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Multilevel analysis of unhealthy bodyweight among women in Malawi: Does urbanisation matter?
Authors: Rotimi Felix Afolabi and Martin Enock Palamuleni
Source: PLOS ONE , Vol. 16, No. 3; DOI:
Topic(s): Body Mass Index (BMI)
Rural-urban differentials
Women's health
Country: Africa
Published: JAN 2021
Abstract: Background Underweight 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. Methods Data 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. Results Urban residents had a significantly higher prevalence of overweight than rural (36.4% vs. 17.2%; p Conclusions The 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.