Undernutrition, polygynous context and family structure: a multilevel analysis of cross-sectional surveys of 350 000 mother–child pairs from 32 countries
Background Contextual factors, especially where people live, has been linked to various health outcomes, therefore, there is an increasing focus on its implication for policies and implementation of health interventions. Polygyny is a widespread practice in sub-Saharan Africa that also reflects soci...
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BMJ Publishing Group
2020-10-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/10/e002637.full |
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| author | Olalekan A Uthman Sanni Yaya Ghose Bishwajit Vijay Kumar Chattu Bright Opoku Ahinkorah Edward Kwabena Ameyaw Abdul-Aziz Seidu Eugene Kofuor Maafo Darteh Seun Stephen Anjorin |
| author_facet | Olalekan A Uthman Sanni Yaya Ghose Bishwajit Vijay Kumar Chattu Bright Opoku Ahinkorah Edward Kwabena Ameyaw Abdul-Aziz Seidu Eugene Kofuor Maafo Darteh Seun Stephen Anjorin |
| author_sort | Olalekan A Uthman |
| collection | DOAJ |
| description | Background Contextual factors, especially where people live, has been linked to various health outcomes, therefore, there is an increasing focus on its implication for policies and implementation of health interventions. Polygyny is a widespread practice in sub-Saharan Africa that also reflects socioeconomic and sociocultural features. This study investigated the association between polygynous context and risk of undernutrition.Methods Recent Demographic and Health Surveys involving 350 000 mother–child pairs from 32 sub-Saharan African countries conducted between 2010 and 2018 as of March 2020, were analysed using relevant descriptive and 3-level multilevel logistic regression modelling. Undernutrition among under-5 was defined as underweight, stunting and wasting using the WHO Multicentre Growth Reference Study. Odd Ratio (OR) at 95% credible interval was used to report the associations.Results The prevalence of contextual polygyny varied widely across the 32 sub-Saharan African countries, the lowest (0%) found in one of the regions in South Africa and the highest (52%) in one of the regions in Uganda. Underweight, stunting and wasting were lowest in Uganda (3.5%, 9.3%–1.27%, respectively), stunting was highest in Mozambique (37.1%) while wasting was highest in Niger (7.7%). Furthermore, the results showed that the contextual prevalence of polygynous practice exacerbates the risk of underweight (1.003 (0.997–1.008)) and wasting (1.014 (1.007–1.021)) among under-5 children, even when gender inequality and sociodemographic indicators were adjusted for. Polygyny was negatively associated with stunting though not significant; multiple births had the strongest and positive association with the risk of undernutrition among under-5 children in sub-Saharan Africa.Conclusions This study further corroborates the strong influence of contextual factors on health outcomes—which is undernutrition in this study. In addition to specific interventions aimed at reducing the prevalence of undernutrition, broader strategies that will address contextual issues are required. |
| format | Article |
| id | doaj-art-bde851f2f43648709bc1881820acca89 |
| institution | DOAJ |
| issn | 2059-7908 |
| language | English |
| publishDate | 2020-10-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-bde851f2f43648709bc1881820acca892025-08-20T02:50:08ZengBMJ Publishing GroupBMJ Global Health2059-79082020-10-0151010.1136/bmjgh-2020-002637Undernutrition, polygynous context and family structure: a multilevel analysis of cross-sectional surveys of 350 000 mother–child pairs from 32 countriesOlalekan A Uthman0Sanni Yaya1Ghose Bishwajit2Vijay Kumar Chattu3Bright Opoku Ahinkorah4Edward Kwabena Ameyaw5Abdul-Aziz Seidu6Eugene Kofuor Maafo Darteh7Seun Stephen Anjorin8Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South AfricaSchool of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, CanadaFaculty of health sciences, University of ottawa, Ottawa, Ontario, CanadaDepartment of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaREMS Consult Limited, Sekondi Takoradi, GhanaInstitute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, New Territories, Hong Kong SAR1 Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, GhanaDepartment of Population and Health, University of Cape Coast, Cape Coast, GhanaWarwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick, Coventry, West Midlands, UKBackground Contextual factors, especially where people live, has been linked to various health outcomes, therefore, there is an increasing focus on its implication for policies and implementation of health interventions. Polygyny is a widespread practice in sub-Saharan Africa that also reflects socioeconomic and sociocultural features. This study investigated the association between polygynous context and risk of undernutrition.Methods Recent Demographic and Health Surveys involving 350 000 mother–child pairs from 32 sub-Saharan African countries conducted between 2010 and 2018 as of March 2020, were analysed using relevant descriptive and 3-level multilevel logistic regression modelling. Undernutrition among under-5 was defined as underweight, stunting and wasting using the WHO Multicentre Growth Reference Study. Odd Ratio (OR) at 95% credible interval was used to report the associations.Results The prevalence of contextual polygyny varied widely across the 32 sub-Saharan African countries, the lowest (0%) found in one of the regions in South Africa and the highest (52%) in one of the regions in Uganda. Underweight, stunting and wasting were lowest in Uganda (3.5%, 9.3%–1.27%, respectively), stunting was highest in Mozambique (37.1%) while wasting was highest in Niger (7.7%). Furthermore, the results showed that the contextual prevalence of polygynous practice exacerbates the risk of underweight (1.003 (0.997–1.008)) and wasting (1.014 (1.007–1.021)) among under-5 children, even when gender inequality and sociodemographic indicators were adjusted for. Polygyny was negatively associated with stunting though not significant; multiple births had the strongest and positive association with the risk of undernutrition among under-5 children in sub-Saharan Africa.Conclusions This study further corroborates the strong influence of contextual factors on health outcomes—which is undernutrition in this study. In addition to specific interventions aimed at reducing the prevalence of undernutrition, broader strategies that will address contextual issues are required.https://gh.bmj.com/content/5/10/e002637.full |
| spellingShingle | Olalekan A Uthman Sanni Yaya Ghose Bishwajit Vijay Kumar Chattu Bright Opoku Ahinkorah Edward Kwabena Ameyaw Abdul-Aziz Seidu Eugene Kofuor Maafo Darteh Seun Stephen Anjorin Undernutrition, polygynous context and family structure: a multilevel analysis of cross-sectional surveys of 350 000 mother–child pairs from 32 countries BMJ Global Health |
| title | Undernutrition, polygynous context and family structure: a multilevel analysis of cross-sectional surveys of 350 000 mother–child pairs from 32 countries |
| title_full | Undernutrition, polygynous context and family structure: a multilevel analysis of cross-sectional surveys of 350 000 mother–child pairs from 32 countries |
| title_fullStr | Undernutrition, polygynous context and family structure: a multilevel analysis of cross-sectional surveys of 350 000 mother–child pairs from 32 countries |
| title_full_unstemmed | Undernutrition, polygynous context and family structure: a multilevel analysis of cross-sectional surveys of 350 000 mother–child pairs from 32 countries |
| title_short | Undernutrition, polygynous context and family structure: a multilevel analysis of cross-sectional surveys of 350 000 mother–child pairs from 32 countries |
| title_sort | undernutrition polygynous context and family structure a multilevel analysis of cross sectional surveys of 350 000 mother child pairs from 32 countries |
| url | https://gh.bmj.com/content/5/10/e002637.full |
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