Adult Female Overweight and Obesity Prevalence in Seven Sub-Saharan African Countries: A Baseline Sub-National Assessment of Indicator 14 Of the Global NCD Monitoring Framework

Introduction Decreasing overweight and obesity prevalence requires precise data at sub-national levels to monitor progress and initiate interventions. This study aimed to estimate baseline agestandardized overweight prevalence at the lowest administrative units among women, 18 years and older, in seven African countries. The study aims are synonymous with indicator 14 of the global non-communicable disease monitoring framework. Methods We used the most recent Demographic and Health Survey and administrative boundaries data from the GADM. Three Bayesian hierarchical models were fitted and model selection tests implemented. The age-standardized prevalence of overweight among adult women at national, first and second administrative levels were individually reported in each country in the form of maps and tables. Results Substantial variation in the age-standardized prevalence of adult female overweight was noted across several second-level administrative units. In numerous locations in Tanzania, Nigeria and Zimbabwe, more than half of the adult female population were overweight and in one location in Tanzania, over 72% of the adult female population were overweight. These estimates were Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 5 October 2020 doi:10.20944/preprints202010.0067. v1 © 2020 by the author(s). Distributed under a Creative Commons CC BY license. roughly twice the national level overweight prevalence and, in some cases, roughly 10 – 20% greater than the overweight prevalence in first-level administrative units. Conclusion The observed overweight burden in subnational administrative units suggests the presence of an epidemic tantamount to the situation in more affluent economies. African countries lack the resources to effectively handle the fallout from such epidemic, therefore motivating the need for increased urgency in adopting WHO obesity-related intervention guidelines and implementing more rigorous studies to validate the study findings. Introduction The probability of premature death (i.e. between the ages of 30 years to 70 years) from major noncommunicable diseases (NCDs) cardiovascular disease, cancers, chronic respiratory diseases and diabetes – is projected to increase in Africa and decrease elsewhere. The global obesity target agreed upon by policymakers in 2013 was to halt the rise in its prevalence within their countries by 2025, relative to the baseline in 2010. Progress towards this target will be monitored by assessment of the age-standardized prevalence of overweight and obesity in individuals aged 18 years and older, which is indicator 14 of the Global NCD monitoring framework. Reaching this target is especially important because obesity is the second largest contributor to noncommunicable disease mortality among African women. Nonetheless, the lack of granular prevalence data to enhance precise planning and action by local stakeholders, especially in the context of the double burden of malnutrition facing many African countries, could potentially interfere with efforts to achieve NCD-related and other health system goals, warranting this study. Although recent and well-designed subnational analysis of overweight and obesity prevalence with various methodologies in SSA women provide some insight into the heterogeneity present at varying administrative levels, the majority of subnational studies are limited in the number of countries studied, the administrative regions covered, and do not account for the large sampling variance introduced by small sample sizes and complex survey sampling designs. Hierarchical Bayesian (HB) models, the method applied in this paper, explicitly accounts for small sample sizes and the large sampling variance it introduces by harnessing spatial and nonspatial relationships. 787 As such, this study applies HB models to provide baseline estimates of age-standardized prevalence of overweight (≥ 25kg/m) among women, 18 years and older, at second-level administrative units in seven SSA nations for sub-national progress monitoring of global obesity targets. Methods Data Sources We used data from the Demographic and Health Surveys (DHS). The DHS are household-based sample surveys of women aged 15 – 49 years that are collected in over 90 countries. Although a description of the survey sampling methodology is available online, we provide a summarized version here. The DHS involved a multi-stage sampling process with the goal of representative estimates for health and social indicators at the national and sub-national levels. First, countries were divided into sub-national units that correspond to existing administrative units such as states or provinces. From each region, enumeration units or clusters were randomly sampled and groups Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 5 October 2020 doi:10.20944/preprints202010.0067. v1