Levels, Trends and Inequalities in Anemia and Obesity Among Adolescent Girls and Adult Women in Sub-Saharan Africa: Reaching the Unreached in a Double Burden Scenario

Objective:

There is limited evidence on the double burden of malnutrition among women in sub-Saharan Africa. We measure trends and inequalities in anemia and obesity to reach the most vulnerable and ensure no woman is left behind.

Methods:

We analyzed 101 DHS surveys between 1993 and 2017 from 35 sub-Saharan African countries. We ran multilevel linear regression models to estimate the average annual rate of change (AARC) in anemia and obesity by woman’s age and place of residence. We quantified the absolute gap in these indicators between subgroups, using the latest surveys.

Results:

50% of women are anemic, with a declining rate from 2000 to 2017: the AARC is -0.62 percentage points (pp) (95%CI -0.23, -1.01), with the slowest decline of -0.46pp among adolescent girls (95%CI -0.07, -0.85). In contrast, obesity is rising at an AARC of 0.28pp overall: 0.36pp among adult women (95%CI 0.30, 0.40), compared with 0.03pp among adolescent girls (95%CI -0.01, 0.07). We observed a three-fold more rapid rise in obesity among women living in the capital city with an AARC of 0.47pp (95%CI 0.39, 0.55), compared with those in rural areas (0.16pp 95%CI 0.12, 0.20). There are large absolute gaps in the obesity prevalence between adult women and adolescent girls ranging from 1.7pp in Ethiopia to 28.5pp in South Africa in 2016. Similar large gaps exist by place of residence.

Conclusions:

A double malnutrition burden is apparent with persisting anemia while obesity rises and gets unequally distributed among sub-Saharan African women. An equity-focused approach is needed to address marked disparities.