Nutrition transition and double burden of malnutrition in Africa: A case study of four selected countries with different social economic development

Abstract

Background: Disease and lifestyle patterns have been changing rapidly especially in Africa due to transformation in economic development and urbanization. Research on the magnitude and consequences of these transformations in Africa is limited. This study investigates the shifts in nutritional status in children and adults in four selected low-, middle- and high-income countries in Africa, identifies factors associated with the shifts, and provides recommendations for future studies.

Methods: Malawi, Kenya, Ghana, and South Africa were selected based on their Gross Domestic Product (GDP). Nationally representative data were obtained from the 2017 Global Nutrition Report, Demographic Health Surveys (DHSs), and the World Health Organization (WHO) database. Prevalence of underweight, overweight, and obesity were assessed and compared across the countries, gender, residence, and over time. Results: South Africa had the highest GDP and largest prevalence of overweight and obesity rates in children < 5 years old and adults > 18 (13.3% and 51.9%, respectively). Malawi, with the lowest GDP, had the highest stunting rate (37.0%). In all 4 countries, but most notably in South Africa, trends indicated that the increasing prevalence of overweight and obesity was much greater than the declining rate of underweight. Malawi, Kenya, and Ghana had a slight decline in overweight prevalence in children under 5 years.

Conclusions: Nutritional shifts are occurring in Africa and seem to be heavily influenced by economic development. The double-burden of malnutrition presents prioritization challenges for policymakers. Attention needs to be shifted towards prevention of obesity, at least in the higher income countries in Africa.

Keywords: Africa; malnutrition; obesity; overweight; social economic status.

Figure 1.. Differences in prevalence (%) of underweight (BMI < 18.5), overweight and obesity (BMI ≥ 25), and obesity (BMI ≥ 30) among adults in 4 selected African countries, by per capita GDP level. Data on the prevalence of underweight, overweight & obesity and Gross Domestic Product per capita were collected from the Global Nutrition Report 2017, and prevalence of obesity were derived from WHO data (2016).

Figure 2.. Time trends (1998–2016) in the prevalence (%) of stunting, wasting, underweight, and overweight/obesity among children under 5 years old from 4 selected African countries. Data on prevalence of stunting, wasting, and underweight for Malawi, Kenya, Ghana, South Africa were derived from the Demographic Health Surveys (1998–2016); Data for overweight/obesity in all countries was from WHO database (1998–2016). DHS for Malawi was available from 2000–2016 and for South Africa was available from 1999–2016.

Figure 3.. Time trend (1998–2016) in the prevalence (%) of underweight (BMI < 18.5), overweight & obesity (BMI ≥ 25) and obesity (BMI ≥ 30) among adults in 4 selected African countries. The data were derived from the WHO and Global Health Repository dataset (1998–2016).