Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.
MRC Centre for Environment and Health, Imperial College London, United Kingdom.
PLoS Med. 2021 Nov 11;18(11):e1003850. doi: 10.1371/journal.pmed.1003850. eCollection 2021 Nov.
Body-mass index (BMI) and blood pressure (BP) levels are rising in sub-Saharan African cities, particularly among women. However, there is very limited information on how much they vary within cities, which could inform targeted and equitable health policies. Our study aimed to analyse spatial variations in BMI and BP for adult women at the small area level in the city of Accra, Ghana.
We combined a representative survey of adult women's health in Accra, Ghana (2008 to 2009) with a 10% random sample of the national census (2010). We applied a hierarchical model with a spatial term to estimate the associations of BMI and systolic blood pressure (SBP) and diastolic blood pressure (DBP) with demographic, socioeconomic, behavioural, and environmental factors. We then used the model to estimate BMI and BP for all women in the census in Accra and calculated mean BMI, SBP, and DBP for each enumeration area (EA). BMI and/or BP were positively associated with age, ethnicity (Ga), being currently married, and religion (Muslim) as their 95% credible intervals (95% CrIs) did not include zero, while BP was also negatively associated with literacy and physical activity. BMI and BP had opposite associations with socioeconomic status (SES) and alcohol consumption. In 2010, 26% of women aged 18 and older had obesity (BMI ≥ 30 kg/m2), and 21% had uncontrolled hypertension (SBP ≥ 140 and/or DBP ≥ 90 mm Hg). The differences in mean BMI and BP between EAs at the 10th and 90th percentiles were 2.7 kg/m2 (BMI) and in BP 7.9 mm Hg (SBP) and 4.8 mm Hg (DBP). BMI was generally higher in the more affluent eastern parts of Accra, and BP was higher in the western part of the city. A limitation of our study was that the 2010 census dataset used for predicting small area variations is potentially outdated; the results should be updated when the next census data are available, to the contemporary population, and changes over time should be evaluated.
We observed that variation of BMI and BP across neighbourhoods within Accra was almost as large as variation across countries among women globally. Localised measures are needed to address this unequal public health challenge in Accra.
在撒哈拉以南非洲城市，尤其是女性，体重指数（BMI）和血压（BP）水平不断上升。然而，关于城市内部这些指数的变化幅度，我们所掌握的信息极为有限，而这些信息可能会为有针对性和公平的卫生政策提供参考。本研究旨在分析加纳阿克拉市小范围地区成年女性的 BMI 和 BP 的空间变化。
我们将加纳阿克拉市的一项成年女性健康代表性调查（2008 至 2009 年）与全国人口普查的 10%随机样本（2010 年）相结合。我们应用具有空间项的层次模型来估计 BMI 和收缩压（SBP）与舒张压（DBP）与人口统计学、社会经济、行为和环境因素的关联。然后，我们使用该模型来估计人口普查中所有阿克拉女性的 BMI 和 BP，并计算每个普查区（EA）的平均 BMI、SBP 和 DBP。BMI 和/或 BP 与年龄、民族（Ga）、当前婚姻状况和宗教（穆斯林）呈正相关，因为它们的 95%可信区间（95% CrI）不包括零，而 BP 也与识字率和体力活动呈负相关。BMI 和 BP 与社会经济地位（SES）和饮酒呈相反的关联。2010 年，18 岁及以上的女性中，有 26%患有肥胖症（BMI≥30kg/m2），21%患有未控制的高血压（SBP≥140 和/或 DBP≥90mmHg）。第 10 百分位和第 90 百分位之间 EA 之间的平均 BMI 和 BP 差异分别为 2.7kg/m2（BMI）和 BP 差异为 7.9mmHg（SBP）和 4.8mmHg（DBP）。阿克拉较富裕的东部地区的 BMI 普遍较高，而该市西部的 BP 较高。本研究的一个局限性是，用于预测小范围变化的 2010 年人口普查数据集可能已经过时；在下一次人口普查数据可用时，应将结果更新到当代人口，并评估随时间的变化。
我们观察到，阿克拉内部街区之间 BMI 和 BP 的变化幅度与全球范围内各国女性之间的变化幅度几乎相同。需要采取本地化措施来应对阿克拉面临的这一不平等公共卫生挑战。
