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BMJ Open Is Committed to Open Peer Review. As Part of This Commitment We Make the Peer Review History of Every Article We Publish Publicly Available BMJ Open: first published as 10.1136/bmjopen-2019-029570 on 8 December 2019. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on September 26, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2019-029570 on 8 December 2019. Downloaded from Socioeconomic and behavioral determinants of overweight/obesity in Botswana: A cross-sectional study Journal: BMJ Open ManuscriptFor ID peerbmjopen-2019-029570 review only Article Type: Research Date Submitted by the 31-Jan-2019 Author: Complete List of Authors: Keetile, Mpho; University of Botswana, Population Studies Navaneetham, Kannan; University of Botswana, Population Studies Letamo, Gobopamang; University of Botswana, Population Studies Bainame, Kenabetsho; University of Botswana, Population Studies Rakgoasi, Serai; University of Botswana, Population Studies Gabaitiri, Lesego; University of Botswana, Statistics Masupe, Tiny; University of Botswana, School of Medicine Molebatsi, Robert; University of Botswana, Sociology Keywords: Overweight, Obesity, Socioeconomic, Behavioural, Botswana http://bmjopen.bmj.com/ on September 26, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 35 BMJ Open 1 2 3 BMJ Open: first published as 10.1136/bmjopen-2019-029570 on 8 December 2019. Downloaded from 4 5 6 Socioeconomic and behavioural determinants of overweight/obesity in 7 Botswana: A cross-sectional study 8 9 10 1 1, 1 11 Mpho Keetile , Kannan Navaneetham Gobopamang Letamo , Kenabetsho 12 Bainame1, Serai Daniel Rakgoasi1, Lesego Gabaitiri2, Tiny Masupe3, Robert 13 14 Molebatsi4. 15 16 Author Affiliations 17 18 1Department of PopulationFor peer Studies, Universityreview of Botswana, only Gaborone, Botswana 19 20 2Department of Statisics, University of Botswana,Gaborone, Botswana 21 22 3School of Medicine, University of Botswana, Gaborone, Botswana 23 4 24 Department of Sociology, University of Botswana, Gaborone 25 26 Corresponding author 27 28 29 Mpho Keetile, Department of Population Studies, Private Bag 00705,University of 30 Botswana, Gaborone, Botswana.email:[email protected]:+26771231375 31 32 33 34 35 36 37 Word count: 3507 http://bmjopen.bmj.com/ 38 39 40 41 42 43 44 45 on September 26, 2021 by guest. Protected copyright. 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 35 1 2 3 Abstract BMJ Open: first published as 10.1136/bmjopen-2019-029570 on 8 December 2019. Downloaded from 4 5 6 Objective 7 8 To undertake a comprehensive assessment of socioeconomic and behavioural 9 10 determinants of overweight/obesity in Botswana. 11 12 Design 13 14 15 The study adopted a cross-sectional design and was conducted in selected urban 16 17 and rural areas of Botswana. Rural areas constituted 15 urban villages and 15 rural 18 For peer review only 19 areas, while urban areas constituted 1 city and 2 towns.Body Mass Index (BMI) was 20 21 categorized into; underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI <25 22 23 24 kg/m2), overweight (25≤BMI<30 kg/m2) and obese (BMI ≥30 kg/m2). We used binary 25 26 logistic regression analysis to estimate determinants of overweight/obesity because 27 28 overweight and obese were coded as: being overweight and obese (BMI≥25) =1; 29 30 31 not overweight and obese =0 (BMI<25).Analysis of questionaire responses used 32 33 logistic regression models. 34 35 Setting 36 37 http://bmjopen.bmj.com/ 38 Botswana 39 40 Participants 41 42 1178 males and females aged 15 years and above from the survey on ‘Chronic Non 43 44 communicable Diseases in Botswana: Chronic disease prevalence, Health Care 45 on September 26, 2021 by guest. Protected copyright. 46 47 Utilization, Health Expenditure and the Life course’, conducted in March 2016. 48 49 Outcome Measures 50 51 Adjusted ORs for socioeconomic and behavioural determinants of 52 53 54 overweight/obesity. 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 35 BMJ Open 1 2 3 Results BMJ Open: first published as 10.1136/bmjopen-2019-029570 on 8 December 2019. Downloaded from 4 5 6 Prevalence of overweight/obesity in the study population was estimated at 41%. The 7 8 adjusted odds of overweight/obesity were highest among women (AOR=2.74, 95% 9 10 11 C.I. =1.92-3.90), in ages 55-64 years (AOR=5.53, 95% C.I. = 2.62-11.6), individuals 12 13 with secondary (AOR=1.70, 95% C.I. = 1.11-2.61) and tertiary or higher education 14 15 (AOR=1.99, 95% C.I. =1.16-3.38), smokers (AOR=2.16, 95% C.I. = 1.22-3.83) and 16 17 poor physically active people (AOR=1.46, 95% C.I. =1.03-3.24). 18 For peer review only 19 20 Conclusion 21 22 23 Being female,elderly, of high education levels, a smoker and having poor physical 24 25 activity were identified as key factors for prevalence of overweight/obesity.These 26 27 28 findings suggest the need for broad based strategies encouraging physical activity 29 30 among different socioeconomic groups. 31 32 33 34 35 36 37 http://bmjopen.bmj.com/ 38 39 40 41 42 43 44 45 on September 26, 2021 by guest. Protected copyright. 46 47 48 49 50 51 52 53 54 55 Key words 56 57 Overweight, Obesity, socioeconomic, behavioral, Botswana 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 35 1 2 3 Strengths and Limitations of the study BMJ Open: first published as 10.1136/bmjopen-2019-029570 on 8 December 2019. Downloaded from 4 5 6 o To our knowledge this is the first cross-sectional study in Botswana to 7 8 comprehensively assess both the socioeconomic and behavioral 9 10 11 determinants of overweight/obesity among adults. 12 13 o Data were collected from a large and randomly selected representative 14 15 16 population. The data contained information on potential confounding factors, 17 18 with a low proportionFor peer of missing review information. only 19 20 o A limitation for this study was that since a cross sectional design was 21 22 23 employed, data on each participant was recorded only once making it difficult 24 25 to infer the temporal association between an explanatory and an outcome 26 27 variable. 28 29 Only an association, and not causation, can be inferred from this study. 30 o 31 32 33 34 35 36 37 http://bmjopen.bmj.com/ 38 39 40 41 42 43 44 45 on September 26, 2021 by guest. Protected copyright. 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 35 BMJ Open 1 2 3 Introduction BMJ Open: first published as 10.1136/bmjopen-2019-029570 on 8 December 2019. Downloaded from 4 5 6 7 The disease profile in Botswana is changing at an alarming rate, with most deaths 8 9 and disability in the foreseeable future likely to be accounted for by the ominous 10 11 epidemics of non-communicable diseases (NCDs) such as heart disease, stroke, 12 13 cancer and other chronic diseases. Children, adults and the elderly are all vulnerable 14 15 16 to the risk factors that contribute to NCDs especially overweight/obesity, due to 17 18 unhealthy diets, lowFor physical peer activity, review exposure to tobacco only smoke and/or the effects 19 20 of the harmful use of alcohol1-3. The key drivers of NCDs are ageing, rapid 21 22 23 unplanned urbanisation, and the globalisation of unhealthy lifestyles. For example, 24 25 globalization of unhealthy lifestyles like unhealthy diets may show up in individuals 26 27 as raised blood pressure, increased blood glucose, elevated blood lipids, and 28 29 1 30 overweight/ obesity . 31 32 Several studies have recently shown that many low income and middle-income 33 34 35 countries (LMICs) are experiencing an increase in the prevalence of 36 4-6 37 overweight/obesity . This prevalence is predicted to continue to increase in the http://bmjopen.bmj.com/ 38 39 future. Much of the increase in prevalence levels for overweight/obesity is expected 40 41 42 in countries such as India, some parts of South-East Asia, China, most of South 43 44 America and some parts of Sub Saharan Africa7-8.Until recently, SSA was minimally 45 on September 26, 2021 by guest. Protected copyright.
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