The Relationship between Hemoglobin Level and Socio-economic Indicators among Women of Childbearing Age in South Africa: A Secondary Analysis of DHS Data.

Abstract

The nutritional double burden of disease refers to the phenomenon of undernutrition, wasting, stunting, micronutrient deficiency coinciding with overweight, obesity, and diet-related non-communicable diseases, within individuals, households and populations throughout the lifecycle. This study aimed to determine whether there were differences in hemoglobin levels between anthropometric categories and socio-economic factors among women aged 15 to 49 years old in South Africa. Data were obtained from the Demographic and Health Survey (DHS) South Africa survey 2016. There were 2690 women between 15 and 49 years old included in the sample. Variables selected for analysis included height and weight, hemoglobin (adjusted for altitude), wealth index, access to improved water and sanitation. Variables were tested for normality using Q-Q plots. Missing data was removed. Frequencies and percentages were reported for categorical data. Non-parametric continuous variables were reported as medians and interquartile ranges. As data were not normally distributed, analysis was conducted using the Kruskall-Wallis test and Mann-Whitney U test. The type I error rate was set to p < .05. Where it was found that a significant difference exists, post hoc Dunn tests were performed to determine the location of the differences. Anemia was prevalent among 28.9% of the sample and 63.5% were either overweight or obese. Hemoglobin levels were significantly different between normal weight women and women with a body mass index in the obese class I and obese class II respectively (Kruskall-Wallis = 27.014; df = 5; p = .000; n = 2690). There were significant differences in hemoglobin levels between women with access to improved sanitation and those without access (Mann-Whitney U test p = .017), but hemoglobin levels were similar between women with access to improved water and those without (Mann-Whitney U test p = .175). Poorer women had significantly different hemoglobin levels to the wealthiest women in the sample (Kruskall-Wallis = 29.568; df = 4; p = .000). The nutritional double burden of disease is prevalent in South Africa among women of childbearing age. A wealth disparity exists among South African women in terms of hemoglobin levels.