Multilevel analysis of unhealthy bodyweight among women in Malawi: Does urbanisation matter?

Abstract

BackgroundUnderweight and overweight constitute unhealthy bodyweight and their coexistence is symptomatic of the dual burden of malnutrition (DBM) of high public health concern in many sub-Saharan Africa countries. Little is known about DBM and its correlates in Malawi, a country undergoing urbanisation. The study examined net effects of urban residence on unhealthy weights amidst individual- and community-level factors among women in Malawi.MethodsData on 7231 women aged 15-49 years nested within 850 communities extracted from 2015-16 Malawi Demographic and Health Survey were analysed. Women's weight status measured by body mass index, operationally categorised as underweight, normal and overweight, was the outcome variable while urban-rural residence was the main explanatory variable. Multilevel multinomial logistic regression analysis was employed at 5% significant level; the relative-risk ratio (RR) and its 95% confidence interval (CI) were presented.ResultsUrban residents had a significantly higher prevalence of overweight than rural (36.4% vs. 17.2%; pConclusionsThe study demonstrated association between urban residence and women overweight. Other important associated factors of overweight included breastfeeding, community education- and poverty-level, while education attainment, marital status and ethnicity were associated with the dual unhealthy weight. Thus, both individual- and community-level characteristics are important considerations for policy makers in designing interventions to address DBM in Malawi.