Temporal trends in the nutritional status of women and children under five years of age in sub-Saharan African countries: ecological study

Sao Paulo Med J. 2018 Sep-Oct;136(5):454-463. doi: 10.1590/1516-3180.2017.0267261117.


Background: While the global prevalence of obesity is rapidly increasing, this pandemic has received less attention in sub-Saharan Africa, particularly in the light of the persistent undernutrition that exists in the context of maternal and child health. We aimed to describe obesity trends among women of childbearing age over recent decades, along with trends in over and undernutrition among children under five years of age, in sub-Saharan African countries.

Design and setting: Ecological study with temporal trend analysis in 13 sub-Saharan African countries.

Methods: This was a description of temporal trends in nutritional status: adult obesity, childhood overweight, low height-for-age (stunting), low weight-for-height (wasting), low weight-for-age (underweight) and low birth weight. Publicly available data from repeated cross-sectional national surveys (demographic and health surveys and multiple-indicator cluster surveys) were used. We chose 13 sub-Saharan African countries from which at least four surveys conducted since 1993 were available. We investigated women aged 15-49 years and children under five years of age.

Results: In multilevel linear models, the prevalence of obesity increased by an estimated 6 percentage points over 20 years among women of childbearing age, while the prevalence of overweight among children under 5 years old was stable. A major decrease in stunting and, to a lesser extent, wasting accompanied these findings.

Conclusions: The upward trend in obesity among women of childbearing age in the context of highly prevalent childhood undernutrition suggests that the focus of maternal and child health in sub-Saharan Africa needs to be expanded to consider not only nutritional deficiencies but also nutritional excess.

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara / epidemiology
  • Birth Weight
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Growth Disorders / epidemiology
  • Humans
  • Infant
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Male
  • Malnutrition / epidemiology*
  • Middle Aged
  • Nutritional Status*
  • Obesity / epidemiology*
  • Overweight / epidemiology
  • Prevalence
  • Socioeconomic Factors
  • Spatio-Temporal Analysis
  • Thinness / epidemiology*
  • Time Factors
  • Young Adult