Menu
Menu
Menu
Menu
Introduction: adult overweight and obesity are public health challenges that are presently overwhelming health systems. Mothers are at an increased risk of overweight and obesity and its accompanying morbidities, especially after several deliveries; however, there is a paucity of data on the factors influencing this. As such, this study aimed to assess the prevalence and determinants of overweight or obesity among post-partum mothers. Methods: using a facility-based cross-sectional study design, mothers were selected as respondents by systematic random sampling between March and June 2018. Mothers of children less than 6 months or older than 24 months and mothers who did not attend antenatal care services were excluded from this survey. The outcome variable was overweight or obesity defined as Body Mass Index ≥ 25 kg/m² and multivariable logistic regression was used to assess factors independently associated with overweight or obesity. Data was entered into and analysed using SPSS version 22. Results: analysis of 455 mothers showed that their average age was 28.0 ± 5.8 years. The prevalence of overweight or obesity was 41.8% (95% C.I = 37.2-46.3) and Christian mothers were twice more likely to be overweight or obese compared to their Muslim peers. Mothers who had a caesarean delivery were 36% (AOR = 1.36; 95% C.I = 1.11-1.66) more likely to be overweight or obese compared to those who had vaginal delivery. Mothers who consumed fresh fruits and vegetables were 42% (0.58; 0.46-0.72) less likely to be overweight or obese as compared to those who did not. We found a significant interaction between increasing age and parity whereby, increasing age among multiparous mothers was significantly less likely to be associated with overweight or obesity (0.92; 0.87-0.97) compared to primiparous mothers. Conclusion: prevalence of overweight or obesity was high, and determinants included socio-demographic factors, consumption of fruits and vegetables and gynaecological factors. Hence, strategies targeting younger women at the antenatal and delivery stages of pregnancy may improve the overall health of women by reducing caesarean sections and promoting breastfeeding.
Study design and duration: a facility-based analytical cross-sectional study design was used. The study respondents were mothers of children aged 6 to 24 months, attending postnatal care services in the 6 sub-district health facilities. Mothers were selected during these postnatal services as respondents between March and June 2018. Study area and setting: Tamale Metropolis is the third-largest city in Ghana. Health-wise, the Metropolis has 6 sub-district health centres. These health centres serve as points of health care delivery for public health interventions where pregnant women and mothers go for reproductive and child welfare services; there are also about 10 private and public hospitals [8]. The 6 facilities were chosen because they form part of the Community-based Health Planning Service (CHPS) programme and hence they are expected to have a high attendance of post-partum mothers [17]. Study participants: the inclusion criteria were mothers who gave consent, attended Antenatal Care (ANC) services, and had a child older than 6 months but younger than 24 months of age. It was also anticipated, as established by some studies, that mothers would have lost the weight they gained during pregnancy within six months after delivery [13,18]; this informed our decision to limit the sample to mothers with children from 6-24 months of age. Sampling: for each of the facilities under the study, health care workers kept a register of post-partum mothers that are scheduled for each of the days of the week as part of their normal routine activities. It was based on these weekly attendance figures that the minimum sample size is obtained for each facility. This was done by taking each facility´s weekly attendance as a fraction of all facilities´ weekly attendance and multiplying this fraction by the minimum sample size required in this survey; this gave the minimum number of questionnaires that were administered in each health facility. Furthermore, respondents were subsequently selected by systematic random sampling from the Antenatal Care (ANC) attendance register of each facility. In the sample selection process, one number from 1 to 4 was randomly selected by the lottery method. Subsequently, every fourth person on the register from the number selected was chosen for interview until the estimated sample size required for the facility was met; the next person in the register replaced any selected respondent who declined participation or did not meet inclusion criteria. Sample size calculation: the sample size calculation was guided by Cochran [19]. Where p = prevalence of overweight or obesity among women of reproductive age in Ghana [3] = 32.4%. E = margin of error = 5% = 0.05 Z = standard normal deviation for 95% C.I. = 1.96. Hence minimum sample size = 336 Data collection: a pre-tested interviewer-administered questionnaire was used to collect data from all mothers during postnatal services. Before data collection, 5% (n=23) of post-partum women were sampled for a pre-test of the questionnaire and were excluded from the survey. The pre-tested questionnaire was used to collect data from all mothers by explaining consent in their preferred language and upon acceptance, responses from the content of the questionnaire was solicited. In the anthropometric sections of the questionnaire, the weight and height of women were measured with a Seca digital weighing scale and a Seca 206 microtoise respectively to the nearest 0.1 decimal. All measurements were duplicated and averaged to reduce random instrumental error. Where there were differences of more than 0.2cm or 0.2kg in duplicate measures, the measurement was retaken for the third time and the two closest values were used. Also, data on the medical and obstetric history were collected from the maternal health record booklet.” Dependent variable: the dependent variable was overweight or obesity defined by the Body Mass Index (BMI), calculated as Overweight or obesity was defined as BMI ≥ 25kg/m2. Demographic and socio-economic characteristics: these characteristics included maternal age (as a continuous variable), religion (Muslim/Christian), education (no education, primary/JHS and SHS/above), occupation (employed/unemployed), marital status (married, not married), wealth index (low/medium /high), gender of child (male/female) and health insurance status (no/yes). We created a household wealth index and ranked the households into tertiles of wealth using the principal component analysis [20]. The wealth index ranked households based on the ownership of durable assets including TV, satellite dish, radio, refrigerator, phone, bicycle, mattress, electric fan DVD/VCD and sewing machine and as well as the material used in building the house, the power source of the household, access to toilet facilities and fuel for cooking in the household. Medical and obstetric history: data from the maternal health record booklets included age of pregnancy at first antenatal service (≤3 months/ >3 months), gestational age at delivery (<38 weeks/ 38 weeks to 42 weeks / 43 weeks and above), mode of delivery (vaginal/caesarean), obstetric abnormality during pregnancy (yes/no), place of delivery (facility-based/home), adequacy of prenatal care (no/yes), childbirth weight (<2.5kg / 2.5kg to 3.9kg / 4kg or more), parity (primiparous/secundiparous/multiparous). Other obstetric history factors, collected from verbal narration included early initiation of BF (no/yes), and mother presently BF the child (no/yes). Dietary intake: we assessed the post-partum mothers´ consumption of different food groups in the last 24-hours using a 7-food group indicator which included (1) cereals, tubers and roots, (2) milk and milk products, (3) organ meat, flesh meats and fish, (4) eggs, (5) legumes, nuts and seeds, (6) dark green leafy vegetables and vitamin A-rich foods and (7) fresh fruits and vegetables. The mothers were asked to mention all foods (including drinks and snacks) they consumed in and outside the home in the last 24-hours (from wake-up to wake-up) preceding the survey. They were then probed for likely forgotten foods and to give a detailed description of foods and beverages consumed, including ingredients for mixed dishes. A score of 1, otherwise 0 was assigned if the mother consumed at least one food item from a food group. Quality control measures: measures such as probability sampling of respondents so that each respondent has an equal chance of being selected at the facility level was used to minimise selection bias. Six field assistants with extensive experience were recruited and trained for 4 days. The data collection tools were pre-tested and translated into the local languages, ensuring that the information collected was appropriate and accurate. On daily basis, anthropometric tools were standardized before actual data collection. Statistical analysis: data was entered into and analysed with SPSS (version 22). We used Chi-square to explore the possible associations between the outcome (overweight or obesity) and categorical/dichotomous predictor variables; one-way ANOVA was used for continuous predictors. Subsequently, univariate, and multivariate logistic regression were used to analyse the magnitude and direction of associations. Variables with P-values < 0.25 [21] in the univariate analysis were further assessed in backward stepwise logistic regression models for the predictors of overweight or obesity. The final models were selected based on the log-likelihood ratio test, Wald test and P-value. A 2-sided P-value ≤ 0.05 with a 95% Confidence Interval (CI) was considered statistically significant. Wald Chi-square test was used to test for interaction. Missing data were excluded from further analysis as it did not affect the minimum sample size required in each facility. The data at the regression analysis did not have missing values and all cases were complete. Ethical consideration: ethical clearance was obtained from the Tamale Teaching Hospital´s Ethical Review Board and the study protocol was approved by the same. Additionally, authorization was granted by the Ghana Health Service (Tamale Metropolitan Health Directorate) and the management of the various reproductive and child welfare centres before the commencement of data collection. Participation in the study was voluntary and informed consent was obtained from the mothers. Participants were assured of their confidentiality and only anonymous identifiers were used, and data were reported in aggregated form. Data availability: the authors have made the data that supports these findings available for editorial and review purposes. Data will be made available to interested persons upon reasonable request from the corresponding author.
N/A
