Socioeconomic and geographic inequalities in maternal overweight and obesity among mothers of children under five years in Ghana: Evidence from the 2022 Ghana Demographic and Health Survey
Abstract
Introduction Maternal overweight and obesity are increasing across sub-Saharan Africa, contributing to non-communicable diseases. This study estimated prevalence, assessed socioeconomic and geographic inequalities, and identified associated factors among mothers of children under five in Ghana. Methods A cross-sectional analysis of the 2022 Ghana Demographic and Health Survey included 4,803 mothers aged 15–49 years with valid BMI measurements. Overweight/obesity was defined as body mass index ≥25 kg/m². Survey-weighted analyses accounted for the complex sampling design. Wealth-related inequality was assessed using the concentration curve and Erreygers Concentration Index (ECI), while associated factors were examined using survey-weighted multivariable logistic regression. Results The prevalence of maternal overweight and obesity was 45.6% (95% CI: 43.1–48.1). Prevalence increased from 16.5% in the poorest quintile to 74.6% in the richest and ranged from 14.3% in the North-East Region to 68.1% in Greater Accra Region. Wealth-related inequality was pro-rich (ECI=0.479; 95% CI: 0.388–0.569; p<0.001). Compared with mothers aged 15–24 years, adjusted odds were higher among those aged 25–34 years (AOR=2.42; 95% CI: 1.77–3.31) and 35–49 years (AOR=3.30; 95% CI: 2.37–4.60). Odds were higher among mothers with primary education (AOR=1.57; 95% CI: 1.06–2.31), secondary/higher education (AOR=1.52; 95% CI: 1.11–2.08), and those in the richest versus poorest wealth quintile (AOR=5.48; 95% CI: 3.31–9.07). Rural residence was associated with lower odds (AOR=0.57; 95% CI: 0.45–0.74), while currently married/cohabiting (AOR=1.49; 95% CI: 1.03–2.18) and formerly married mothers (AOR=1.72; 95% CI: 1.03–2.88) had higher odds than never-married mothers. Conclusion Maternal overweight and obesity affect nearly one in two mothers of children under five in Ghana and are unequally distributed by socioeconomic and geographic characteristics. Obesity prevention and NCD strategies should account for the pronounced wealth gradient and regional variation.