A Double Burden of Malnutrition Among Women in the Reproductive Age (15-49 years) in Sierra Leone: A Secondary Data Analysis of the Demographic Health Survey of 2019 (SLDH-2019)

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Abstract Background: A double burden of malnutrition is rising globally but particularly in sub-Saharan Africa. Recently in Sierra Leone, the incidence of overweight, obesity, and overnutrition among women have sharply increased. This study aimed to determine the prevalence of different malnutrition categories (underweight, overweight, obesity, and overnutrition) and associated factors among women of reproductive age in Sierra Leone using Demographic Health Survey of 2019. Methods: We conducted data analysis of 7,514 women aged 15 to 49 years. Data was collected using validated questionnaires. Participants were selected using a multistage stratified sampling approach. A multivariable regression analysis was used to determine factors associated with different malnutrition categories. Results: The prevalence of underweight was, 6.7%(95%CI:4.5%-8.9%); overweight, 19.7%(95%CI:17.7%-21.7%); obesity, 7.4% (95% CI:5.2%-9.6%); and overnutrition, 27.1%(95%CI:25.2%-29.0%). Underweight was more likely in 25-34 years (AOR=1.670, 95%CI:1.254-2.224;p<0.001) than 15-24 years; unlikely among single women (AOR=0.594,95%CI:0.467-0.755;p<0.001) than married. Unlikely in the north (AOR=0.734,95%CI:0.559-0.963;p=0.026) compared to east, and unlikely among those who did not listen to radios (AOR=0.673;95%CI:0.549-0.826;p<0.001) compared to those who did. Overweight was unlikely among 25-34 years (AOR=0.609,95%CI:0.514-0.722;p<0.001) and 35-49 years (AOR=0.480,95%CI:0.403-0.571;p<0.001) than 15-24 years; likely among single women (AOR=1.470,95%CI:1.249-1.730;p<0.001) compared to married; unlikely among working-class (AOR=0.840,95%CI:0.720-0.980;p=0.026) compared to not working-class; most likely in the north (AOR=1.325,95%CI:1.096-1.602;p=0.004), and unlikely in the south (AOR=0.755,95%CI:0.631-0.903;p=0.002) compared to east; unlikely among middle-wealth-index (AOR=0.656,95%CI:0.535-0.804;p<0.001), richer-wealth-index (AOR=0.400,95%CI:0.309-0.517;p<0.001), and richest-wealth-index (AOR=0.317,95%CI:0.234-0.431;p<0.001) compared to poorest-wealth-index respectively, and likely among women who did not listen to radios (AOR=1.149; 95%CI:1.002-1.317;p=0.047) compared to those who did. Determinants of obesity and overnutrition were the same with overweight, except they were unlikely in female-headed-households (AOR=0.717,95%CI:0.578-0.889;p<0.001). Conclusion: The prevalence of different types of malnutrition among women 15-49 years in Sierra Leone were high; affirming a double burden of malnutrition. It was likely to be underweight among 25-34 years. The predictors of overweight, obesity, and overnutrition were single women, from the north and not listening to radios. There is an urgent need for policies on healthy lifestyles and the dangers of malnutrition.

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