertension. Area deprivation had a significant inverse association with the risk of hypertension. Individuals from the least deprived areas had higher odds of hypertension compared to highly deprived areas 1.59 (95% CI 1.30, 1.89). Additionally, the association between literacy a proxy of socio-economic status and hypertension varied with a place of residence. Literate individuals from highly deprived areas were likely to have a higher odds of hypertension compared to those with no formal education. In contrast, literate from the least deprived areas had lower odds of hypertension. These results identify counterintuitive patterns of associations between residential characteristics and hypertension in Nepal, as compared with most of the epidemiological data from high-income countries. Differential stages of demographic and nutritional transitions between and within the countries might explain these associations.

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BackgroundMultimorbidity is associated with cognitive decline. Little information exists regarding whether the relationship between multimorbidity and cognitive decline has changed over the last few decades.ObjectiveTo compare estimates of the association between multimorbidity (MM) and performance on cognitive tests in two prospective cohorts of Canadian community‐dwelling older adults recruited 24 years apart.MethodWe analyzed the two datasets separately, including participants ≥65 years from both baseline and first follow‐up of the Canadian Study of Health and Aging (CSHA, 1991 – 2001; first follow up in 1996) and the Canadian Longitudinal Study on Aging (CLSA, 2015 – ongoing; first follow up in 2018). We excluded participants with baseline dementia. In both cohorts, we defined MM as two or more conditions from a list of 14. The neuropsychological tests were Animal Naming Test (ANT) and the Rey Auditory Verbal Learning Test (RAVL) for both cohorts. Tests of frontal function were the Digit Symbol Substitution Test (DSST) in the CSHA and the Mental Alternation Task (MAT) in the CLSA. We performed multilevel linear modelling. We controlled for confounders, which were detected using a Directed Acyclic Graph.ResultWe included 497 participants from the CSHA and 9308 from the CLSA. The mean age was 78.0 in the CSHA and 72.0 in the CLSA, and male accounted for 36.4% in the CSHA and 50.2 in the CLSA. Mean MM was 2.1 in both cohorts, with a higher prevalence of MM in women (CSHA 63.9%; CLSA 64.2%) than in men (CSHA 55.8%; CLSA 59.5%). When comparing both cohorts, we found that baseline MM was not associated with changes in the Z‐scores for the ANT (CSHA: 0.16, CI95: ‐0.014 to 0.34; CLSA: ‐0.002, CI95: ‐0.044 to 0.04), RAVL delayed recall (CSHA ‐0.033, CI95: ‐0.23 to 0.16; CLSA: 0.031, IC95: ‐0.013 to 0.074), or DSST in CSHA (0.1, CI95: ‐0.084 to 0.29) / MAT in CLSA (0.008, CI95: ‐0.035 to 0.052).ConclusionWe did not find differences in Z‐scores changes over 5 years follow up in the CSHA and 3 years follow up in the CLSA, for three neuropsychological tests among Canadians ≥65 years recruited over two decades apart.