Gender differences in sociodemographic and behavioural factors associated with BMI in an adult population in rural Burkina Faso – an AWI-Gen sub-study

ABSTRACT

Background: The global health transition is linked with an increased burden of non-communicable diseases with cardiovascular diseases leading the epidemic. In sub-Saharan Africa (SSA), the prevalence of obesity has increased during the past decades and there is a need to investigate the associated driving factors. In Burkina Faso obesity remains low, especially in rural areas. In this study we recruited middle-aged adults, as part of a larger study on genetic and environmental contributions to cardiometabolic disease among Africans.

Objectives: To investigate the distribution of BMI and prevalence of obesity in a cross-sectional population-based study and to determine the sociodemographic and behavioural correlates with BMI.

Methods: Participants (N = 2,076) were recruited from the Nanoro Health and Demographic Surveillance System area and were aged 40–60 years. We applied hierarchical modelling to identify factors associated with BMI and structural equation modelling to identify mediated effects of sociodemographic and behavioural variables on BMI.

Results: Data are presented on 2,076 participants (49.9% female). Men had significantly higher BMI than women with medians of 21.1 (19.2 – 23.4) vs 19.8 (18.1 – 21.6) (p < 0.001), and there were significantly more underweight women compared to men (31.0% vs 17.4%) (p < 0.001). More men were overweight and obese than women (11.9% vs 5.2% and 2.2% vs 1.4%). Socioeconomic status was the major contributor to increased BMI for men, and education was the main contributor in women. Tobacco smoking and chewing, and problematic alcohol consumption were associated with a decrease in BMI in men and women.

Conclusion: Overweight and obesity are relatively low among adults in rural Burkina Faso, and men had a higher median BMI than women. Behavioural factors, including tobacco use and alcohol consumption, contributed to a decrease in BMI, whereas socioeconomic status and education (which were both generally low in this community) contributed to an increase in BMI.

SPECIAL ISSUE:

• BMI distribution across African communities

KEYWORDS:

• BMI
• underweight
• problematic alcohol consumption
• chewing tobacco
• hierarchical model
• structural equation model

Responsible Editor Peter Byass, Umeå University, Sweden

Responsible Editor Peter Byass, Umeå University, Sweden

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 sterling contributions of our fieldworkers, 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 AWI-Gen study include the following: Michèle Ramsay (PI, Wits), Osman Sankoh (co-PI, INDEPTH), Stephen Tollman and Kathleen Kahn (Agincourt PI), Marianne Alberts (Dikgale PI), Catherine Kyobutungi (Nairobi PI), Halidou Tinto (Nanoro PI), Abraham Oduro (Navrongo PI), Shane Norris (Soweto PI), and Scott Hazelhurst, Nigel Crowther, Himla Soodyall and Zane Lombard (Wits). We would like to acknowledge each of the following investigators for their significant contributions to this research, mentioned according to affiliation: Wits AWIGen Collaborative Centre – Stuart Ali, Ananyo Choudhury, Scott Hazelhurst, Freedom Mukomana, Cassandra Soo; Soweto (DPHRU): Nomses Baloyi, Yusuf Guman.

This paper describes the views of the authors and does not necessarily represent the official views of the funder.

Disclosure statement

None of the authors have any competing interest.

Ethics and consent

This study received the approval of Human Research Ethics Committee (Medical), University of the Witwatersrand/South Africa (M121029), the approval of the Centre Muraz Institutional Ethics Committee/Burkina Faso (015-2014/CE-CM) and the approval of the National Ethics Committee For Health Research/Burkina Faso (2014-08-096). All the participants signed an Informed Consent Form before any study procedure was performed.

Paper context

Sub-Saharan Africa is displays regional and sex-specific disparities in obesity. This population-based cross-sectional study implemented in the Nanoro’s HDSS area showed that there is a high prevalence of underweight among middle-aged adults with women suffering the highest burden. We found that SES, education, tobacco (smoking and chewing) and alcohol consumption are correlated with BMI in the rural Burkina Faso.

Additional information

Funding

The AWI-Gen Collaborative Centre is funded by the NIH (Grant no. U54HG006938) as part of the H3Africa Consortium.

Notes on contributors

Alain S. Tougma

Study conception and design: RPB, HS, MR, HT Acquisition of data: RPB, HS, NDS, JDB, DV, ML, SZK, ML, AST, SO Analysis and interpretation of data: RPB, RT, HS, BB Drafting of manuscript: RPB, HS Critical revision: RBP, HS, RT, NJC, SN