The double burden household in sub-Saharan Africa: maternal overweight and obesity and childhood undernutrition from the year 2000: results from World Health Organization Data (WHO) and Demographic Health Surveys (DHS)

Abstract

Background: Previous studies have characterized an increasing trend of double burden households, or households with individuals experiencing both undernutrition and obesity, in countries undergoing a nutrition transition. Although most prior studies indicate the prevalence of double burden households is highest in middle-income countries, there is some support for an increase in double burden households in sub-Saharan African countries as well.

Method: Using data from the Demographic Health Surveys (DHS) and the World Health Organization (WHO), the prevalence of double burden households in sub-Saharan African countries was calculated and the associations between prevalence of overweight/obese adults and underweight, stunted and wasted children were evaluated at the country and household (DHS only) levels. Restricted analyses and frequencies were calculated using urban-only datasets. Surveys from 28 African countries were available using WHO data and 26 from the DHS surveys. Only surveys that were conducted after 2000 were included in analyses.

Results: Using the WHO datasets, there were inverse associations between the prevalence of overweight and obesity in adults and underweight, stunting and wasting in children. Correspondingly, there were positive associations between adult underweight and child underweight, stunting and wasting. These associations were not significant in a smaller sample size using urban-only surveys. The prevalence of double burden households in DHS datasets was low: under 5 percent for obese mothers and underweight, stunted or wasted child pairs with a slightly higher percentage for overweight mothers and children with undernutrition. Restricting the analysis to urban only populations did not increase the frequencies of double burden households significantly.

Conclusion: There was a low prevalence of double burden households in recent data from sub-Saharan Africa. Countries that have a high prevalence of child undernutrition correspondingly have a high prevalence of adult underweight and low prevalence of adult overweight and obesity.

Figure 1

Child stunting prevalence in relation to adult obesity (by country). WHO data defining adult obesity as BMI≥30.

Figure 2

Child underweight prevalence in relation to adult underweight. WHO data defining adult underweight as BMI <18.5.

Figure 3

Child stunting prevalence in relation to adult underweight (by country). WHO data defining adult underweight as a BMI <18.5.

Figure 4

DHS maternal overweight and obesity by country. DHS data defining maternal overweight and obesity as BMI ≥25.

Figure 5

Maternal obesity and child stunting by country. DHS data defining childhood stunting as height-for-age Z score <-2. Maternal obesity defined as BMI ≥30.

Figure 6

Maternal obesity and child underweight by country. DHS data defining childhood underweight as weight-for-age Z score <-2. Maternal obesity defined as BMI ≥30.

Figure 7

Maternal overweight and obesity in relation to child stunting by country. DHS data defining childhood stunting as height-for-age Z score <-2. Maternal overweight and obesity defined as BMI ≥25.