Is the positive association between middle-income and rich household wealth and adult sub-Saharan African women’s overweight status modified by the level of education attainment? A cross-sectional study of 22 countries

Abstract

Background: Previous 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. Methods: Demographic 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/m 2. 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.

Differentials in prevalence and correlates on uptake of tetanus toxoid and intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy: A community-based cross-sectional study in The Gambia

“…This is similar to previous studies. 45 , 46 Therefore, the pivotal role of the community and opinion leaders, especially in deep-rooted cultural societies, should be integrated and strengthened in our maternal and child health programs.…”

“…This necessitates a strong collaboration between the healthcare workers and community leaders for the promotion of expectant women’s optimal ANC attendance and ensures that everyone receives the required dose of IPTp-SP. 42 , 45 …”

“…This necessitates a strong collaboration between the healthcare workers and community leaders for the promotion of expectant women's optimal ANC attendance and ensures that everyone receives the required dose of IPTp-SP. 42,45 With regard to the update of adequate TT immunization, women with a reduced number of ANC visits were less likely to receive the required doses of TT compared to those with at least five ANC visits. These results were also supported by other studies.…”

Assessing comparative asset-based measures of material wealth as predictors of physical growth and mortality

“…Women's age was treated as categorical with each year as a category, in order to understand any relationships that can't be captured using linear or quadratic functions. Although there is some evidence of non-linearity at higher educational levels, education often has a positive relationship with BMI in low- and middle-income countries ( Hruschka et al, 2019 ; Mazariegos et al, 2021 ; Ozodiegwu et al, 2020 ). This variable was dummy-coded to represent years of education (none, primary, secondary, and post-secondary) ( Frost et al, 2005 ; Rodolfo et al, 2000 ).…”

Evaluating the Performance of Five Asset-based Wealth Indices in Predicting Socioeconomic Position in Rural Bangladesh

“…Social scientists and policymakers frequently use asset-based wealth indices as proxies for socioeconomic position to monitor socioeconomic inequalities in health and well-being and access to education and other social services (Filmer and Pritchett 2001; Godoy et al 2010; Gupta et al 2017; Gwatkins et al 2007; Hruschka et al 2014; Mohsena et al 2010; Ozodiegwu et al 2020; Pollack et al 2007; Rutstein and Staveteig 2014; Smits and Steendijk 2015; Woolard et al 2021). Such indices assign households a relative wealth value based on a weighted checklist of easy-to-assess household assets and access to services (Kaiser et al 2017; Woolard et al 2021).…”