Multilevel analysis of unhealthy bodyweight among women in Malawi: Does urbanisation matter?

Abstract

Background Underweight and overweight constitute unhealthy bodyweight and their coexistence is symptomatic of the dual burden of malnutrition (DBM) of high public health concern in many sub-Saharan Africa countries. Little is known about DBM and its correlates in Malawi, a country undergoing urbanisation. The study examined net effects of urban residence on unhealthy weights amidst individual- and community-level factors among women in Malawi. Methods Data on 7231 women aged 15–49 years nested within 850 communities extracted from 2015–16 Malawi Demographic and Health Survey were analysed. Women’s weight status measured by body mass index, operationally categorised as underweight, normal and overweight, was the outcome variable while urban-rural residence was the main explanatory variable. Multilevel multinomial logistic regression analysis was employed at 5% significant level; the relative-risk ratio (RR) and its 95% confidence interval (CI) were presented. Results Urban residents had a significantly higher prevalence of overweight than rural (36.4% vs. 17.2%; p< 0.001) but a -non-significant lower prevalence of underweight (6.2% vs. 7.4%; p = 0.423). Having adjusted for both individual- and community-level covariates, compared to rural, living in urban (aRR = 1.25; CI: 1.02–1.53) accounted for about 25% higher risk of being overweight relative to normal weight. Higher education attainment, being married and belonging to Chewa, Lomwe or Mang’anja ethnic group significantly reduced the risk of being underweight but heightened the risk of being overweight. Being older and living in wealthier households respectively accounted for about 3- and 2-times higher likelihood of being overweight, while breastfeeding (aRR = 0.65; CI: 0.55–0.76) was protective against overweight. Living in communities with higher poverty and higher education levels reduced and increased the risk of being overweight, respectively. Evidence of community’s variability in unhealthy weights was observed in that 11.1% and 3.0% respectively of the variance in the likelihood of being overweight and underweight occurred across communities. Conclusions The study demonstrated association between urban residence and women overweight. Other important associated factors of overweight included breastfeeding, community education- and poverty-level, while education attainment, marital status and ethnicity were associated with the dual unhealthy weight. Thus, both individual- and community-level characteristics are important considerations for policy makers in designing interventions to address DBM in Malawi.

Pattern of weight gain in pregnant women in slum areas of Hamadan using multilevel ordinal regression

“…Since the majority of women in the present study had a diploma or lower education level and in terms of employment they were housewives, creating appropriate strategies can be effective in improving the health literacy of households in these areas. The strength of the present study has been the availability of pre-pregnancy BMI data (strong predictor of GWG) in most participants (91%) as well as the evaluation of GWG in all weeks of pregnancy, and of course use of multi-level models that are accurate in outcome prediction [ 40 ]. However, one of the limitations of our study was the lack of access to information on nutritional factors of pregnant women residing in slum areas.…”

Then and Now: Investigating Anthropometrics and Child Mortality among Females in Malawi

“…These spatial outcomes may represent many distal and surrogate conditions in areas and how those conditions shape health (BMI) [72]. The higher prevalence of obesity in the areas in the central and southern regions may be a population effect-densely populated areas are likely to have high proportions of obese persons [20]. Additionally, residents may quickly form unhealthy behaviors (i.e., dietary and physical activity) which, in turn, increase obesity risk [18,19,25].…”

“…Among the many factors implicated in the relationship between BMI, poor maternal health, and birth outcomes; age, residence, wealth, education, and behavior are mainstream 2 of 17 in Malawi [15,18]. The prevalence of obesity is higher among urban females than in their rural counterparts [19,20]. Furthermore, the risk of overweight and obesity increases with age.…”

Multilevel Analysis of Urban–Rural Variations of Body Weights and Individual-Level Factors among Women of Childbearing Age in Nigeria and South Africa: A Cross-Sectional Survey

“…Additionally, variances can be found in the overweight and obesity categories in Models 2 and 3 with respect to Nigeria and South Africa ( Table 4 ). These findings indicated that universal strategies to control overweight and obese body categories may not consistently show effective outcomes in both countries [ 17 , 34 , 62 ]. For instance, some strategic interventions or preventive approaches regarding the problem of body weight in Nigeria may not be equally effective in South Africa.…”

“…According to the South Africa Demographic Health Survey (SADHS), the trend analysis indicated that the mean BMI among women aged 15 and older has increased from 27.3 in 1998 to 29.2 in 2016, and the prevalence of overweight/obesity among women of childbearing age rose from 56% to 68%, with a decreased prevalence of underweight from 6% to 3% [ 12 ]. In Nigeria and South Africa, underweight prevalence is declining to an extent, in comparison to overweight/obesity, which has a higher prevalence [ 11 , 12 , 15 , 16 ]; yet, other countries are still observing an increased prevalence of underweight [ 17 , 18 ]. Hitherto, studies on malnutrition conducted in Nigeria and South Africa have shown that overweight or obese women of childbearing age were more likely to be older, educated, married, in the highest wealth quintile, and residing in urban areas [ 11 , 12 ].…”