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. 2020 Oct;5(10):e002948.
doi: 10.1136/bmjgh-2020-002948.

Trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa since 2000: a cross-sectional series study

Safia S Jiwani  1 , Giovanna Gatica-Domínguez  2 , Inacio Crochemore-Silva  2 , Abdoulaye Maïga  3 , Shelley Walton  3 , Elizabeth Hazel  3 , Barbara Baille  4 , Sujata Bose  5 , William K Bosu  6 , Kofi Busia  7 , Tome Ca  8 , Ferima Coulibaly-Zerbo  9 , Cheikh Mbacké Faye  10 , Richard Kumapley  11 , Vrinda Mehra  11 , Serge M A Somda  8 , Roosmarijn Verstraeten  12 , Agbessi Amouzou  3
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Free PMC article

Trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa since 2000: a cross-sectional series study

Safia S Jiwani et al. BMJ Glob Health. 2020 Oct.
Free PMC article

Abstract

Introduction: Evidence on the rate at which the double burden of malnutrition unfolds is limited. We quantified trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa.

Methods: We analysed 102 Demographic and Health Surveys between 1993 and 2017 from 35 countries. We assessed regional trends through cross-sectional series analyses and ran multilevel linear regression models to estimate the average annual rate of change (AARC) in the prevalence of underweight, anaemia, anaemia during pregnancy, overweight and obesity among women by their age, residence, wealth and education levels. We quantified current absolute inequalities in these indicators and wealth-inequality trends.

Results: There was a modest decline in underweight prevalence (AARC=-0.14 percentage points (pp), 95% CI -0.17 to -0.11). Anaemia declined fastest among adult women and the richest pregnant women with an AARC of -0.67 pp (95% CI -1.06 to -0.28) and -0.97 pp (95% CI -1.60 to -0.34), respectively, although it affects all women with no marked disparities. Overweight is increasing rapidly among adult women and women with no education. Capital city residents had a threefold more rapid rise in obesity (AARC=0.47 pp, 95% CI 0.39, 0.55), compared with their rural counterparts. Absolute inequalities suggest that Ethiopia and South Africa have the largest gap in underweight (15.4 pp) and obesity (28.5 pp) respectively, between adult and adolescent women. Regional wealth inequalities in obesity are widening by 0.34 pp annually.

Conclusion: Underweight persists, while overweight and obesity are rising among adult women, the rich and capital city residents. Adolescent girls do not present adverse nutritional outcomes except anaemia, remaining high among all women. Multifaceted responses with an equity lens are needed to ensure no woman is left behind.

Keywords: nutrition; public health.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Inequalities in prevalence (%) of underweight (A), anaemia (B), anaemia during pregnancy (C), overweight (D) and obesity (E) by women’s wealth, age, residence and education.
Figure 2
Figure 2
Trend in prevalence (%) of underweight (A), anaemia (B), anaemia during pregnancy (C), overweight (D) and obesity (E) by women’s wealth, age, residence and education.
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