Education and prevalence of overweight and obesity among reproductive age group women in Ethiopia: analysis of the 2016 Ethiopian demographic and health survey data

This cross-sectional study was done based on the 2016 EDHS data. The survey included a nationally representative sample of women (aged 15–49 years) and men (aged 15–59 years) from the nine regions and two administrative cities of the country [14]. However, the current study involved non-pregnant reproductive age group women only because, unlike men, overweight and obesity in women are more prevalent and are associated with multiple problems including increased risk of diabetes, hypertension, caesarean delivery, postpartum hemorrhage, high birth weight babies, and infant overweight and obesity [1]. Pregnant women were excluded, because, pregnancy nullifies the values of BMI and data about BMI was not collected among pregnant, and those women who have had a birth in the 2 months before the survey in the 2016 EDHS [14].

In the 2016 EDHS, a two stage stratified sampling technique was employed to select representative samples for the country as whole. The regions in the country were stratified into urban and rural areas. Then, samples of enumeration areas (EAs) were selected in each stratum in two stages. In the first stage, 645 EAs were selected with probability proportional to the EA size. The EA size is the number of residential households in the EA as determined in the 2007 Ethiopian Population and Housing Census. A household listing operation was implemented in the selected EAs, and the resulting lists of households served as the sampling frame for the selection of households in the second stage. In the second stage, a fixed number of 28 households per cluster were selected with an equal probability systematic selection from the newly created household listing. All women aged 15–49 years who were usual members of the selected households or who spent the night before the survey in the selected households were eligible for the female survey [14]. For the purpose of this study, from the total, 15,683 women participants of the 2016 EDHS, a sub-sample of 2848 reproductive age group women aged 15–49 years who had a complete response to all variables of interest were selected and retained for analysis after excluding women who were pregnant.

In the 2016 EDHS, a standardized and validated questionnaire were adapted from the DHS Program’s standard Demographic and Health Survey questionnaires in a way to reflect the population and health issues relevant to Ethiopia. The survey data were collected from January 18 to June 27, 2016 by trained field workers [14]. For the purpose of the current study, the women’s data from the 2016 EDHS was utilized.

In addition to education, several important covariates like, respondent’s age, and wealth index were analyzed depending on their availability in the 2016 EDHS data (Fig 1). Educational level of participants was categorized as; no education, primary, secondary, and higher education. Additional details of independent variables are available somewhere else [28]. The dependent variables of interest were overweight and obesity among non-pregnant women aged 15–49 years. These outcome variables of interest were categorized as follows based on the WHO Classification of body mass index; overweight if the BMI is 25.0–29.9 kg/m² and obese if it is≥30 kg/m² [2]. The combined prevalence of overweight and obesity was determined by merging the two outcomes together.

In this study 2848 participants of the 2016 EDHS were included. More than half, 53.2% of the participants were Orthodox Christianity followers, 23.7% Muslims, 21.9% Protestants, 0.7% Catholics and the remaining 0.5% were traditional and other religion followers. Regarding to educational status of the study participants, 43.2% had no education and the remaining 56.8% had completed up to higher levels of education. Majority, 63% of the participants were rural dwellers. Furthermore, 59.6% of the participants were in the first (rich) wealth index quintile, 15.9% were in the second (middle) quintile and 24.5% were in the third (poor) quintile (Table 1).

The prevalence of overweight and obesity among reproductive age group women was 11.5 and 3.4% respectively and, the combined prevalence of overweight and obesity was 14.9% (Table 2).

The prevalence of overweight and obesity was higher, 37, 26.7 and 16.2% respectively among women with a higher, secondary and primary level of education compared to 5.8% among women with no education. Besides, the prevalence of overweight and obesity was 19.8 and 16.2% among women with age group of > = 35 years and 25–34 years respectively compared to 6.6% in women with age group of 15–24 years. Similarly, the prevalence of overweight and obesity was also higher, 23.7% in women with rich wealth quintile compared to 1.4% in women with poor wealth quintile (Table 3).

Besides, respondent’s age, region, residence, wealth index, frequency of watching television, and frequency of using internet were positively associated with the odds of overweight and obesity among women. The odds of overweight and obesity among respondents aged 25–34 years and > =35 years was more than 3 (AOR = 3.03, 95% CI, 2.06, 4.48) and 6.5 (AOR = 6.51, 95% CI, 4.08, 10.37) times higher respectively than those aged 15–24 years old. The odds of being overweight and obese among respondents living in Oromia, Somali, Benishangul, Harari, Addis Ababa, and Dire Dawa was higher than those who live in Tigray region.

Similarly, the odds of those who live in urban areas was more than 3 folds higher (AOR = 3.11, 95% CI, 2.02, 4.80) than those who live in rural areas. Wealth index was also significantly associated with overweight and obesity. The odds of being overweight and obese among respondents of rich wealth quintile class was around 5 times higher (AOR = 4.82, 95% CI, 2.40, 9.71) than those who are from poor wealth quintile class. Frequency of media use was also significantly associated with overweight and obesity. The odds of being overweight and obese was higher among those watch television at least once a week (AOR = 1.91, 95% CI, 1.26, 2.90) and use internet at least once a week (AOR = 1.89, 95% CI, 1.06, 3.36) compared to those who did not use it at all (Table 4).

One of the main strength of this study is its large sample size and the random sampling method used to recruit participants in the survey which makes the study participants a true representative of reproductive age group non-pregnant women in Ethiopia. The quality of the data is also assured as the EDHS uses well-trained field personnel’s, a standardized protocol, and validated tools in the data collection process. However, as a limitation, some of the very important determinants of overweight and obesity such as physical activity and dietary habits were not included in this study because, the relevant information’s regarding these variables are not available in the 2016 EDHS dataset. The other important limitation is the information in the survey was self-reported, so some degree of under-reporting of socially unacceptable behaviors and over-reporting of socially desirable behaviors are likely [14].