title: Urban-rural and geographic differences in overweight and obesity in four sub-Saharan African adult populations: a multi-country cross-sectional study.
abstract: Overweight and obesity are on the rise in developing countries including sub-Saharan Africa. We undertook a four-country survey to show the collective burden of these health conditions as they occur currently in sub-Saharan Africa and to determine the differences between urban and rural populations and other socio-economic factors.
  
  
  
  Participants were nurses in two hospitals in Nigeria (200), school teachers in South Africa (489) and Tanzania (229), and village residents in one peri-urban (297) and one rural location in Uganda (200) who completed a standardised questionnaire. Their height and weight were measured and body mass index calculated. Factor analysis procedure (Principal component) was used to generate a wealth index. Univariate and multivariate analyses with binary logistic regression models were conducted to examine the associations between potential correlates and the prevalence of overweight and obesity with 95 % confidence intervals.
  
  
  
  The prevalence of overweight and obese (combined) was 46 %, 48 %, 68 %, 75 % and 85 % in rural Uganda, peri-urban Uganda, Nigeria, Tanzania and South Africa (SA), respectively. Rural Uganda, Peri- urban Uganda, Nigeria, Tanzania and SA had obesity prevalence of 10 %, 14 %, 31 %, 40 % and 54 %, respectively (p < 0.001). Overall, prevalence of overweight was 374 (31 %) and obesity, 414 (34 %). Female sex was a predictor of overweight and obesity (combined) in peri-urban Uganda [AOR = 8.01; 95 % CI: 4.02, 15.96) and obesity in rural Uganda [AOR = 11.22; 95%CI: 2.27, 55.40), peri-urban Uganda [AOR = 27.80; 95 % CI: 7.13, 108.41) and SA [AOR = 2.17; 95 % CI: 1.19, 4.00). Increasing age was a predictor of BMI > =25 kg/m2in Nigeria [Age > =45 - AOR = 9.11; 95 % CI: 1.72, 48.16] and SA [AOR = 6.22; 95 % CI: 2.75, 14.07], while marital status was predictor of BMI > =25 kg/m2only in peri-urban Uganda. [Married - AOR = 4.49; 95 % CI: 1.74, 11.57]. Those in Nigeria [AOR = 2.56; 95 % CI: 1.45, 4.53], SA [AOR = 4.97; 95 % CI: 3.18, 7.78], and Tanzania [AOR = 2.68; 95 % CI: 1.60, 4.49] were more likely to have BMI > =25 kg/m2compared with the rural and peri-urban sites.
  
  
  
  The high prevalence of overweight and obesity in these sub-Saharan African countries and the differentials in prevalence and risk factors further highlights the need for urgent focused intervention to stem this trend, especially among women, professionals and urban dwellers.
authors: Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria. ikeajayi2003@yahoo.com.
authors: IkeOluwapo O
authors: IO
authors: Ajayi
authors: Institute of Human Virology, Abuja, Nigeria.|School of Medicine Greenbaum Cancer Center and Institute of Human Virology, University of Maryland, Baltimore, MD, USA.
authors: Clement
authors: C
authors: Adebamowo
authors: Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.|Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors: Hans-Olov
authors: HO
authors: Adami
authors: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors: Shona
authors: S
authors: Dalal
authors: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors: Megan B
authors: MB
authors: Diamond
authors: Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
authors: Francis
authors: F
authors: Bajunirwe
authors: Department of Epidemiology & Biostatistics, Makerere School of Public Health, Kampala, Uganda.
authors: David
authors: D
authors: Guwatudde
authors: Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors: Marina
authors: M
authors: Njelekela
authors: Department of Epidemiology & Biostatistics, Makerere School of Public Health, Kampala, Uganda.
authors: Joan
authors: J
authors: Nankya-Mutyoba
authors: Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors: Faraja S
authors: FS
authors: Chiwanga
authors: The South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa.|Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors: Jimmy
authors: J
authors: Volmink
authors: Department of Epidemiology & Biostatistics, Makerere School of Public Health, Kampala, Uganda.
authors: Robert
authors: R
authors: Kalyesubula
authors: Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors: Carien
authors: C
authors: Laurence
authors: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors: Todd G
authors: TG
authors: Reid
authors: Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors: Douglas
authors: D
authors: Dockery
authors: Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors: David
authors: D
authors: Hemenway
authors: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors: Donna
authors: D
authors: Spiegelman
authors: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.|Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors: Michelle D
authors: MD
authors: Holmes
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology; D015995:Prevalence; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D013019:South Africa; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: Nigeria; Prevalence of obesity and overweight; South Africa; Sub-Saharan Africa; Tanzania; Uganda; risk factors for over-nutrition