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Usui R, Aomori M, Kanamori S, Sehi BTJ, Watabe S. Association of Obesity With Health Literacy and Weight Perception Among Women Merchants in Abidjan, Côte d'Ivoire: A Cross-Sectional Study. Health Lit Res Pract 2024; 8:e102-e112. [PMID: 38852072 DOI: 10.3928/24748307-20240521-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND In Abidjan, Côte d'Ivoire's largest city, obesity rates among women are increasing, posing a major health challenge, especially for the working generation. Merchants represent 64.3% of working women and are a typical occupation for women with low- and middle-income. Health literacy is used to prevent and overcome chronic diseases and can be used as anti-obesity measures. OBJECTIVE The aim of this study was to examine the relationship between obesity, health literacy, and weight perception among women merchants in Abidjan. METHODS In this cross-sectional study, we conducted a complete enumeration survey among women merchants in a market in Abidjan from December 2020 to December 2021. In addition to anthropometric measurements, structured face-to-face interviews were conducted. The participants were asked about their weight perception, weight management behaviors, and sociodemographic attributes. They also responded to the Health Literacy Questionnaire (HLQ). Data were tabulated using descriptive statistics, and multiple logistic regression analysis was performed to examine obesity's association with HLQ scales, weight perception, and weight management behaviors. KEY RESULTS Of the 873 participants, 259 (29.7%) were obese; 82% of them underestimated their weight. Obesity was associated with a higher rate of HLQ1 (Feeling understood and supported by health care providers) (odds ratio [OR] = 2.926, confidence interval [CI]:1.450-5.901, p = .03), a lower score of HLQ3 (Actively managing my health) (OR = 0.343, CI:0.165-0.716, p = 0.004), a lower rate of accurate weight perception (OR = 0.145, CI: 0.093-0.224, p < .001), and a lower rate of eating at least three meals per day (OR = 0.401, CI:0.260-0.617, p < .001). CONCLUSIONS Findings from this study of Abidjan women merchants include obese participants' lack of a proactive attitude toward personal health management, and the association of factors such as inaccurate weight perception and eating fewer than three meals per day with obesity. These finding have important implications for future anti-obesity measures. [HLRP: Health Literacy Research and Practice. 2024;8(2):e102-e112.].
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Manne-Goehler J, Rahim N, van Empel E, de Vlieg R, Chamberlin G, Ihama A, Castle A, Mabweazara S, Venter WDF, Chandiwana N, Levitt NS, Siedner M. Perceptions of Health, Body Size, and Nutritional Risk Factors for Obesity in People with HIV in South Africa. AIDS Behav 2024; 28:367-375. [PMID: 37632604 PMCID: PMC10841992 DOI: 10.1007/s10461-023-04152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
Metabolic disease is increasing in people with HIV (PWH) in South Africa, but little is known about self-perceptions of body size, health, and nutritional behavior in this population. We performed a cross-sectional analysis of individual-level data from the 2016 South Africa Demographic and Health Survey. This survey measured HIV serostatus and body mass index (BMI). We categorized participants into six BMI groups: 18.5-22 kg/m2, 22-25 kg/m2, 25-27.5 kg/m2, 27.5-30 kg/m2, 30-35 kg/m2, and ≥ 35 kg/m2 and stratified them by HIV serostatus. Our outcomes were self-reported (1) body size and (2) health status among all participants, and intake of (3) chips and (4) sugar-sweetened beverages (SSB) in PWH. We described these metrics and used multivariable regression to evaluate the relationship between the nutritional behaviors and BMI ≥ 25 kg/m2 in PWH only, adjusting for age, sex, educational attainment, and household wealth quintile. Of 6138 participants, 1163 (19.7%) were PWH. Among PWH, < 10% with a BMI 25-30 kg/m2, < 20% with a BMI 30-35 kg/m2 and < 50% with a BMI ≥ 35 kg/m2 self-reported as overweight or obese. PWH reported being in poor health at higher rates than those without HIV at each BMI category except ≥ 35 kg/m2. In adjusted models, SSB consumption was associated with BMI ≥ 25 kg/m2 (1.13 [1.01-1.25], t-statistic = 2.14, p = 0.033) in PWH. Perceptions of body size may challenge efforts to prevent weight gain in PWH in South Africa. SSB intake reduction should be further explored as a modifiable risk factor for obesity.
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Affiliation(s)
- Jennifer Manne-Goehler
- Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- MRC/Wits Rural Public Health and Heath Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Nicholas Rahim
- Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eva van Empel
- Foundation for General Practitioner Training, UMC Utrecht, Utrecht, The Netherlands
| | - Rebecca de Vlieg
- Foundation for General Practitioner Training, Maastricht University, Eindhoven, The Netherlands
| | - Grace Chamberlin
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | - Alison Castle
- Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Africa Health Research Institute, Kwazulu-Natal, South Africa
| | | | - Willem D F Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomathemba Chandiwana
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mark Siedner
- Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Africa Health Research Institute, Kwazulu-Natal, South Africa
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Quantifying impact of obesity on cardiometabolic comorbidities and public health implications: Insights from South Africa. Obes Res Clin Pract 2023; 17:122-129. [PMID: 36870866 DOI: 10.1016/j.orcp.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION South Africa has the highest obesity and hypertension rates in the African region. In this cross-sectional study, we aimed to quantify the correlates and burden of obesity and their impacts on cardiometabolic conditions. METHODS The study population was 80,270 men(41 %) and women(59 %) who participated in South African national surveys (2008-to-2017). Weighted-logistic regression models and the population attributable risk (PAR %) were used after accounting for the correlation structure of the risk factors in a multifactorial setting. RESULTS Overall, 63 % of the women and 28 % of the men were either overweight or obese. Parity was identified as the most influential factor and exclusively associated with 62 % of the obesity in women; being married/cohabiting had the highest impact on obesity in men and associated with 37 % of the obesity. Overall, 69 % of them had comorbidities including hypertension, diabetes and heart disease. More than 40 % of the comorbidities were attributed to overweight/obesity. CONCLUSION Developing culturally appropriate prevention programs are urgently needed to raise awareness of obesity, hypertension and their impacts on severe cardiometabolic diseases. This approach would also significantly reduce COVID-19 related poor health outcomes and premature deaths.
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Samadoulougou S, Diallo M, Cissé K, Ngwasiri C, Aminde LN, Kirakoya-Samadoulogou F. High Urban-Rural Inequities of Abdominal Obesity in Malawi: Insights from the 2009 and 2017 Malawi Noncommunicable Disease Risk Factors Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11863. [PMID: 36231161 PMCID: PMC9565120 DOI: 10.3390/ijerph191911863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Geographical disparities in abdominal obesity (AO) exist in low-income countries due to major demographic and structural changes in urban and rural areas. We aimed to investigate differences in the urban-rural prevalence of AO in the Malawi population between 2009 and 2017. We conducted a secondary analysis of data from the Malawi 2009 and 2017 STEPS surveys. AO (primary outcome) and very high waist circumference (secondary outcome) were defined using WHO criteria. Prevalence estimates of AO and very high waist circumference (WC) were standardized by age and sex using the age and sex structure of the adult population in Malawi provided by the 2018 census. A modified Poisson regression analysis adjusted for sociodemographic covariates was performed to compare the outcomes between the two groups (urban versus rural). In total, 4708 adults in 2009 and 3054 adults in 2017 aged 25-64 were included in the study. In 2009, the age-sex standardized prevalence of AO was higher in urban than rural areas (40.9% vs 22.0%; adjusted prevalence ratio [aPR], 1.51; 95% confidence interval [CI], 1.36-1.67; p < 0.001). There was no significant trend for closing this gap in 2017 (urban 37.0% and rural 21.4%; aPR, 1.48; 95% CI, 1.23-1.77; p < 0.001). This urban-rural gap remained and was slightly wider when considering the 'very high WC' threshold in 2009 (17.0% vs. 7.1%; aPR, 1.98; 95%CI, 1.58-2.47; p < 0.001); and in 2017 (21.4% vs. 8.3%; aPR, 2.03; 95%CI, 1.56-2.62; p < 0.001). Significant urban-rural differences exist in the prevalence of AO and very high WC in Malawi, and the gap has not improved over the last eight years. More effective weight management strategies should be promoted to reduce health care disparities in Malawi, particularly in urban areas.
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Affiliation(s)
- Sékou Samadoulougou
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute, Quebec, QC G1V 4G5, Canada
- Centre for Research on Planning and Development, Université Laval, Quebec, QC G1V 0A6, Canada
| | - Mariam Diallo
- Département de Biochimie et Microbiologie, UFR-SVT, Université Joseph Ki-Zerbo, Ouagadougou 03 BP 7021, Burkina Faso
| | - Kadari Cissé
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Calypse Ngwasiri
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
| | | | - Fati Kirakoya-Samadoulogou
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
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Pradeilles R, Holdsworth M, Olaitan O, Irache A, Osei-Kwasi HA, Ngandu CB, Cohen E. Body size preferences for women and adolescent girls living in Africa: a mixed-methods systematic review. Public Health Nutr 2022; 25:738-759. [PMID: 33593472 PMCID: PMC9991778 DOI: 10.1017/s1368980021000768] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To synthesise evidence on body size preferences for females living in Africa and the factors influencing these. DESIGN Mixed-methods systematic review including searches on Medline, CINHAL, ASSIA, Web of Science and PsycINFO (PROSPERO CRD42015020509). A sequential-explanatory approach was used to integrate quantitative and qualitative findings. SETTING Urban and rural Africa. PARTICIPANTS Studies of both sexes providing data on body size preferences for adolescent girls and women aged ≥10 years. RESULTS Seventy-three articles from twenty-one countries were included: fifty quantitative, fifteen qualitative and eight mixed methods. Most studies reported a preference for normal or overweight body sizes. Some studies of adolescent girls/young women indicated a preference for underweight. Factors influencing preferences for large(r) body sizes included: socio-demographic (e.g. education, rural residency), health-related (e.g. current BMI, pubertal status), psycho-social (e.g. avoiding HIV stigma) and socio-cultural factors (e.g. spouse's preference, social standing, cultural norms). Factors influencing preferences for slim(mer) body sizes included: socio-demographic (e.g. higher socioeconomic status, urban residency, younger age), health-related (e.g. health knowledge, being nulliparous), psycho-social (e.g. appearance, body size perception as overweight/obese) and socio-cultural factors (e.g. peer pressure, media). CONCLUSIONS Preference for overweight (not obese) body sizes among some African females means that interventions need to account for the array of factors that maintain these preferences. The widespread preference for normal weight is positive in public health terms, but the valorisation of underweight in adolescent girls/young women may lead to an increase in body dissatisfaction. Emphasis needs to be placed on education to prevent all forms of malnutrition.
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Affiliation(s)
- Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences (SSEHS), Loughborough University, LoughboroughLE11 3TU, UK
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | | | - Ana Irache
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Christian B Ngandu
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Emmanuel Cohen
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
- UMR CNRS-MNHN 7206 « Eco-anthropologie », Musée de l’Homme, Paris, France
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