Spatial distribution and associated factors of Co-occurrence of Overweight/Obesity and Anemia among reproductive women in SubSaharan Africa: a multilevel analysis, DHS 2016-2021

Abstract

Background: Overweight/ Obesity (OWOB) is one of the major public health problems that affects both developed and developing nations. The co-occurrence of overweight/ obesity and anemia is thought to be largely preventable if detected early. To date, no spatial analyses have been performed to identify areas of hotspots of co-occurrence of OWOB and anemia among reproductive women in Sub-Saharan Africa (SSA). Therefore, determining the geographic distributions of OWOB and anemia co-occurrence and its associated factors is important for prioritizing prevention and intervention programs in SSA. Objective: To assess the spatial distribution and associated factors of co-occurrence of overweight/ obesity and anemia among reproductive women in sub-Saharan Africa. Methods: Data for the study were drawn from a Demographic and Health Survey (DHS), a nationally representative cross-sectional survey conducted in the era of Sustainable Development Goals (SDGs). Seventeen SSA countries and a total weighted sample of 108,161 reproductive women (15–49 years) were included in our study. The data extraction, recoding and analysis were done using STATA V.17. For the spatial analysis (autocorrelation, hot-spot and interpolation) ArcGIS version 10.7 software, and for SaTScan analysis, SaTScan version 10.1 software was used. Descriptive statistics were presented using frequency tables and percentages. We employed multilevel logistic regression to investigate associated factors of cooccurrence of OWOB and anemia. In the multivariable analysis variables with a p-value of ≤0.05 are considered as a significant factor associated with co-occurrence of OWOB and anemia among reproductive women 15–49 years. Results: The overall co-occurrence of OWOB and anemia among reproductive women in SSA was 12 % (95%CI: 9 -14%). The spatial analysis revealed that the co-occurrence of OWOB and anemia among women significantly varied across SSA. (Global Moran’s I=0.583163, p<0.001). The primary-cluster spatial window was located in Liberia, Guinea, Gambia, Sira Leon, Mauritania, Mali, Cameron and Nigeria with a Log-Likelihood Ratio (LRR) of 1687.30, Relative Risk (RR) of 2.58 at a p-value < 0.001. In multilevel analysis, women aged 25-34 years (AOR = 1.91, 95%CI: 1.78, 2.04), women aged 35-49 years (AOR=2.96, 95% CI: 2.76, 3.17), married (AOR=1.36, 95% CI: 1.27, 1.46), widowed (AOR=1.22, 95%CI: 1.06, 1.40), divorced (AOR=1.36, 95% CI: 1.23, 1.50), media exposure (AOR=1.31, 95%CI: 1.23, 1.39), middle income (AOR=1.19, 95%CI: 1.11, 1.28), high income/rich (AOR=1.36, 95%CI: 1.26, 1.46), not working (AOR=1.13, 95% CI:1.07, 1.19), traditional contraceptive utilization (AOR=1.39, 95%CI: 1.23, 1.58) and no contraceptive use (AOR=1.27, 95%CI: 1.20, 1.56), and no health insurance coverage (AOR=1.36, 95%CI: 1.25, 1.49). From community-level variables urban residence (AOR=1.61, 95%CI: 1.50, 1.73), lower middle-income country (AOR=2.50, 95%CI: 2.34, 2.66) and upper middle-income country (AOR=2.87, 95%CI: 2.47, 3.34), were significantly associated with a higher odds of co-occurrence of OWOB and anemia. Conclusion and recommendations: The spatial distribution of co-occurrence of OWOB and anemia was significantly varied across the SSA country. Both individual and community-level factors were significantly associated with the co-occurrence of OWOB and anemia. Therefore, public health programmers and other stalk holders who are involved in maternal healthcare should work together and give priority to hotspot areas of co-occurrence in SSA