Undernutrition, polygynous context and family structure: a multilevel analysis of cross-sectional surveys of 350 000 mother–child pairs from 32 countries

Abstract

BackgroundContextual factors, especially where people live, has been linked to various health outcomes, therefore, there is an increasing focus on its implication for policies and implementation of health interventions. Polygyny is a widespread practice in sub-Saharan Africa that also reflects socioeconomic and sociocultural features. This study investigated the association between polygynous context and risk of undernutrition.MethodsRecent Demographic and Health Surveys involving 350 000 mother–child pairs from 32 sub-Saharan African countries conducted between 2010 and 2018 as of March 2020, were analysed using relevant descriptive and 3-level multilevel logistic regression modelling. Undernutrition among under-5 was defined as underweight, stunting and wasting using the WHO Multicentre Growth Reference Study. Odd Ratio (OR) at 95% credible interval was used to report the associations.ResultsThe prevalence of contextual polygyny varied widely across the 32 sub-Saharan African countries, the lowest (0%) found in one of the regions in South Africa and the highest (52%) in one of the regions in Uganda. Underweight, stunting and wasting were lowest in Uganda (3.5%, 9.3%–1.27%, respectively), stunting was highest in Mozambique (37.1%) while wasting was highest in Niger (7.7%). Furthermore, the results showed that the contextual prevalence of polygynous practice exacerbates the risk of underweight (1.003 (0.997–1.008)) and wasting (1.014 (1.007–1.021)) among under-5 children, even when gender inequality and sociodemographic indicators were adjusted for. Polygyny was negatively associated with stunting though not significant; multiple births had the strongest and positive association with the risk of undernutrition among under-5 children in sub-Saharan Africa.ConclusionsThis study further corroborates the strong influence of contextual factors on health outcomes—which is undernutrition in this study. In addition to specific interventions aimed at reducing the prevalence of undernutrition, broader strategies that will address contextual issues are required.

Polygyny and intimate partner violence in sub-Saharan Africa: Evidence from 16 cross-sectional demographic and health surveys

“…This variable has been defined in the DHS as the number of other wives that the partner of currently married women (women who are either legally or formally married or who are living in a consensual union) has. Reference to the use of this variable has been published elsewhere ( Anjorin et al, 2020 ; Smith-Greenaway & Trinitapoli, 2014 ). However, in this study, only currently married women were considered in order to understand the link between current marital structure and IPV.…”

Women empowerment indices and utilization of health facilities during childbirth: evidence from the 2019 Sierra Leone demographic health survey

“…Similarly, polygamy has been shown by Stephen et al in Nigeria [ 31 ] and Lowe et al [ 32 ] in The Gambia to have a negative impact on maternal healthcare utilization. Dilution and scarcity of resources in polygamous families are common mechanisms that are used to explain the decreased likelihood of health facility utilization among women in polygamous relationships [ 12 , 31 , 33 ]. This has been debated against in some literature with some reporting that some polygamous men tend to be wealthy [ 34 ].…”

Influence of Maternal Exposure to Mass Media on Growth Stunting Among Children Under Five: Mediation Analysis Through the Water, Sanitation, and Hygiene Program

“…Given that our findings suggest that there is a positive association between media access and water, sanitation, and hygiene practice, it is possible that mass media could be used as the primary means of health intervention and health education. Published literature has discussed how mass media can be used to promote health knowledge and behaviors [ 46 ]—radios were reportedly the most frequently used channel, followed by television [ 24 , 47 ]. This is consistent with our results, which indicated that radio usage has the highest usage.…”