Geographic and Socioeconomic Disparities in Nutritional Status of Women in Pakistan: Secondary Analysis from Pakistan National Nutrition Survey

Abstract Background: Pakistan is experiencing a rapid nutrition transition with a shift from underweight to overweight and obesity. This paper will examine the role of household socioeconomic position (SEP), community SEP and urbanicity on the nutritional status (underweight, overweight and obesity) of Pakistani women. Methods: We analysed data on 34,391 women aged ≥20 years enrolled in 2011 National Nutritional Survey of Pakistan (NNS). The NNS is a nationally representative survey employing a multistage stratified cluster sampling design. We assessed household SEP through a wealth index constructed using items from household possessions, utilities and housing conditions. We assessed the relationship of urbanicity, household and community SEP with categories of body mass index (BMI) using multinomial logistic regression where normal BMI (18.6-22.5 kg/m 2 ) was the reference category. Results: Overall, 15% of women were underweight (BMI<18.5 kg/m 2 ), 14% were pre-overweight (BMI 23.00-24.9 kg/m 2 ), 22% were overweight (BMI 25.0-29.99 kg/m 2 ) and 12% were obese (BMI≥30.0 kg/m 2 ). Households with higher SEP were associated with increased levels of overweight-1 (aOR: 2.91; 95%CI: 2.41-3.50), overweight-2 (aOR: 4.15; 95%CI: 3.31-5.19) and obesity (aOR: 6.20; 95%CI: 4.92-7.81) among women. Women were more likely to be obese in major urban (aOR: 2.34; 95%CI: 2.02-2.71) and urban (aOR: 1.84; 95%CI: 1.62-2.09) areas compared to rural areas. At the community level, communities in rural areas were more likely to have higher levels of underweight, while communities in urban areas were more likely to have higher levels of obesity. Furthermore, the likelihood of underweight and overweight women coexisting within the same community was low in major urban (r=0.67), urban (r=0.55) and rural (r=0.54) areas. Conclusions: In Pakistan, overweight and obesity among women is associated with urbanicity and household and community SEP. Women living in urban areas with high household and community SEP were associated with higher levels of overweight and obesity. Our findings suggest the importance of interventions targeting undernutrition in rural areas and overnutrition in urban areas.