Food insecurity, Nutrition and Health Status in Unguja, Zanzibar

Abstract

Data from epidemiological studies that investigate food insecurity, health and nutrition status and includes the entire household members is very rare in sub-Saharan Africa. This thesis, with the scope of a project, “Access to Food and Nutrition Status of the Zanzibari Population” is the first in Tanzania to investigate and report potential role of socio- demographic factors of food access, food insecurity and food consumption and the implications for health, nutrition and inflammatory response including all members living in the same household. The present thesis investigated the prevalence of malnutrition in the study population and provided population-based data on food consumption and individual dietary diversity. Furthermore, the theses investigated the relationship between food access and sociodemographic correlates with food consumption score and food insecurity experience scale. Specific anthropometric indices of malnutrition were used to investigate and determine their association to cardio-metabolic risk factors, leptin and inflammatory markers. The cross-sectional population-based survey providing the data for the individual papers of this thesis was conducted in 2013 and included 80 randomly selected Shehias (wards) in Unguja Island. Anthropometric data (weight, height, mid-upper arm circumference, waist and hip circumference, and body composition) and face-to-face interviews were assessed for all members in the household. Furthermore, blood pressure and bio-samples; urine and blood were also collected. The study recruited 1314 participants of which 54.54% were female. The overall mean age was 23.6 ± 18.9 years ranging between 0-95 years. The overall prevalence of underweight in the study population was 36.53% with the highest prevalence in children under 14 years. The prevalence of overweight and obesity in the study population was 13.10% and 8.14% respectively; with the highest prevalence in women. Furthermore, the study reported 65% of the surveyed households had poor food consumption and about one-third (32%) were severe food insecure. Severe food insecurity was more prevalent in polygamous households and larger households, even in the interaction with poor FA; larger households were associated with severe food insecurity. About 29% of the participants above 5 years had abnormal values of low high-density lipoprotein cholesterol (HDL-C) (29%) with the highest prevalence observed in participants aged ≥18 to <45 years. Hypertension increased with age, and was most prevalent in participants aged 45 years and above. High levels of low low-density lipoprotein cholesterol in the study population was associated with high waist circumference and high percentage body fat (OR=2.52 (95% CI 1.24 to 5.13), OR=1.91 (95% CI 1.02 to 3.58), respectively. Additionally, BMI and WC were associated with high levels of HbA1c (OR=2.08 (95% CI 1.15 to 3.79), OR=3.01 (95% CI 1.51 to 6.03), respectively. Nevertheless, individuals with high waist circumference were twice more likely to have hypertension compared to those with high BMI and high percentage body fat. On the contrary, in another publication with a slightly larger sample, thinness was reported to be associated with hypertension. Also, observed in children a significant reduced chance of hypertension for higher urinary sodium-to-potassium compared to a lower ratio. In the association between obesity indices and inflammatory markers, the study reported strong association between obesity with leptin and CRP in the highest quartiles. However, in the combined models, the associations were observed between BMI (OR = 6.36 [95% CI, 1.09; 34.12]); WC (OR = 4.87 [95% CI, 1.59; 14.94]); and %BF (OR = 19.23 [95% CI, 4.70; 78.66]) and leptin in the fourth quartile; also, between %BF and CRP in the third quartile (OR = 3.49 [95% CI 1.31; 9.31]). Malnutrition exists in communities as a result of food and nutrition insecurity which is affected by several factors that need to be addressed. Community based-interventions are needed to increase awareness of malnutrition and its consequences in the community by targeting the risk factors for primary prevention. Local institutions should form a fundamental part of the strategy to fight malnutrition in the general population and especially in at-risk groups, including the elderly. Nutrition interventions on healthier diets and improved methods of food preparation, encouragement on physical activity should be key parts of care planning to improve health status and quality of life. Additionally, secondary prevention measures are needed to target those at high risk by conducting early routine screening.