Socio-demographic and behavioural determinants of body mass index among an adult population in rural Northern Ghana: the AWI-Gen study

ABSTRACT

Background: Obesity and associated cardiometabolic diseases are increasing in urban sub-Saharan Africa due to a complex epidemiological and nutritional transition. Related data on rural communities is scarce.

Objectives: The study characterized the socio-demographic and behavioural factors influencing body mass index (BMI) among adults in rural Northern Ghana

Methods: A population-based cross-sectional study involving adults aged 40–60 years residing in the Kassena-Nankana districts was undertaken. Demographic, socio-economic and behavioural data were collected along with measures of anthropometry. We determined factors associated with BMI among women and men.

Results: A total of 2014 adults were studied. The median age was 51 (IQR 45–57) years and 54% were women. The prevalence of overweight/obesity was higher among women than men (18.4% vs. 7.2%; p < 0.001), whilst underweight was more prevalent in men (18.3% vs. 13.1%; p = 0.001). Participants with the highest level of education and a high household socio-economic status had higher BMIs than those in the lowest strata in both men (β = 0.074, p = 0.028 and β = 0.072, p < 0.001, respectively) and women (β = 0.174, p = 0.001 and β = 0.109, p < 0.001, respectively). Men (β = −0.050; p < 0.001) and women (β = −0.073; p < 0.001) of the Nankana ethnic group had a lower BMI than the Kassena ethnic group. Among men, alcohol consumption (β = −0.021; p = 0.001) and smoking (β = −0.216; p < 0.001) were associated with lower BMI. Smokeless tobacco was associated with lower BMI among women. Pesticide exposure was associated with higher BMI (β = 0.022; p = 0.022) among men.

Conclusion: Age, sex, ethno-linguistic group and prevailing socio-demographic and behavioural factors within this rural community in Northern Ghana influence BMI. The observed positive association between pesticide use and BMI warrants further investigation.

KEYWORDS:

• Cardiometabolic diseases
• socio-demographic and behavioural risk
• pesticides
• BMI
• rural Northern Ghana

Responsible Editor Nawi Ng, Umeå University, Sweden

Special Issue BMI distribution across African communities

Responsible Editor Nawi Ng, Umeå University, Sweden

Special Issue BMI distribution across African communities

Acknowledgments

This study would not have been possible without the generosity of the participants who spent many hours responding to questionnaires, being measured and having samples taken. We wish to acknowledge the contributions of our fieldworkers, research assistants, phlebotomists, laboratory scientists, administrators, data personnel and other investigators who contributed to the data and sample collections, processing, storage and shipping.

Investigators responsible for the conception and design of the original AWI-Gen study include the following: Michèle Ramsay (PI, Wits); Osman Sankoh (co-PI, INDEPTH); Alisha Wade, Stephen Tollman and Kathleen Kahn (Agincourt); Marianne Alberts (Dikgale); Catherine Kyobutungi (Nairobi); Halidou Tinto (Nanoro); Abraham Oduro (Navrongo); Shane Norris (Soweto); and Scott Hazelhurst, Nigel Crowther, Himla Soodyall and Zane Lombard (Wits).

We are grateful to the following people from Wits AWI-Gen Collaborative Centre: Stuart Ali, Scott Hazelhurst, Freedom Mukomana and Cassandra Soo who contributed to data management and quality control processes. We would like to also acknowledge in particular Nigel J. Crowther, Shane Norris, Stuart Ali and Michèle Ramsay for the initial reviewing of this paper. The AWI-Gen study team that performed the study in the Navrongo HDSS included: Godfred Agongo, Lucas Amega-Etego, Cornelius Debpuur, Engelbert Adamwaba Nonterah and Abraham Rexford Oduro.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Ethics approval was received from the University of the Witwatersrand Human Research Ethics Committee (approval number: M121029), the Ghana Health Service Ethics Review Committee (approval number: GHS-ERC: 05/05/14) and the Navrongo Health Research Institutional Review Board (Approval number: NHRCIRB178). Community engagement and sensitization with the selected communities on the study was carried out after ethics approval and before commencement of participant recruitment. Individual participants gave their informed consent by signing or thumb-printing on an informed consent form in the language they understood.

Paper context

Research into obesity within rural Ghana is scarce except for an ongoing verbal autopsy programme within the NHDSS which demonstrates rising levels of CVD-related deaths (unpublished). This study is the first to report on the socio-demographic and behavioural factors influencing BMI among adults in rural Northern Ghana. The data suggests that improvements in socio-demographic status within this population may be accompanied by rising levels of obesity and will require developing appropriate monitoring and intervention programmes.

Supplemental data for this article can be accessed here.

Additional information

Funding

The AWI-Gen Collaborative Centre is funded by the National Human Genome Research Institute (NHGRI), the National Institute of Environmental Health Sciences (NIEHS), the Office of AIDS research (OAR) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), of the National Institutes of Health (NIH) under award number U54HG006938, as part of the H3Africa Consortium, by the Department of Science and Technology, South Africa, award number DST/CON 0056/2014, and by the African Partnership for Chronic Disease Research (APCDR).

Notes on contributors

Engelbert Adamwaba Nonterah

EN, CD, GA, LA and AO conducted the study and collected data. EN, CD, GA, NC and MR conceived and planned the paper. EN, GA and NC analysed the data. EN, CD and GA wrote the first draft. CD, LA, NC, MR and AO critically reviewed the paper. EN, CD, GA, LA, NC, MR and AO all read through and approved the final draft for submission.