Socioecological Approach to Understanding Overnutrition Among Married and Cohabiting Women in Nigeria
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Abstract
Overweight and obesity are currently an epidemic affecting both developed and developing countries. Sub-Saharan Africa has a double burden of being underweight and obese and has recently been battling an alarming increase in the prevalence of overweight. This study investigates the predictors of overnutrition among married women of reproductive age in Nigeria using the socioecological model (SEM) as a framework. The study hypothesizes that the Southern region will have a higher burden of overnutrition than the Northern region. The 2018 Nigeria Demographic and Health Survey (NDHS) was analyzed. A total of 8,531 non-pregnant married women met the inclusion criteria. Hierarchical multilevel logistic regression models were fitted, informed by the SEM framework. The occurrence of overnutrition was found to be 31.4%, with regional variations showing 31.7% in the South and 31.3% in the North. When all covariates were fitted in a model, being older, being a Christian, having tertiary education, having an older partner with tertiary education, being wealthy, and living in the urban area were predictors of overnutrition in multivariate analysis. Overnutrition among Nigerian married women was high, especially in the Southern region. Predictors of overweight are at all the SEM levels; therefore, it is better to consider all the levels when planning public health interventions.
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References
• Adeloye, D., Ige-Elegbede, J. O., Ezejimofor, M., Owolabi, E. O., Ezeigwe, N., Omoyele, C., Mpazanje, R. G., Dewan, M. T., Agogo, E., Gadanya, M. A., Alemu, W., Harhay, M. O., Auta, A., & Adebiyi, A. O. (2021). Estimating the prevalence of overweight and obesity in Nigeria in 2020: A systematic review and meta-analysis. Annals of Medicine, 53(1), 495–507. https://doi.org/10.1080/07853890.2021.1897665
• Ahmad, K., Khanam, T., Keramat, S. A., Islam, I., Kabir, E., & Khanam, R. (2020). Interaction between the place of residence and wealth on the risk of overweight and obesity in Bangladeshi women. PLOS ONE, 15(2), Article e0243349. https://doi.org/10.1371/journal.pone.0243349
• Ahmed, K. Y., Abrha, S., Page, A., Arora, A., Shiferaw, S., Tadese, F., Seifu, C. N., Yeneabat, T., Alemu, E., Gebremichael, D. Y., Seiko, A., & Ogbo, F. A. (2020). Trends and determinants of underweight and overweight/obesity among urban Ethiopian women from 2000 to 2016. BMC Public Health, 20(1), Article 1276. https://doi.org/10.1186/s12889-020-09345-6
• Al Kibria, G. M., Swasey, K., Hasan, M. Z., Sharmeen, A., & Day, B. (2019). Prevalence and factors associated with underweight, overweight and obesity among women of reproductive age in India. Global Health Research and Policy, 4(1), Article 24. https://doi.org/10.1186/s41256-019-0117-z
• Alabi, T. A., & Badru, O. A. (2021, December 5–10). Regional variations in overweight/obesity in Nigeria: Whither cosmopolitan-success and conservative-failure hypothesis? International Union for the Scientific Study of Population Conference. https://ipc2021.popconf.org/abstracts/210291
• Alabi, T. A., & Badru, O. A. (2023). Slim north, fat south: Explaining regional differences in abnormal weights in Nigeria. Journal of Biosocial Science, 1–25. https://doi.org/10.1017/S0021932023000238
• Axelsson Fisk, S., Lindström, M., Perez-Vicente, R., & Merlo, J. (2021). Understanding the complexity of socioeconomic disparities in smoking prevalence in Sweden: A cross-sectional study applying intersectionality theory. BMJ Open, 11(2), Article e042323. https://doi.org/10.1136/bmjopen-2020-042323
• Baniissa, W., Radwan, H., Rossiter, R., Fakhry, R., Al-Yateem, N., Al-Shujairi, A., Hasan, S., MacRidis, S., Farghaly, A. A., Naing, L., & Awad, M. A. (2020). Prevalence and determinants of overweight/obesity among school-aged adolescents in the United Arab Emirates: A cross-sectional study of private and public schools. BMJ Open, 10(12), Article e038667. https://doi.org/10.1136/bmjopen-2020-038667
• Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Harvard University Press.
• Castro, A. D. C. O., Silveira, E. A., Falco, M. D. O., Nery, M. W., & Turchi, M. D. (2016). Overweight and abdominal obesity in adults living with HIV/AIDS. Revista Da Associacao Medica Brasileira, 62(4), 353–360. https://doi.org/10.1590/1806-9282.62.04.353
• Cavazzotto, T. G., Stavinski, N. G. de L., Queiroga, M. R., da Silva, M. P., Cyrino, E. S., Junior, H. S., & Vieira, E. R. (2022). Age and sex-related associations between marital status, physical activity and TV time. International Journal of Environmental Research and Public Health, 19(1), Article 502. https://doi.org/10.3390/IJERPH19010502
• Cham, B., Scholes, S., Fat, Linda, N., Badjie, O., Groce, N. E., & Mindell, J. S. (2020). The silent epidemic of obesity in The Gambia: Evidence from a nationwide, population-based, cross-sectional health examination survey. BMJ Open, 10(6), Article e033882. https://doi.org/10.1136/bmjopen-2019-033882
• Chen, X., Hu, X., Shi, S., & Tian, Q. (2020). Socioeconomic and demographic factors for spousal resemblance in obesity status in China. Healthcare, 8(4), Article 415. https://doi.org/10.3390/healthcare8040415
• Chia, C. W., Egan, J. M., & Ferrucci, L. (2018). Age-related changes in glucose metabolism, hyperglycemia, and cardiovascular risk. Circulation Research, 123(7), 886–904. https://doi.org/10.1161/CIRCRESAHA.118.312806
• Diendéré, J., Kaboré, J., Somé, J. W., Tougri, G., Zeba, A. N., & Tinto, H. (2019). Prevalence and factors associated with overweight and obesity among rural and urban women in Burkina Faso. Pan African Medical Journal, 34, Article 199. https://doi.org/10.11604/pamj.2019.34.199.20250
• Dipietro, L., Evenson, K. R., Bloodgood, B., Sprow, K., Troiano, R. P., Piercy, K. L., Vaux-Bjerke, A., & Powell, K. E. (2019). Benefits of physical activity during pregnancy and postpartum: An umbrella review. Medicine and Science in Sports and Exercise, 51(6), 1292–1302. https://doi.org/10.1249/MSS.0000000000001941
• Kandala, N., & Stranges, S. (2014). Geographic variation of overweight and obesity among women in Nigeria: A case for nutritional transition in sub-Saharan Africa. PLOS ONE, 9(6), Article e101103. https://doi.org/10.1371/journal.pone.0101103
• Mangemba, N. T., & San Sebastian, M. (2020). Societal risk factors for overweight and obesity in women in Zimbabwe: A cross-sectional study. BMC Public Health, 20(1), Article 103. https://doi.org/10.1186/s12889-020-8215-x
• Mathur, P., & Pillai, R. (2019). Overnutrition: Current scenario & combat strategies. The Indian Journal of Medical Research, 149(6), 695–705. https://doi.org/10.4103/IJMR.IJMR_1703_18
• Mengesha Kassie, A., Beletew Abate, B., & Wudu Kassaw, M. (2020). Education and prevalence of overweight and obesity among reproductive age group women in Ethiopia: Analysis of the 2016 Ethiopian demographic and health survey data. BMC Public Health, 20(1), Article 1189. https://doi.org/10.1186/s12889-020-08941-w
• Merlo, J., Wagner, P., & Leckie, G. (2019). Health & Place A simple multilevel approach for analysing geographical inequalities in public health reports: The case of municipality differences in obesity. Health & Place, 58, Article 102145. https://doi.org/10.1016/j.healthplace.2019.102145
• Mndala, L., & Kudale, A. (2019). Distribution and social determinants of overweight and obesity: A cross-sectional study of non-pregnant adult women from the Malawi Demographic and Health Survey (2015-2016). Epidemiology and Health, 41, Article e2019039. https://doi.org/10.4178/epih.e2019039
• Mohajan, D., & Mohajan, H. K. (2023). A study on body fat percentage for physical fitness and prevention of obesity: A two compartment model. Journal of Innovations in Medical Research, 2(4), Article 4. https://doi.org/10.56397/JIMR/2023.04.01
• Mukora-Mutseyekwa, F., Zeeb, H., Nengomasha, L., & Adjei, N. K. (2019). Trends in prevalence and related risk factors of overweight and obesity among women of reproductive age in Zimbabwe, 2005–2015. International Journal of Environmental Research and Public Health, 16(15), Article 2758. https://doi.org/10.3390/ijerph16152758
• Murakami, K., Ohkubo, T., & Hashimoto, H. (2017). Distinct association between educational attainment and overweight/obesity in unmarried and married women: Evidence from a population-based study in Japan. BMC Public Health, 17(1), Article 903. https://doi.org/10.1186/s12889-017-4912-5
• National Population Commission (NPC) [Nigeria] & ICF. (2019, October). Nigeria Demographic and Health Survey 2018. https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf
• Nyanhanda, T., Mwanri, L., & Mude, W. (2023). Double burden of malnutrition: A population level comparative cross-sectional study across three sub-Saharan African countries—Malawi, Namibia and Zimbabwe. International Journal of Environmental Research and Public Health, 20(10), Article 5860. https://doi.org/10.3390/ijerph20105860
• Okoh, M. (2013). Socio-demographic correlates of overweight and obesity among women of reproductive age in Nigeria socio-demographic correlates of overweight and obesity among women of reproductive age in Nigeria. African Journal of Reproductive Health, 17(4), 66–76. https://www.ajrh.info/index.php/ajrh/article/view/1217
• Saghafi-Asl, M., Aliasgharzadeh, S., & Asghari-Jafarabadi, M. (2020). Factors influencing weight management behavior among college students: An application of the Health Belief Model. PLOS ONE, 15(2), Article e0228058. https://doi.org/10.1371/journal.pone.0228058
• Sarma, H., Saquib, N., Hasan, M., Saquib, J., Rahman, A. S., Khan, J. R., Uddin, J., Cullen, M. R., & Ahmed, T. (2016). Determinants of overweight or obesity among ever-married adult women in Bangladesh. BMC Obesity, 3, Article 13. https://doi.org/10.1186/s40608-016-0093-5
• Song, J., Zhang, J., Fawzi, W., & Huang, Y. (2020). Double burden of malnutrition among Chinese women of reproductive age and their social determinants. Nutrients, 12(10), Article 3102. https://doi.org/10.3390/nu12103102
• Sutradhar, I., Akter, T., Hasan, M., Das Gupta, R., Joshi, H., Haider, M. R., & Sarker, M. (2021). Nationally representative surveys show gradual shifting of overweight and obesity towards poor and less-educated women of reproductive age in Nepal. Journal of Biosocial Science, 53(2), 214–232. https://doi.org/10.1017/S0021932020000152
• Tanwi, T. S., Chakrabarty, S., Hasanuzzaman, S., Saltmarsh, S., & Winn, S. (2019). Socioeconomic correlates of overweight and obesity among ever-married urban women in Bangladesh. BMC Public Health, 19(1), Article 842. https://doi.org/10.1186/s12889-019-7221-3
• Tuoyire, D. A., Kumi-Kyereme, A., & Doku, D. T. (2016). Socio-demographic trends in overweight and obesity among parous and nulliparous women in Ghana. BMC Obesity, 3(1), Article 44. https://doi.org/10.1186/s40608-016-0124-2
• Vézina-Im, L. A., Lebel, A., Gagnon, P., Nicklas, T. A., & Baranowski, T. (2018). Association between sleep and overweight/obesity among women of childbearing age in Canada. Canadian Journal of Public Health, 109(4), 516–526. https://doi.org/10.17269/s41997-018-0071-4
• Were, J. M., Kyeremeh, E., Annor, B. O., Campbell, M. K., & Stranges, S. (2022). Abstract MP23: Does predictors of overweight/obesity among women vary based on the residential setting? A multilevel analysis of repeated cross-sectional data in Nigeria. Circulation, 145(Suppl_1). https://doi.org/10.1161/CIRC.145.SUPPL_1.MP23
• Williams, J., Allen, L., Wickramasinghe, K., Mikkelsen, B., Roberts, N., & Townsend, N. (2018). A systematic review of associations between non-communicable diseases and socioeconomic status within low- and lower-middle-income countries. Journal of Global Health, 8(2), Article 020409. https://doi.org/10.7189/JOGH.08.020409
• World Health Organization (WHO). (2021, June 9). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight