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And Overnutrition Among Women in Nigeria: a Population-Based Analysis Uthman, Olalekan A www.ssoar.info Patterns, distribution, and determinants of under- and overnutrition among women in Nigeria: a population-based analysis Uthman, Olalekan A. Postprint / Postprint Zeitschriftenartikel / journal article Zur Verfügung gestellt in Kooperation mit / provided in cooperation with: www.peerproject.eu Empfohlene Zitierung / Suggested Citation: Uthman, O. A. (2009). Patterns, distribution, and determinants of under- and overnutrition among women in Nigeria: a population-based analysis. Journal of Public Health, 17(5), 289-299. https://doi.org/10.1007/s10389-009-0251-z Nutzungsbedingungen: Terms of use: Dieser Text wird unter dem "PEER Licence Agreement zur This document is made available under the "PEER Licence Verfügung" gestellt. Nähere Auskünfte zum PEER-Projekt finden Agreement ". For more Information regarding the PEER-project Sie hier: http://www.peerproject.eu Gewährt wird ein nicht see: http://www.peerproject.eu This document is solely intended exklusives, nicht übertragbares, persönliches und beschränktes for your personal, non-commercial use.All of the copies of Recht auf Nutzung dieses Dokuments. Dieses Dokument this documents must retain all copyright information and other ist ausschließlich für den persönlichen, nicht-kommerziellen information regarding legal protection. You are not allowed to alter Gebrauch bestimmt. Auf sämtlichen Kopien dieses Dokuments this document in any way, to copy it for public or commercial müssen alle Urheberrechtshinweise und sonstigen Hinweise purposes, to exhibit the document in public, to perform, distribute auf gesetzlichen Schutz beibehalten werden. Sie dürfen dieses or otherwise use the document in public. Dokument nicht in irgendeiner Weise abändern, noch dürfen By using this particular document, you accept the above-stated Sie dieses Dokument für öffentliche oder kommerzielle Zwecke conditions of use. vervielfältigen, öffentlich ausstellen, aufführen, vertreiben oder anderweitig nutzen. Mit der Verwendung dieses Dokuments erkennen Sie die Nutzungsbedingungen an. Diese Version ist zitierbar unter / This version is citable under: https://nbn-resolving.org/urn:nbn:de:0168-ssoar-203398 J Public Health (2009) 17:289–299 DOI 10.1007/s10389-009-0251-z ORIGINAL ARTICLE Patterns, distribution, and determinants of under- and overnutrition among women in Nigeria: a population-based analysis Olalekan A. Uthman Received: 10 June 2008 /Accepted: 18 December 2008 /Published online: 20 February 2009 # Springer-Verlag 2009 Abstract more likely to be obese. There is a need for public health Objective To determine the patterns and determinants of programs to promote nutritious food and a healthy lifestyle to nutritional status among women in Nigeria. address both types of malnutrition at the same time. It will also Methods Using a body mass index (BMI) category of 18.5– be important for these programs to be age and region sensitive. 24.99 kg/m2 (normal weight) as the reference, set of univariable and multivariable multinomial logistic regression Keywords Malnutrition . Obesity. Socioeconomic status . models were fitted to investigate the independent association Nigeria between different sociodemographic characteristics and nu- tritional status. Results were presented in the form of relative risk ratios (RRR) with significance levels and 95% confidence Background intervals (95% CI). Results Almost two-thirds of women had BMIs in the Increasingly, health systems in poor countries are simulta- normal range. Of the total sample, 14.5% of subjects were neously confronting under- and overnutrition—not only at classified as underweight, 14.3% as overweight and 5.5% as the national level, but also within households (Caulfield, obese. The youngest women are the most likely subgroup to de Onis, Blossner & Black 2004). Both under- and be thin; one-quarter of women aged 15–19 have a BMI of less overnutrition are linked with a range of adverse health 2 than 18.5 kg/m . There is significant regional variation, with conditions. Body mass index (BMI), a measure to deter- the prevalence of thinness ranging from 6% in the north central mine the amount of body fat and amount of lean body area to 22% in the northeast. There was a clear socioeconomic mass, can be used to determine if a person is underweight, distribution underlying patterns of nutritional status, with normal weight, overweight or obese (BMI is calculated by women in low socioeconomic positions (SEP) experiencing a dividing a person’s weight in kilograms by the square of the greater risk of being underweight and those in high SEPs person’s height in meters, kg/m2). The underweight experiencing the greatest risk of being overweight and obese. (defined as having a BMI of less than 18.5 kg/m2) are Conclusions The results show that women in low SEPs are susceptible to poor maternal and infant health as well as more likely to be underweight, and women in high SEPs are childhood growth problems and compromised mental development. Meanwhile, obesity, defined as a BMI of O. A. Uthman more than 30 kg/m2, is associated with such chronic diseases Public Health, Epidemiology and Biostatistics, as stroke, hypertension, cardiovascular disease, type-2 diabe- The Public Health Building, The University of Birmingham, tes and certain forms of cancer. Obesity is a serious public Birmingham B15 2TT, UK health problem with immense health, social and economic O. A. Uthman (*) implications (Gill King & Caterson 2005). Obesity is fast Center for Evidence-Based Global Health, approaching cigarette smoking as the major preventable Save the Youth Initiative, cause of mortality (Gill et al. 2005). In public health terms, Ilorin, Nigeria e-mail: [email protected] the greatest burden of disease arises from obesity-related e-mail: [email protected] morbidity (World Health Organization 2000). 290 J Public Health (2009) 17:289–299 The emergence of the dual burden household is a result Committee in the Ministry of Health in Nigeria. All study of the nutrition transition underway in developing countries participants gave informed consent before participation, and that are becoming more prosperous and urbanized. These all information was collected confidentially. countries are seeing a decrease in physical activity levels and a shift in diets to include more fats and sugars (Popkin Sampling technique & Gordon-Larsen 2004). With the globalization of food markets, developing countries have larger quantities of low- Methods used in the Nigeria 2003 DHS have been cost, high-calorie foods. Influential marketing persuades published elsewhere (National Population Commision & poorer households to purchase more of these cheap foods ORC Macro 2004). Briefly, the survey used a two-stage (Caballero 2005). The excess energy from these foods may cluster-sampling technique. The country was stratified into affect adults and children within the same household 36 states and the Federal Capital Territory (FCT) of Abuja. differently. For example, young children may easily use Each domain is made up of enumeration areas (EAs) up the excess energy and still be underweight, while adults established by a general population and housing census in may end up gaining weight (Caballero 2005). Physical 1991. The sampling frame was a list of all EAs (clusters). activity levels and food distribution within the household Within each domain, a two-stage sample was selected. The may also vary from one family member to another, further first stage involved selecting 466 clusters (primary sam- contributing to the under-/overweight phenomenon (Doak, pling units) with a probability proportional to the size, the Adair, Monteiro & Popkin 2000). Nutritional status can be size being the number of households in the cluster. The influenced by both social and biological factors. Previous second stage involved the systematic sampling of house- studies (Cooper et al. 1997; Forrest et al. 2001; Lawoyin holds from the selected clusters. All women aged 15 to et al. 2002; Okesina, Oparinde, Akindoyin & Erasmus 49 years in the selected households were interviewed. The 1999) found that adult women from Nigeria were more likely sample was selected using a stratified two-stage cluster to be overweight than their male counterparts, suggesting design consisting of 365 clusters taken from a list of nutritional differentials may be biologically influenced. enumeration areas developed for the 1991 Population The International Obesity Task Force (IOTF) and the World Census. A nationally representative probability sample of Health Organization (WHO) have identified the emerging 7,864 households was then selected from the clusters, in patterns of both under- and overnutrition, especially in middle- which all women aged 15 to 49 years were eligible to be income and developing countries, as among the top ten future interviewed. global health problems (Cole, Bellizzi, Flegal, & Dietz 2000; World Health Organization 2004b). “There is need to Data collection simultaneously address the infectious disease epidemics, especially HIV/AIDS, and the potentially serious chronic Data were collected by visiting households and conducting disease epidemics associated with overweight and obesity” face-to-face interviews to obtain information on demo- warned the WHO (World Health Organization 2002). graphic characteristics, wealth, nutritional and sexual However, the specific epidemiological and demographic behavior, among other data, between March and August features of these nutritional changes in developing countries 2003. The final analytical
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