RESUMO
BACKGROUND: Maternal nutritional status before and during pregnancy is an important determinant of foetal health. In West Africa, maternal and child undernutrition remains a major public health problem and it is important to establish the mechanistic pathway linking the two disorders to help address the problem. We therefore assessed the mediating role of low birth weight (LBW) in the relationship of maternal undernutrition with child undernutrition in West Africa. METHODS: We included recent (2010-2019) DHS data from thirteen West African countries. Poisson regression model with robust standard errors was used to assess the relationship between maternal undernutrition (body mass index and anaemia) and child undernutrition (stunting, wasting, underweight, and anaemia). Structural equation modelling was used to conduct the mediation analysis. RESULTS: Prevalence of stunting, wasting, underweight, and anaemia among under-five children in West Africa was found to be 32.4%, 8.1%, 20.1%, and 71.5%, respectively. We found children of underweight mothers to be more likely to be undernourished (stunted, wasted, and underweight) and anaemic compared to children of normal-weight mothers. Also, children of anaemic mothers were more likely to be stunted and anaemic but not wasted compared with children of non-anaemic mothers. LBW mediated the observed relationships between maternal BMI and childhood stunting (22.6%), and maternal anaemia and childhood stunting (24.9%), wasting (11.7), and anaemia (6.6%). CONCLUSION: We found maternal undernutrition to be associated with child undernutrition in West Africa with LBW noted to be a mediator of the observed relationship. We recommend that, to address the child undernutrition problem in West Africa, governments and policymakers must integrate measures to address the burden of LBW.
RESUMO
In Sub-Saharan Africa and other developing regions, there has been very little systematic attempt to document the uses and perceived health benefits of urban green spaces in cities and the factors influencing usage. We therefore sought to establish the availability, accessibility and use of urban green spaces, and the perceived health benefits in an African population. We also ascertained the factors influencing use and development of green spaces at home. A population-based survey was conducted in Accra, the capital city of Ghana, spanning 11 Municipal and 3 Sub-Metropolitan areas. Multivariable binary logistic regression adjusting for potential confounders was used to establish the association between green space use and development at home, and socio-demographic, neighbourhood and health factors. Odds ratios and their corresponding 95% confidence intervals were estimated from the models. Several socio-demographic (gender, age, marital status, occupation, ethnicity, religion) and district-level (population density, income level, neighbourhood greenness) factors were associated with use of green spaces and development of green spaces at home in Accra. Residents who were worried about depletion of green spaces in their community were more likely to develop green spaces at home. In neighbourhoods with moderate and high level of greenness, residents were less likely to develop green spaces at home. Five-percent and 47% of green space users in Accra reported witnessing an improvement in their physical and mental health, respectively, from use of green spaces. The study findings can inform policy action for promoting use and development of green spaces in African cities and for mitigating depletion and degradation of the limited urban greenery.
