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Small area variations and factors associated with blood pressure and body mass index in adult women in Accra, Ghana: Bayesian spatial analysis of a representative population survey and census data

Small area variations and factors associated with blood pressure and body mass index in adult women in Accra, Ghana: Bayesian spatial analysis of a representative population survey and census data
Small area variations and factors associated with blood pressure and body mass index in adult women in Accra, Ghana: Bayesian spatial analysis of a representative population survey and census data
Background: 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.

Methods and findings: 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 A limitation of our study was that the 2010 census dataset used for predicting small area variations is potentially outdated; the results should be updated when the next census data are available, to the contemporary population, and changes over time should be evaluated.

Conclusions: 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.
1549-1277
Clark, Sierra N.
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Bennett, James E.
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Arku, Raphael E.
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Hill, A G
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Fink, Günther
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Adanu, Richard M.
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Biritwum, Richard B.
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Darko, Rudolph
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Bawah, Ayaga
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Duda, Rosemary B.
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Ezzati, Majid
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Clark, Sierra N.
13eaf21f-662e-45c5-9322-4f355b62f423
Bennett, James E.
dbebee46-fddf-4cde-86b1-deeceb5a5fac
Arku, Raphael E.
b9604145-c20d-42b7-ae55-a8149d06a46a
Hill, A G
5b17aa71-0c14-4fbf-8bc9-807c8294d4ae
Fink, Günther
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Adanu, Richard M.
184a080e-c402-4d91-b898-72cf3d672b40
Biritwum, Richard B.
0408b7ab-3a85-47a5-8b32-22ce2cb12ba1
Darko, Rudolph
8c180370-791f-40e9-9965-d003c201b3f4
Bawah, Ayaga
2de40296-6427-47e1-b13d-65489a040345
Duda, Rosemary B.
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Ezzati, Majid
ae456202-d532-4c14-a785-82b4b7d2e37b

Clark, Sierra N., Bennett, James E., Arku, Raphael E., Hill, A G, Fink, Günther, Adanu, Richard M., Biritwum, Richard B., Darko, Rudolph, Bawah, Ayaga, Duda, Rosemary B. and Ezzati, Majid (2021) Small area variations and factors associated with blood pressure and body mass index in adult women in Accra, Ghana: Bayesian spatial analysis of a representative population survey and census data. PLoS Medicine, 18 (11), [e1003850]. (doi:10.1371/journal.pmed.1003850).

Record type: Article

Abstract

Background: 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.

Methods and findings: 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.

Conclusions: 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.

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Accepted/In Press date: 14 October 2021
e-pub ahead of print date: 11 November 2021
Published date: 11 November 2021
Additional Information: Funding: Data collection in the WHSA was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Health, Poverty and Place in Accra, Ghana, grant number R01 HD054906) and Hewlett/PRB (Reproductive and Overall Health Outcomes and Their Economic Consequences for Households in Accra, Ghana, PI: AH). Analyses undertaken in the paper were funded by the Wellcome Trust (Pathways to Equitable Healthy Cities project, 209376/Z/17/Z, PI: ME), the Presidents PhD scholarship from Imperial College London (SC) and the Canadian Institutes of Health Research PhD scholarship (DFS - 157830) (SC). Infrastructure support for the Department of Epidemiology and Biostatistics was provided by the NIHR Imperial Biomedical Research Centre. For the purpose of Open Access, the authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Identifiers

Local EPrints ID: 452299
URI: http://eprints.soton.ac.uk/id/eprint/452299
ISSN: 1549-1277
PURE UUID: b224c8e3-2baf-41ea-9f27-1d7713a5c7b4
ORCID for A G Hill: ORCID iD orcid.org/0000-0002-4418-0379

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Date deposited: 06 Dec 2021 17:30
Last modified: 06 Jun 2024 01:48

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Contributors

Author: Sierra N. Clark
Author: James E. Bennett
Author: Raphael E. Arku
Author: A G Hill ORCID iD
Author: Günther Fink
Author: Richard M. Adanu
Author: Richard B. Biritwum
Author: Rudolph Darko
Author: Ayaga Bawah
Author: Rosemary B. Duda
Author: Majid Ezzati

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