THE ASSOCIATION OF ORPHAN AND VULNERABLE CHILD (OVC) PRIMARY CAREGIVING, HOUSEHOLD WEALTH, AND FEMALE AUTONOMY ON WOMEN'S BODY MASS INDEX IN NAMIBIA, SWAZILAND AND ZAMBIA

Abstract

Background: This dissertation investigates factors associated with orphan and vulnerable child (OVC) caregivers' body mass index (BMI) in Namibia, Swaziland and Zambia.

Methods: Secondary analyses were performed using cross-sectional data from Demographic Health Surveys conducted in 2006 and 2007. Manuscript 1 included de facto women from Namibia (n=6,638), Swaziland (n=3,285), and Zambia (n=4,497). Manuscript 2 included de jure women from Namibia (n=6,305), Swaziland (n=2,786), and Zambia (n=4,389). Manuscript 3 included married de jure women from Namibia (n=2,633), Swaziland (n=1,395), and Zambia (n=2,920). Statistical analyses using data from 20-49 year old women included weighted marginal means, logistic regression, and Sobel and Goodman tests.

Results: Manuscript 1. OVC caregivers' overweight prevalence ranged from 26.98% (Namibia) to 61.3% (Swaziland). Namibian OVC caregivers were less likely to be overweight than non-OVC caregivers and non-caregivers not living with OVC. Swazi and Zambian OVC caregivers were more likely to be overweight than non-caregivers. In Namibia, women's age modified the effect of the association between OVC caregiving and overweight status.

Manuscript 2. Namibian and Swazi OVC caregivers had lower Absolute Wealth Index (AWI) mean scores than non-OVC caregivers and non-caregivers. In Zambia, OVC caregivers had a lower mean AWI score than non-caregivers living with an OVC but a higher mean AWI score than non-OVC caregivers. In all countries, even small increases in household wealth (e.g., being a poorer women - 2 to 3 AWI items) were associated with higher odds for being overweight regardless of women's caregiving status.

Manuscript 3. Women's educational attainment increased the odds for being overweight in Swaziland and Zambia, and decreased the odds for being underweight in Namibia. Decision-making autonomy mediated the association between AWI and OVC caregivers' BMI in Zambia (Z=2.13, p=0.03).

Conclusions. As Africa is experiencing a nutritional and HIV/AIDS transition, overweight problems among OVC caregivers has emerged and should be addressed. These findings support the World Health Organization's recommendations that African countries should focus on addressing infectious diseases as well as the emergence of chronic diseases. Some African public health systems and OVC programs may face a new overweight epidemic alongside existing ones such as HIV/AIDS, tuberculosis, and malaria.