Risk Factors of Obesity Among Women of Reproductive Age in Vihiga County, Kenya

Abstract

As the prevalence of obesity is increasing globally, the burden of malnutrition is shifting in the developing countries. In low and middle income countries, women are the most widely affected population by the obesity burden. A similar trend is witnessed in Kenya, as 43.4% of women are overweight or obese. Obesity among women, particularly of reproductive age, has been associated with significant morbidity and mortality that may be passed on to their offspring. Since the commencement of the Kenya Demographic Health Surveys, limited studies have been done, despite the increasing reported prevalence of obesity among women of reproductive age, to determine the associated risk factors of obesity among this target group in the rural population, including Vihiga County. This study aimed to determine the risk factors of obesity among women of reproductive age in Vihiga County. A cross-sectional survey used a semi structured questionnaire to collect data on the sociodemographic profile, nutrition status, factors influencing obesity including knowledge, attitude and practices, nutritional practices, food security and lifestyle habits. Multi-stage sampling was used to select two sub-counties and four wards from the sub-counties. Segmentation method and simple random sampling were used to identify women to include in the study. A total of 106 women of reproductive age were included. Data was analyzed using descriptive and inferential statistics. The prevalence of obesity among women of reproductive age in the County was 13.2% by body mass index while the average waist circumference was 80.76cm. Theprevalence of obesity had almost doubled, from 7% to 13.2%, since 2014, while the average waist circumference, 80.76 cm, was higher than the national average of 79.1 cm. The number of women at increased risk of metabolic diseases regarding waist-hip ratio was, 25%; this figure is less than the recorded 2015 national statistics of 36%. Age, marital status and education level were identified as non-modifiable risk factors among this target group. Age significantly predicted BMI (OR=1.44; 95% CI, 1.24-1.68), waist circumference (WC) (OR=3.02; 95% CI, 2.11-4.34), and waist-hip ratio (OR=1.004; 95% CI, 1.001-1.007),p<0.001; older women were at a higher risk of high BMI, WC and WHR. Marital status significantly predicted BMI (OR=0.00; 95% CI, 0.00-0.16), WC(OR=5.40; 95% CI, 1.06-8.57) and WHR (OR=1.33; 95% CI, 1.07-1.65), p<0.05. Single women were 5.40 times more likely to have central obesity than the married women while separated women were 1.33 more times likely to have a higher waist hip ratio. Education level significantly predicted WC,(OR=0.003; 95% CI, 0.001-0.7), p<0.05. Women with primary education were less likely to xiii have central obesity compared to women with no formal education. The number of children born to a woman, time of consumption of the last meal of the day and the frequency of consumption of flesh meats were modifiable risk factors to the BMI of the women. Increase in the number of children increased the likelihood of a high BMI by 2.13 times (95% CI, 1.16-3.93), p<0.05, while late eating and frequently consuming flesh meats increased the women‟s risk to obesity regarding BMI by 3.50 (95% CI, 1.19-10.32) and 3.32 (95% CI,1.04-10.58) times, respectively, p<0.05. Modifiable risk factors to central obesity included, the number of children born to a woman (OR=7.51; 95% CI, 1.69-33.88), frequently consuming flesh meat (OR=20.45, 95% CI, 1.20-348.62) and frequently consuming white tubers or roots (OR=0.05, 95% CI, 0.01-0.72) and frequently consuming organ meats (OR=0.01, 95% CI, 0.009-0.12), p<0.05. The latter two were protective against central obesity. Contrastingly, frequently consuming sugar increased the risk of metabolic disorders regarding waist hip ratio by 1.015 times (95% CI, 1.000-1.028), p<0.05.According to this study, the obesity prevalence in Vihiga County among women of reproductive age has increased and was attributed to risk factors such as age, marital status, education level, the number of children, time of consumption of the last meal of the day and frequently consuming white tubers or roots, flesh meats, sugar, and organ meats. Since majority of the modifiable risk factors were dietary, it is imperative for the county government to implement setting specific interventions including nutrition education targeting dietary and lifestyle habits. Also, raising awareness on the influence of age, marital status and parity on obesity will be necessary, the county government can include, in addition to educating the women on proper nutrition during pregnancy, physical activity interventions to help manage the extra weight gained during pregnancy among the women. Lastly, increase accessibility and awareness on the importance of basic education