Double burden of malnutrition among women in South Africa: evidence from the demographic health survey

Chiwawa, Tinotenda Gerald Geoffrey

Double burden of malnutrition among women in South Africa: evidence from the demographic health survey

Thesis / Dissertation

2025

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Background: The global shifts in nutrition patterns have been associated with an increasing number of individuals experiencing multiple forms of malnutrition, collectively termed the double burden of malnutrition (DBM). It is defined as the coexistence of undernutrition and overnutrition within the same population, community, or individual. The phenomenon can manifest at individual, household, or population levels and has significant public health implications. Methodology: The thesis includes a comprehensive literature review examining theoretical, methodological, and empirical studies on the DBM among women. The findings reviewed that the DBM is now prevalent in the poorest low- or middle-income countries, which include Sub Saharan Africa. South Africa is one of the top five African countries with the highest prevalence of overweight and obese individuals, particularly among women (34%). Women are now at a heightened risk of experiencing the DBM. Most studies on the DBM involving women in South Africa were primarily focused on either household contexts or individual prevalence of Body Mass Index challenges. This study seeks to fill the research gap by examining socioeconomic inequalities in the DBM among non-pregnant women in South Africa and identifying the main contributing factors. The outcome variable for this study is the DBM and it was defined as the coexistence of underweight and overweight/obese non-pregnant women in South Africa. Data from the 2016 South Africa Demographic Health Survey was utilised to calculate the prevalence of the DBM among the selected women aged 15-49 years. The initial sample size was 11083 women, but due to missing data and the exclusion of pregnant women, the final sample size was reduced to 3262 non-pregnant women. The concentration curve and the concentration index were used to assess the socioeconomic inequalities. Finally, an in-depth decomposition analysis uncovered the key driving factors contributing to the observed inequalities. The data management, exploration, and analysis were done using Stata 17 statistical software. Results: A total of 39% (1261 out of 3262) of non-pregnant women were found to experience the DBM. The prevalence varied across demographic groups, with higher rates observed among women aged 35-44 years, unemployed, Black/African, unmarried, urban residents, and those in the middle wealth quintiles. Socioeconomic inequalities related to the DBM were evident, illustrated by a pro-rich distribution in the concentration curve and a positive CI value of 0.14. Factors such as education, employment, health insurance, marital status, and watching TV contributed positively to socioeconomic inequality, while factors like parity and place of residence exhibited negative contributions. Conclusion: The findings of this study provide valuable insights into the DBM among non-pregnant women in South Africa. The high prevalence of the DBM, particularly among certain demographic groups, underscores the need for targeted interventions. The socioeconomic inequalities related to DBM, as evidenced by a pro-rich distribution highlight the complex interplay of numerous factors. These findings suggest that addressing the DBM in South Africa among women requires a multifaceted approach considering the socioeconomic context.

Keywords

Public health

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