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Original research
Trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa since 2000: a cross-sectional series study
  1. Safia S Jiwani1,
  2. Giovanna Gatica-Domínguez2,
  3. Inacio Crochemore-Silva2,
  4. Abdoulaye Maïga1,
  5. Shelley Walton1,
  6. Elizabeth Hazel1,
  7. Barbara Baille3,
  8. Sujata Bose4,
  9. William K Bosu5,
  10. Kofi Busia6,
  11. Tome CA7,
  12. Ferima Coulibaly-Zerbo8,
  13. Cheikh Mbacké Faye9,
  14. Richard Kumapley10,
  15. Vrinda Mehra10,
  16. Serge M A Somda7,
  17. Roosmarijn Verstraeten11,
  18. Agbessi Amouzou1
  1. 1International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, RS, Brazil
  3. 3Regional Office, UNICEF, Dakar, Senegal
  4. 4Alive & Thrive/FHI Solutions, Washington, DC, USA
  5. 5Department of Public Health and Research, West Africa Health Organization, Bobo Dioulasso, Burkina Faso
  6. 6Department of Healthcare Services, West Africa Health Organization, Bobo Dioulasso, Burkina Faso
  7. 7Department of Planning and Health Information, West African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso
  8. 8Regional Office AFRO, World Health Organization, Brazzaville, Congo
  9. 9West Africa Regional Office, African Population and Health Research Center, Dakar, Senegal
  10. 10Data and Analytics Section, Division of Data, Analysis, Planning and Monitoring, UNICEF, New York, New York, USA
  11. 11Division of Poverty, Health and Nutrition, International Food Policy Research Institute, Dakar, Senegal
  1. Correspondence to Safia S Jiwani; sjiwani1{at}jhu.edu

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.

  • nutrition
  • public health
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjgh-2020-002948

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    Footnotes

    • Handling editor Seye Abimbola

    • Twitter @SafJiwani, @SergeSomda

    • Collaborators This analysis is based on two sub-regional analytical workshops conducted in June and October 2019 as part of the Countdown to 2030 regional initiative for Western Africa, led by the West African Health Organization and supported by the African Population Health Research Centre (APHRC). We are grateful to all workshop participants and institutions for their invaluable contributions.

    • Contributors SSJ and AA conceptualised the paper. SSJ, GG-D and IC-S conducted the analysis. SSJ wrote the initial draft. All authors contributed to earlier versions of the draft and approved the final manuscript.

    • Funding This work was part of a series of two analytical workshops led by the Countdown to 2030 in Western Africa, funded by the Bill & Melinda Gates Foundation and the Alive and Thrive Project of FHI360.

    • Disclaimer The funders had no role in the development of this manuscript.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval was not needed for this secondary analysis of publicly available data. The institutions that conducted the surveys were responsible for ethical clearance.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on request. Data analysed in this study were obtained from the International Center for Equity in Health (equidade.org) which systematically compiles and analyses national household survey data including the Demographic and Health Surveys (DHS), which are publicly available and accessible at www. dhsprogram.com.